Large Language and Vision Assistant in Dermatology: A Game Changer or Just Hype?

The integration of artificial intelligence (AI) in healthcare, particularly in the field of dermatology, has experienced significant progress through the creation of advanced tools such as the Large Language and Vision Assistant (LLaVA). This comprehensive review examines whether LLaVA represents a significant breakthrough or merely a passing trend in dermatological practice. By incorporating both language and visual analysis capabilities, LLaVA aims to support enhanced diagnostic accuracy, patient engagement, and customized treatment planning, as evidenced by current research and case studies. However, its practical utility in a clinical setting remains a subject of debate. We explore the visual assistant chatbot's potential in improving diagnostic precision, especially in analyzing skin lesions and conditions that are visually complex. The tool's capacity to process and interpret dermatological images using advanced algorithms could aid clinicians in early detection and management of skin diseases. Furthermore, LLaVA's interactive nature potentially improves patient education and adherence to treatment protocols. Despite these advantages, there are noteworthy limitations and risks. The accuracy of LLaVA in handling atypical or rare dermatological cases is an area of concern. The tool's reliance on existing medical data raises questions about bias and the generalizability of its findings. Additionally, ethical considerations, such as patient data privacy and the potential for overreliance on AI in clinical decision-making, are critical issues that need addressing. This article aims to provide dermatologists with a comprehensive understanding of large language and visual assistant's capabilities and limitations. We discuss practical guidelines for its integration into research and clinical educational augmentation, ensuring that dermatologists can make informed decisions about employing this technology for the enhancement of patient care and treatment outcomes. The question remains: is LLaVA a game changer in dermatology, or is it just hype? This review endeavours to answer this, establishing a foundation for knowledgeable and efficient application of visual AI chatbots in dermatology practices.

Thermo-SPT: A new skin prick test evaluation framework based on low-cost, portable smartphone thermography.

BACKGROUND: Although the skin prick test (SPT) is a reliable procedure to confirm IgE-dependent allergic sensitization in patients, the interpretation of the test is still performed manually, resulting in an error-prone procedure for the diagnosis of allergic diseases. OBJECTIVE: To design and implement an innovative SPT evaluation framework using a low-cost, portable smartphone thermography, named Thermo-SPT, to significantly improve the accuracy and reliability of SPT outcomes. METHODS: Thermographical images were captured every 60 s for a duration of 0 to 15 min using the FLIR One app, and then analysed with the FLIR Tool® . The definition of 'Skin Sensitization Region' area was introduced to analyse the time-lapse thermal changes in skin reactions over several time periods during the SPT. The Allergic Sensitization Index (ASI) and Min-Max Scaler Index (MMS) formulae were also developed to optimize the identification of the peak allergic response time point through the thermal assessment (TA) of allergic rhinitis patients. RESULTS: In these experimental trials, a statistically significant increase in temperature was detected from the fifth minute of TA for all tested aeroallergens (all p values < .001 ). An increase was observed in the number of false-positive cases, where patients with clinical symptoms not consistent with SPT were evaluated as positive on TA assessment, specifically for patients diagnosed with Phleum pratense and Dermatophagoides pteronyssinus. Our proposed technique, the MMS, has demonstrated improved accuracy in identifying P. pratense and D. pteronyssinus compared with other SPT evaluation metrics, specifically starting from the fifth minute. For patients diagnosed with Cat epithelium, although not statistically significant initially, an increasing trend was determined in the results at the 15 min (ΔT (T15 - T0 ), p = .07 ; ASIT15 , p < .001 ). CONCLUSIONS: This proposed SPT evaluation framework utilizing a low-cost, smartphone-based thermographical imaging technique can enhance the interpretability of allergic responses during the SPT, potentially reducing the need for extensive manual interpretation experience as standard SPTs.

Dermatology consultation requests from a university hospital's pediatric and adult emergency departments: A 5-year retrospective analysis.

