An original study of ChatGPT-3.5 and ChatGPT-4 Dermatological Knowledge Level based on the Dermatology Specialty Certificate Examinations.

BACKGROUND: The global use of artificial intelligence has the potential to revolutionize the healthcare industry. Despite the fact that artificial intelligence is becoming more popular, there is still a lack of evidence on its use in dermatology. OBJECTIVE: The study aimed to determine the capacity of ChatGPT-3.5 and ChatGPT-4 to support dermatological knowledge and clinical decision-making in medical practice. METHODS: Three dermatology specialty certificate tests, in English and Polish, consisting of 120 single-best-answer, multiple-choice format questions each, were used to assess ChatGPT-3.5 and ChatGPT-4 performance. RESULTS: ChatGPT-4 exceeded the 60% pass rate in every performed test, with a minimum of 80% and 70% correct answers for the English and Polish versions, respectively. ChatGPT-4 performed significantly better on each exam (p<0.01), regardless of the language, compared to ChatGPT-3.5. Furthermore, ChatGPT-4 answered clinical picture-type questions with an average accuracy of 92.98% and 84.21% for English and Polish questions respectively. The difference between the tests in Polish and English did not turn out to be significant but still, ChatGPT-3.5 and ChatGPT-4 in English performed better overall than in Polish by an average of 8 percentage points for each test. Incorrect ChatGPT answers were highly correlated with a lower difficulty index, which denotes questions with higher difficulty in most of the tests. (p<0.05). CONCLUSION: The dermatological knowledge level of ChatGPT was high, with a significantly better performance of ChatGPT-4 than ChatGPT-3.5. Although the use of ChatGPT will not replace the doctor's final decision, physicians should support artificial intelligence development in dermatology to raise the standards of medical care.

Interdisciplinary approach to synthesis, stability and antimicrobial activity of silver nanoparticles.

Introduction: Chronic wounds are an increasing problem for health care all over the world. New treatment options for this illness are desired, especially antimicrobial agents. Silver nanoparticles (AgNPs) can be a potential substance that may be used in treatment of chronic wounds due to the growing antibiotic resistance. Aim: To synthetize silver nanoparticles that are stable, pure and effective against bacteria. Material and methods: The synthesis was conducted with chemical methods using different coating factors. The antistaphylococcal properties were analysed with the microdilution method to determine minimal inhibition concentrations (MIC) value. AgNPs were purified by dialysis. Moreover, keratinocyte cytotoxic properties of AgNPs were also assessed. Results: A method of synthesizing stable and efficient AgNPs has been developed. The type of the coating substance has a significant effect on AgNPs antimicrobial properties. Most of the silver nanoparticles, synthesized based on literature data, turned out to be durable during a few hours. This study has proven that depending on the coating factor, AgNPs stability ranges from 4 weeks to even 12 months. Unfortunately, the type of the stabilizer used also affects the cytotoxicity of AgNPs. It has been shown that dialysis is a substance purification method that is cheap, simple and easy to apply when dealing with high volume solutions. Conclusions: AgNPs could be an alternative to widely used antibiotics and disinfectants. Nevertheless, the introduction of those substances to health care requires detailed long-term research not only in the field of safe use, yet also durability and purity of AgNPs solutions used.

Microbiome in Hidradenitis Suppurativa-What We Know and Where We Are Heading.

Recently, interest in the microbiome of cutaneous diseases has increased tremendously. Of particular interest is the gut-brain-skin axis proposed by Stokes and Pillsbury in 1930. The microbiome has been suggested in the pathogenesis of hidradenitis suppurativa, however the link between the commensals and the host is yet to be established. Across all studies, the increased abundance of Porphyromonas, Peptoniphilus, and Prevotella spp., and a loss of skin commensal species, such as Cutibacterium in HS lesions, is a consistent finding. The role of gut and blood microbiome in hidradenitis suppurativa has not been fully elucidated. According to studies, the main link with the intestine is based on the increased risk of developing Crohn's disease and ulcerative colitis, however, further research is highly needed in this area. Lifestyle, dietary approaches, and probiotics all seem to influence the microbiome, hence being a promising modality as adjuvant therapy. The aim of this review was to present the latest reports in the field of research on skin, blood, and gut microbiome in terms of hidradenitis suppurativa.

Immunomodulatory Drugs in the Treatment of Hidradenitis Suppurativa-Possibilities and Limitations.

Hidradenitis suppurativa, also known as acne inversa, is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. Treatment is rather difficult and typically requires the use of multiple modalities. Regardless of the presence of several therapeutic options, treatment often turns out to be ineffective or poorly selected concerning the clinical picture of the disease. Thus, the search for new biologics and other target treatments of hidradenitis suppurativa is ongoing. The safety and efficacy of adalimumab, still the only U.S. Food and Drug Administration approved biologic in the hidradenitis suppurativa treatment, paved the way for new drugs to be compared with it. Several more drugs with new immunological targets are currently under investigation for the treatment of acne inversa. The aim of the article was to present the current and future targets of acne inversa treatment, simultaneously providing insights into the molecular pathomechanisms of the disease.

Off-Label Use of Botulinum Toxin in Dermatology-Current State of the Art.

Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacteria. Among seven different isoforms, only BoNT-A and BoNT-B are commercially used. Currently, botulinum toxin has been indicated by the U.S. Food and Drug Administration in several disorders, among others: chronic migraine, hyperhidrosis, urinary incontinence from detrusor overactivity, or cosmetics. However, there are numerous promising reports based on off-label BTX usage, indicating its potential effectiveness in other diseases, which remains unknown to many. Among them, dermatological conditions, such as rosacea, annal fissure, Raynaud phenomenon, hypertrophic scars and keloids, and also hidradenitis suppurativa, are currently being investigated. This article aims to provide a comprehensive update on the off-label use of botulinum toxin in dermatology, based on an analysis and summary of the published literature.

Could a handbook serve as a useful educational intervention in improving disease knowledge? A cross-sectional study among patients with hidradenitis suppurativa in Poland.

Introduction: Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin disease characterized by the occurrence of severe, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. The disease is of interest to many researchers, however, verified information for patients is still limited. Aim: To evaluate the baseline knowledge about acne inversa among patients suffering from the disease as well as to assess whether an educational intervention as a handbook can improve patients' knowledge of their illness. Material and methods: This research study was a cross-sectional survey conducted on HS Facebook support group. The respondents completed an anonymized questionnaire assessing their state of knowledge about acne inversa. After 1 month they were presented with a handbook. Thereafter the patients completed nearly the same anonymized questionnaire assessing the state of knowledge after reading the handbook. Results: We enrolled 102 participants before (group A) and 30 participants after (group B) the educational intervention. The vast majority of the participants (83.3%) appraised the idea of preparing a handbook as 10 points. In both groups, respondents who were aware of their disease severity had significantly superior results than the participants who were not. After reading the handbook extensively, more patients assessed the state of their general HS knowledge as 'good' than before. Conclusions: Our study demonstrated that knowledge about HS among patients is still insufficient. Tools such as handbooks may prove useful in disseminating expertise and helping patients to understand their disease.

Wound debridement products and techniques: clinical examples and literature review.

The term "debridement" stands for the removal of necrotic material, scabs, devitalized tissues, dried serous fluid, infected tissues, biofilm, stratified epidermis, pus, hematomas, foreign bodies, bone fragments and other impurities whose presence delays wound healing. It is an inseparable element of wound healing therapy. Properly performed debridement leads to improvement of microcirculation in the wound, reduction in inflammation and lowering of the level of metalloproteinases, stimulation of wound edges and epidermis, reduction in unpleasant odour and reduction in the risk of infection and improvement of the patient's quality of life. There are many debridement techniques approved by the European Wound Management Association. The selection of the most appropriate method depends on many factors such as tissue type, presence of biofilm, depth and location of the wound, underlying cause (venous, arterial), skills of the person performing the debridement and the preferences of the patient him/herself. In our work we present not only a systematic review of most of the debridement techniques used nowadays, but also our clinical cases showing results of those different techniques.

Comparison of the efficacy of novel non-invasive mechanical debridement methods - sterile sponge, monofilament fibre cloth and non-woven cloth impregnated with sodium hyaluronate and phospholipids in relation to traditional sterile gauze.