BACKGROUND: Unnecessary dermatology consultation requests from emergency departments (EDs) are a common occurrence worldwide. AIM: This study aimed to analyze the demographic and clinical characteristics of patients consulted to the dermatology department for dermatologic disorders by a university hospital's pediatric ED (PED) and adult ED (AED). MATERIALS AND METHODS: The electronic medical records of 2316 dermatology consultation requests from the PED and AED during a 5-year period were retrospectively reviewed. Patient demographic and clinical characteristics, dermatological diagnoses, and time of day of dermatology consultation requests from the PED and AED were retrospectively analyzed. RESULTS: The electronic medical records of 1845 consultation requests with complete data were included in the study. There were 969 (52.5%) consultation requests from the PED and 876 (47.5%) from the AED. Mean time from onset of dermatological symptoms to ED presentation was 31.6 d. Herpes zoster infections (18.5%), adverse cutaneous drug reactions (8.1%), and urticaria with angioedema (7.9%) were the most common skin disorders resulting in consultation requests from the AED, versus non-specific viral infections (9.2%), insect bites (8.3%), and atopic dermatitis (8.2%) from the PED. In all, 11.5% of ED patients that received dermatology department consultation required hospitalization due to dermatologic disorders. CONCLUSION: As patients commonly present to EDs with non-urgent dermatological diseases, ED physicians should receive training on common dermatological diseases so as to decrease the number of unnecessary dermatology consultation requests.

Expression of HLA class I and class II genes in patients with multiple skin warts.

Human leukocyte antigens (HLAs), which are genetic markers that have critical roles in the immune response against pathogens, vary greatly among individuals. The aim of the study is to investigate the frequency of HLA class I (HLA-A, HLA-B and HLAC) and class II (HLA-DRB1, HLA-DQB1 and HLA-DQA1) genes in patients with multiple skin warts and to elucidate the role of these genes in the genetic susceptibility to skin warts. Peripheral venous blood samples were collected from 100 patients with multiple skin warts and 300 healthy individuals (controls). HLA typing was performed after DNA isolation from the blood samples. The HLA-A*02 (odds ratio [OR]: 0.12; p = 0.0019), HLA-DQA1*03:01 (OR: 0.45; p = 0.0017) and DQA1*05:01 (OR: 0.17; p < 0.0001) genes were significantly more prevalent in the patients than in the healthy individuals and were thus identified as risk genes. The HLA-DQA1*01:01 (OR: 0.17; p < 0.0001), HLA-DQA1*01:02 (OR: 0.17; p < 0.0001), HLA-DQA1*01:03 (OR: 0.11; p < 0.0001), HLA-DQA1*02:01 (OR:027; p<0.0001) and HLA-DQA1*05:05 (OR:0.16; p<0.0001) genes were classified as protective genes because of their low frequencies in the patients. The limitation of the study is that Human papillomavirus typing could not be performed while investigating the relationship between skin warts and HLA class I and class II genes. Our data suggest the role of HLA genes in the development of skin warts. However, other components of the major histocompatibility complex system and acquired factors of the immune system could also be involved and should be further investigated.

Serial Quantiferon-TB Gold test results in 279 patients with psoriasis receiving biologic therapy.

The risk of active tuberculosis is still a concern in patients receiving biologics. To determine the risk of latent tuberculosis infection (LTBI) reactivation by Quantiferon-TB Gold (QFT) assay in psoriatic patients treated with biologics in 11 years' follow-up, along with chest radiography alterations. This retrospective study included 279 patients with plaque-type and/or pustular, or nail psoriasis who were treated with biologics, and had results for ≥2 LTBI tests. The QFT outcomes were defined according to the baseline and the follow-up QFT results; seroconversion as from negative to positive, seroreversion as from positive to negative, persistently seronegative as invariantly negative, persistently seropositive as invariantly positive, and other any result was accepted as indeterminate. Demographic features, the presence and the type of any chest X-ray abnormality was noted during the follow-up. Of 279 baseline QFT tests, the vast majority were negative (n = 193; 69%), with a less of positive (n = 86; 31%). Ten (5.2%) of 193 patients converted from negative to positive QFT status after starting biologic therapy (P < 0.001) during 11 years' follow-up. Although these 10 patients exhibited seroconversion of QFT from negative to positive, only one patient was diagnosed with active TB. There was no statistically significant difference among biologics as regards with QFT seroconversion risk (P = .09). This study showed that 5.2% of patients showed seroconversion. Annual QFT testing remains a necessary and mandatory tool to prevent further TB reactivation in psoriasis patients taking biologic therapy although only one patient was diagnosed with active TB in this cohort.