Introduction: According to the European guidelines, the first step for local wound preparation is debridement, which stands for removing of devitalized tissue such as slough or necrosis. There are numerous types of debridement, but not all of them can be performed by non-specialists. Most of the research investigating efficiency of novel debridement products are carried out or funded by pharmaceutical companies. Aim: To compare the efficacy of relative necrotic tissue removal after 30 days on patients subjected to debridement with sterile sponge, monofilament fibre cloth, non-woven cloth impregnated with sodium hyaluronate and phospholipids and traditional sterile gauze. Material and methods: By use of photographic documentation at 7 days' intervals and planimetry methods, the total wound surface area and sloughy tissue area was measured. Results: Results have shown that monofilament cloth was the most effective, removing on average 63.44 ±32.91% of necrotic tissue after the first procedure and 74.65 ±30.95% within 30 days of application, in comparison to the sterile gauze group that had on average only 23.53 ±19.16% of necrotic tissue removed at day 0 and 44.95 ±31.47% removed at day 30. Moreover, patients using all 3 products tested reported higher satisfaction with that treatment than those treated with gauze. Conclusions: Results imply that all those methods could be considered as they are well accepted by patients and cause less pain during the procedure, which is essential for good compliance and complete resolution of the lesions.

Combination of hyaluronic acid fillers and personalized skincare as a perfect tool in aesthetic medicine.

Nowadays the desire to look younger has increased. The most popular noninvasive rejuvenation method is hyaluronic acid (HA) filler injection. However, aging of the skin involves multiple pathological processes, which can be managed by using topical formulations with sophisticated active agents addressing problems such as extracellular matrix degradation, textural variances, and dyschromias. A single site experience trial was conducted to assess the efficacy of HA dermal filler injections combined with personally prepared, bespoke formulations on epidermis and dermis condition. A total of 15 female participated in the study. Mid and lower face were treated with Saypha® HA fillers injection with volume chosen by the investigator performed with 25G/50mm cannula. The formulations for topical skincare consisted of substances chosen from 19 active agents, which were scientifically proven. The subjects were supposed to use them for 6 weeks. Fourteen subjects completed the study, and one subject was lost to follow-up. The age of the study population ranged from 36 to 58 years. The average amounts of Saypha volume plus, Saypha volume, and Saypha filler used per subject were 2.8 ml, 2.25 ml and 1.7 ml, respectively. The most typical skin dysfunctions were loss of elasticity (12 subjects), hyperpigmentation (nine subjects), erythema (eight subjects), and hyperseborrhea with enlarged pores (five subjects). After completing the study all subjects were satisfied. Combined therapies based on HA fillers and personalized skincare with Universkin™ products show promising results in patients with skin problems due to aging.

Neonatal lupus erythematosus - practical guidelines.

BACKGROUND: Neonatal lupus erythematosus is an autoimmune disease acquired during fetal life as a result of transplacental passage of maternal anti-Sjögren's-syndrome-related antigen A (anti-SSA/Ro), anti-Sjögren's-syndrome-related antigen B (anti-SSB/La) or anti-U1 ribonucleoprotein (anti-U1-RNP) antinuclear autoantibodies. CONTENTS: Clinical manifestations include skin lesions, congenital heart block, hepatobiliary involvement and cytopenias. Most of the disorders disappear spontaneously after clearance of maternal antibodies. Cardiac symptoms, however, are not self-resolving and often pacemaker implantation is required. Diagnosis is based on clinical presentation and the presence of typical antibodies in the mother's or infant's serum. OUTLOOK: Neonatal lupus erythematosus may develop in children born to anti-SSA/Ro or anti-SSB/La women with various systemic connective tissue diseases. However, in half of the cases, the mother is asymptomatic, which may delay the diagnosis and have negative impact on the child's prognosis. Testing for antinuclear antibodies should be considered in every pregnant woman since early treatment with hydroxychloroquine or intravenous immunoglobulin (IVIG) has proven to be effective in preventing congenital heart block.

Chronic venous disorders - common and yet unknown - a study of public awareness and primary symptoms in a selected group of patients.

INTRODUCTION: Chronic venous disorder (CVD) is thoroughly spread across the globe. It affects about 40% of the Polish population. European guidelines underline that there are no data on the percentage of people who have first symptoms of chronic venous insufficiency. AIM: To determine the frequency and pattern of first symptoms and examine public knowledge on CVD in a selected group of patients. MATERIAL AND METHODS: Our study group consists of 175 patients who took part in preventive assessment of nevi. To determine public knowledge on CVD, we constructed a questionnaire, which consisted of two sections: one part to be completed by the patient and the other by the doctor. RESULTS: The median age was 41 years. From 175 patients, about 40% claimed that they do not recognize CVD. Only about half of them knew how to diagnose and treat it. Most of them associate telangiectasia and varicose veins as primary signs and symptoms of CVD. CONCLUSIONS: Despite the fact that the disease itself is common, the level of public awareness is astonishingly low. Majority of patients tested could not associate first signs and symptoms, even though most of them had primary symptoms of the disease. In order to avoid high-cost treatment of ulcers and varicose veins, we should spread the knowledge on CVD.

Lipidated Analogs of the LL-37-Derived Peptide Fragment KR12-Structural Analysis, Surface-Active Properties and Antimicrobial Activity.

An increasing number of multidrug-resistant pathogens is a serious problem of modern medicine and new antibiotics are highly demanded. In this study, different n-alkyl acids (C2-C14) and aromatic acids (benzoic and trans-cinnamic) were conjugated to the N-terminus of KR12 amide. The effect of this modification on antimicrobial activity (ESKAPE bacteria and biofilm of Staphylococcus aureus) and cytotoxicity (human red blood cells and HaCaT cell line) was examined. The effect of lipophilic modifications on helicity was studied by CD spectroscopy, whereas peptide self-assembly was studied by surface tension measurements and NMR spectroscopy. As shown, conjugation of the KR12-NH2 peptide with C4-C14 fatty acid chains enhanced the antimicrobial activity with an optimum demonstrated by C8-KR12-NH2 (MIC 1-4 µg/mL against ESKAPE strains; MBEC of S. aureus 4-16 µg/mL). Correlation between antimicrobial activity and self-assembly behavior of C14-KR12-NH2 and C8-KR12-NH2 has shown that the former self-assembled into larger aggregated structures, which reduced its antimicrobial activity. In conclusion, N-terminal modification can enhance antimicrobial activity of KR12-NH2; however, at the same time, the cytotoxicity increases. It seems that the selectivity against pathogens over human cells can be achieved through conjugation of peptide N-terminus with appropriate n-alkyl fatty and aromatic acids.

Cutaneous cryptococcosis: an underlying immunosuppression? Clinical manifestations, pathogenesis, diagnostic examinations and treatment.

Due to constantly growing population of immunocompromised patients the fungi became a widespread threat to modern medicine. HIV carriers, solid organ transplant recipients constitute most of those patients. Cryptococcosis is a frequent cause of life-threatening infections, affecting mostly immunosuppressed patients. This article presents current knowledge on cryptococcal infections, including epidemiology, clinical aspects, diagnosis and recommended treatment. In reference to our patient, who developed a disseminated and fulminant subtype of the disease, we wanted to underline the need to examine patients thoroughly. The highest aim of those measures would be to avoid lethal consequences.

Angioedema. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society (PTD) and Polish Society of Allergology (PTA).

Angioedema is a non-inflammatory oedema of the subcutaneous tissue and/or mucosal membranes. It most commonly coexists with urticaria wheals and is considered to be a deep form of urticaria. Less commonly, it occurs in isolation and can take two basic forms: acquired angioedema and hereditary angioedema. Currently, there are 4 defined types of acquired angioedema and 7 types of hereditary angioedema. Treatment of angioedema depends on its form and etiological factors. Especially the genetic form, i.e. hereditary angioedema, is a considerable challenge for medical specialists, particularly dermatologists and allergists.

New indications for topical ivermectin 1% cream: a case series study.

INTRODUCTION: Topical ivermectin is an effective treatment for inflammatory papulopustular rosacea in adults. Positive therapeutic effects of ivermectin due to its potential anti-inflammatory properties could be achieved in the other facial dermatoses. AIM: To assess the efficacy of topical ivermectin 1% cream therapy in mild and moderate perioral dermatitis (PD), seborrheic dermatitis (SD) and acne vulgaris (AV). MATERIAL AND METHODS: The study comprising 20 patients diagnosed with PD (8), SD (8) and AV (4) was conducted between November 2016 and July 2017. Two scales were applied to establish efficacy of the treatment: Investigator Global Assessment score (IGA) and Patient Global Assessment of Treatment (PGA). RESULTS: All patients responded to the treatment with topical ivermectin very well with a gradual reduction in inflammatory skin lesions. Complete or almost complete clearance (IGA score 0-1) was achieved in 20 cases. Four patients with PD achieved IGA 0-1 after 4 weeks of treatment, 1 patient after 5 weeks, 2 patients after 6 weeks and 1 patient after 12 weeks. In the total group of 8 patients with SD, 4 presented IGA 0 after 4 weeks of therapy, while 4 patients demonstrated IGA 1 after 6 weeks. Patients with AV required 8 and 10 weeks to obtain IGA 1. Nineteen patients of the studied group reported "very good" or "excellent" response to the therapy, only one patient with AV assessed therapy with topical ivermectin as "good". The adverse events were transient and manifested as mild-moderate desquamation, stinging and burning in 2 patients with PD. CONCLUSIONS: Topical ivermectin was well tolerated and beneficial for treatment of mild and moderate PD, SD and AV.