The effect of the COVID-19 pandemic on dermatology consultation requests from adult and paediatric emergency departments.

AIM: This study aimed to determine the characteristics of dermatology consultation requests from the adult and paediatric emergency departments (EDs) of a university hospital during 8 months of the COVID-19 pandemic in 2020 and to compare them with the same 8 months of 2019. MATERIALS AND METHODS: Electronic medical records of dermatology consultation requests from adult and paediatric EDs between 15 March 2019 and 15 November 2019, and between 15 March 2020 and 15 November 2020 were retrospectively reviewed. RESULTS: The study included 495 consecutive dermatology consultation requests. In total, 283 (57%) consultation requests occurred in 2019, vs 212 (43%) between in 2020 during the COVID-19 pandemic. The number of consultation requests per day was significantly lower in 2020 (0.9 ± 0.1 per day) than in 2019 (1.15 ± 0.1 per day; P = .002), and was significantly lower in March, April and May 2020, as compared with March, April, and May 2019 (P = .004, P = .001, and P = .001, respectively). The median time from onset of dermatological symptoms to ED presentation was significantly longer in 2020 than in 2019 (4 days in 2019 vs 7 days in 2020; P < .001). Dermatological emergencies in 2019 and 2020 constituted 6.7% of all emergency presentations, with no significant difference between the 2 years (7.1% of all ED presentations in 2019, vs 6.1% in 2020; P = .795). CONCLUSION: COVID-19 restrictions and fear of COVID-19 infection might have discouraged patients from presenting to EDs because of skin problems; however, the easing of COVID-19 restrictions might lead to an increase in ED presentations, including non-urgent dermatological disorders. In order to reduce unnecessary use of EDs and prevent ED overcrowding, the general public should be educated about what constitutes a dermatological emergency.

Evaluation of dermoscopic criteria for seborrheic keratosis on non-polarized versus polarized dermoscopy.

BACKGROUND: The two dermoscopic methods, polarized dermoscopy (PD) and non-polarized dermoscopy (NPD), use different types of light sources. Here, we aimed to explore the differences between these two methods in the diagnosis of seborrheic keratosis (SK). MATERIALS AND METHODS: The images of 121 cases of SK taken by a digital camera equipped with NPD and PD were evaluated against 14 dermoscopic criteria of SK. RESULTS: The agreement levels between NPD and PD were fair to perfect against the dermoscopic criteria of SK. Perfect agreement was observed in fingerprint-like structures (κ = 0.812) and linear irregular vessels (κ = 0.807). Substantial agreement was determined in comedo-like openings (κ = 0.640), hairpin vessels (κ = 0.609), a moth-eaten border (κ = 0.642), sharp demarcation (κ = 0.637), network-like structures (κ = 0.662), and a mica-like pattern (κ = 0.639). Moderate agreement was found in milia-like cysts (κ = 0.550), fissures and ridges (κ = 0.554), dotted vessels (κ = 0.496), and color variability (κ = 0.438). Fair agreement was obtained only in comma vessels (κ = 0.340). CONCLUSION: Based on our results, we cannot recommend an absolute dermoscopic method for the diagnosis of SK; rather, we suggest that the methods are complementary.

Correlation of Reflectance Confocal Microscopy and Dermatopathology Findings in a Case of Acrodermatitis Chronica Atrophicans.

Acrodermatitis chronica atrophicans (ACA) that is characterized by thin, papery dry, translucent, and alopecic patches with visible superficial veins is a late cutaneous manifestation of Lyme borreliosis. Clinical findings, a history of exposure to tick bite, and serology are helpful for the diagnosis of ACA and sometimes a biopsy is performed to rule out other infectious or inflammatory processes. In this study, we report reflectance confocal microscopy (RCM) findings in a case of ACA. RCM examination revealed a flattened surface with broadened skin folds, a flattened dermoepidermal junction with few papillae and less bright basal cells and multiple small bright reflecting spots in the dermis. To the best of our knowledge, this is the first description of the RCM findings in this disorder.

Evaluation of clinical and serological findings for diagnosis of cutaneous anthrax infection after an outbreak.

PURPOSE: Anthrax, caused by the bacterium Bacillus anthracis, is one of the oldest documented infectious diseases in both livestock and humans. We aimed to evaluate clinical findings and risk factors of patients with cutaneous anthrax infection and report anti-lethal factor (LF) IgG and anti-protective antigen (PA) IgG titers in the serologic diagnosis of disease. METHODS: In this study, serum samples of 18 cutaneous anthrax patients were collected and anti-LF IgG and anti-PA IgG titers were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Twelve (67%) males and 6 (33%) females, with a mean age of 36.06 ± 16.58 years were included in the study. Risk factors identified in the patient population studied were slaughtering (28%), flaying (56%), chopping meat (67%), burying diseased animal corpses (17%) and milking (6%) livestock. Black eschar formation (94%), pruritus (78%) and painful lymphadenopathy (61%) were first three common clinical signs and symptoms, respectively. Fourteen (78%) patients produced a positive IgG response against PA, 11 (61%) patients produced against LF. Three (17%) patients had no response to either antigen. CONCLUSIONS: A detailed history of contact with sick animals or animal products along with clinical findings should be taken at the first step for the diagnosis of cutaneous anthrax infection. Serologic detection of anti-LF IgG and anti-PA IgG with ELISA may be useful auxillary method for establishing the diagnosis.

Autoimmune estrogen dermatitis in an infertile female.

Autoimmune estrogen dermatitis is a cyclical cutaneous eruption that occurs premenstrually and goes to the rapid resolution within a few days of menstrual cycles. The disorder has variable clinical manifestations consisting of macules, papules, vesicles, urticarial lesions, bullae, eczematous plaques, and erythema multiforme-like lesions. Herein, we present a case of a 30-year-old woman with attacks of edema and erosions involving the oral and genital mucosal sites on every first day of her menstruation period. She had also multiple endocrinological problems such as hypotroidism and infertility. To determine the sex hormon sensitivity, intradermal skin tests were performed. Based on her personal history and skin test findings, a diagnosis of autoimmune estrogen dermatitis was made. After the oophorectomy, she was free from the skin and mucosal symptoms. We propose that it is important to suspect the diagnosis of autoimmune estrogen dermatitis in patients who present with recurrent cylic eruptions and it must be kept in mind that these patients might have a concomitant infertility.

A rare involvement in skin cancer: Merkel cell carcinoma with bone marrow infiltration in a kidney transplant recipient.

A 60-year-old man presented with a painless, rapidly growing, haemorrhagic pink nodule on the posterior of his thigh that had developed 1 month previously. He had a diagnosis of IgA nephropathy and had received a renal allograft 7 years before. An excisional biopsy was performed and the diagnosis of Merkel cell carcinoma (MCC) was made. No distant metastases was detected. 10 months after first presentation, due to the development of acute pancytopenia and concomitant FDG PET/CT findings compatible with disease progression, bone marrow biopsy was performed which revealed metastasis of MCC. Dermatologists and oncologists should be aware that MCC could potentially involve the bone marrow in organ transplant recipients. In the follow-up period, a complete blood count should be carried out; FDG PET/CT can be obtained to follow up the metabolic status of the disease and bone marrow biopsy should be performed if necessary.