Counter-ion effect on antistaphylococcal activity and cytotoxicity of selected antimicrobial peptides.

In view of an appreciable increase in resistance of Staphylococcus aureus to the conventional antibiotics, it is desired to develop new effective drugs. Antimicrobial peptides (AMPs) seem to be attractive candidates. In general, AMPs samples used for in vitro studies consist of a peptide, counter-ion, and water. The presence of the counter-ion could be significant as it affects peptide secondary structure and biological activity. The purpose of this study was to estimate the impact of counter-ion on antistaphylococcal activity of selected AMPs (CAMEL, citropin 1.1, LL-37, pexiganan, temporin A). To do this, three kinds of salts were prepared, namely, acetates, hydrochlorides, and trifluoroacetates. In addition, the hemolytic activity against human red blood cells (hRBCs) and cytotoxicity (HaCaT) were determined. The results indicate that there is a substantial difference between different salts, but the pattern is not consistent for the peptides. In general, the antistaphylococcal activity decreased in the order: CAMEL > temporin A > pexiganan > citropin 1.1 â‰« LL-37. The highest selectivity indexes were determined for CAMEL hydrochloride, pexiganan acetate, and temporin A trifluoroacetate. This study shows how important is to take into account the kind of counter-ions when designing novel peptide-based antimicrobials.

Retrospective Analysis of Pediatric Dermatologic Hospital Admissions.

Statistical data on the frequency of skin conditions in the Pomeranian region of Poland are limited in the field of pediatric dermatology, requiring a multidisciplinary approach to each patient. Dermatitis and skin allergies are the 10 most common pediatric conditions, with a prevalence of 20% among such chronic illnesses in developed countries. This analysis is limited to the recurrence of dermatologic diseases in the hospitalized pediatric population within the Pomeranian region for the purpose of future targeted education. Retrospective analysis included 282 participants over a 3-year period between 2013 and 2015, with admissions to the Department of Dermatology, Venereology, and Allergology at the Medical University of Gdansk. Diagnoses were obtained from the ward admission book and CliniNet database.

Activity of antimicrobial peptides and conventional antibiotics against superantigen positive Staphylococcus aureus isolated from patients with atopic dermatitis.

INTRODUCTION: Staphylococcus aureus causes a diverse array of diseases, ranging from relatively harmless localized skin infections to life-threatening systemic conditions. It secretes toxins directly associated with particular disease symptoms. AIM: To determine the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) colonization among patients with atopic dermatitis and to assess the antimicrobial susceptibility to conventional antibiotics and selected antimicrobial peptides among toxin-producing strains and nonproducing strains. MATERIAL AND METHODS: One hundred patients with atopic dermatitis and 50 healthy people were microbiologically assessed for the carriage of S. aureus. Antimicrobial susceptibility tests were performed using the broth microdilution method for conventional antibiotics and antimicrobial peptides (CAMEL, Citropin 1.1, LL-37, Temporin A). Detection of genes lukS/lukF-PV, tst, sea-sed, eta and etb by multiplex PCR was performed. RESULTS: Staphylococcus aureus strains were isolated from the majority of patients, from either the skin (75%) or the anterior nares (73%). Among the conventional antibiotics tested, the highest rates of resistance were observed for ampicillin, daptomycin, lincomycin and erythromycin. Antimicrobial peptides did not show significant diversity in activity. Among MSSA strains greater differentiation of secreted toxins was observed (sec, eta, pvl, tsst, etb, seb), while in the group of MRSA strains secretion of 3 toxins (pvl, eta, seb) was noted. CONCLUSIONS: Antimicrobial resistance continues to evolve. It is important to monitor S. aureus infections. The profile of toxins produced by S. aureus strains is an important consideration in the selection of an antimicrobial agent to treat infections.