Opinion statement
The development and implementation of artificial intelligence is beginning to impact the care of dermatology patients. Although the clinical application of AI in dermatology to date ...has largely focused on melanoma, the prevalence of non-melanoma skin cancers, including basal cell and squamous cell cancers, is a critical application for this technology. The need for a timely diagnosis and treatment of skin cancers makes finding more time efficient diagnostic methods a top priority, and AI may help improve dermatologists’ performance and facilitate care in the absence of dermatology expertise. Beyond diagnosis, for more severe cases, AI may help in predicting therapeutic response and replacing or reinforcing input from multidisciplinary teams. AI may also help in designing novel therapeutics. Despite this potential, enthusiasm in AI must be tempered by realistic expectations regarding performance. AI can only perform as well as the information that is used to train it, and development and implementation of new guidelines to improve transparency around training and performance of algorithms is key for promoting confidence in new systems. Special emphasis should be placed on the role of dermatologists in curating high-quality datasets that reflect a range of skin tones, diagnoses, and clinical scenarios. For ultimate success, dermatologists must not be wary of AI as a potential replacement for their expertise, but as a new tool to complement their diagnostic acumen and extend patient care.
Dermatology consultation for cases of presumed cellulitis improves diagnostic accuracy and management. However, access to in-person consultation remains limited, a gap that could be filled with ...teledermatology. Augmented teledermatology may improve outcomes. In this cross-sectional study, 20 dermatologists (60% of whom reported conducting inpatient consults > 1 month per year) reviewed 10 real-life cases representing either cellulitis or pseudocellulitis as diagnosed by in-person dermatology consultation. For each case, respondents recorded their diagnosis, confidence, and management decisions after viewing the history and standard teledermatology photos, the responses to a physician-reported cellulitis questionnaire, and finally thermal images. Overall mean diagnostic accuracy increased from 84 ± 4% with the history and physical to 89 ± 3% when adding a cellulitis questionnaire and thermal images (
p
= 0.23). Accuracy for cellulitis cases specifically significantly increased from 76 ± 6% to 88 ± 4% when adding a cellulitis questionnaire and thermal images (
p
= 0.049). Accuracy for pseudocellulitis was consistently ≥ 94%. Augmented teledermatology with a standardized questionnaire and thermal images improved diagnostic accuracy for cases of cellulitis and may increase physician confidence. Dermatologists were able to accurately diagnose regardless of experience with inpatient consults, increasing the pool of potential dermatologists who could diagnose cellulitis remotely.
Janus kinase (JAK) inhibitors are increasingly used across a range of dermatologic conditions. Adverse events of acne have been noted in some studies in clinical practice, but the scope of this ...outcome across JAK inhibitors has not been established.
To systematically analyze all published phase 2 and 3 placebo-controlled randomized clinical trials (RCTs) of JAK inhibitors for the risk of acne as an adverse effect of these medications.
Comprehensive search of Ovid MEDLINE and PubMed databases through January 31, 2023.
Inclusion criteria were phase 2 and 3 placebo-controlled RCTs of JAK inhibitors published in English with reported adverse events of acne.
Two reviewers independently reviewed and extracted information from all included studies.
The primary outcome of interest was the incidence of acne following JAK inhibitor use. A meta-analysis was conducted using random-effects models.
A total of 25 unique studies (10 839 unique participants; 54% male and 46% female) were included in the final analysis. The pooled odds ratio (OR) was calculated to be 3.83 (95% CI, 2.76-5.32) with increased ORs for abrocitinib (13.47 95% CI, 3.25-55.91), baricitinib (4.96 95% CI, 2.52-9.78), upadacitinib (4.79 95% CI, 3.61-6.37), deucravacitinib (2.64 95% CI, 1.44-4.86), and deuruxolitinib (3.30 95% CI, 1.22-8.93). Estimated ORs were higher across studies investigating the use of JAK inhibitors for the management of dermatologic compared with nondermatologic conditions (4.67 95% CI, 3.10-7.05) as well as for JAK1-specific inhibitors (4.69 95% CI, 3.56-6.18), combined JAK1 and JAK2 inhibitors (3.43 95% CI, 2.14-5.49), and tyrosine kinase 2 inhibitors (2.64 95% CI, 1.44-4.86).
In this systematic review and meta-analysis, JAK inhibitor use was associated with an elevated odds of acne. Patients should be properly counseled on this potential adverse effect of these medications before treatment initiation. Future studies are needed to further elucidate the pathophysiology of this association.
The use of artificial intelligence (AI) is expanding throughout the field of medicine. In dermatology, researchers are evaluating the potential for direct-to-patient and clinician decision-support AI ...tools to classify skin lesions. Although AI is poised to change how patients engage in health care, patient perspectives remain poorly understood.
To explore how patients conceptualize AI and perceive the use of AI for skin cancer screening.
A qualitative study using a grounded theory approach to semistructured interview analysis was conducted in general dermatology clinics at the Brigham and Women's Hospital and melanoma clinics at the Dana-Farber Cancer Institute. Forty-eight patients were enrolled. Each interview was independently coded by 2 researchers with interrater reliability measurement; reconciled codes were used to assess code frequency. The study was conducted from May 6 to July 8, 2019.
Artificial intelligence concept, perceived benefits and risks of AI, strengths and weaknesses of AI, AI implementation, response to conflict between human and AI clinical decision-making, and recommendation for or against AI.
Of 48 patients enrolled, 26 participants (54%) were women; mean (SD) age was 53.3 (21.7) years. Sixteen patients (33%) had a history of melanoma, 16 patients (33%) had a history of nonmelanoma skin cancer only, and 16 patients (33%) had no history of skin cancer. Twenty-four patients were interviewed about a direct-to-patient AI tool and 24 patients were interviewed about a clinician decision-support AI tool. Interrater reliability ratings for the 2 coding teams were κ = 0.94 and κ = 0.89. Patients primarily conceptualized AI in terms of cognition. Increased diagnostic speed (29 participants 60%) and health care access (29 60%) were the most commonly perceived benefits of AI for skin cancer screening; increased patient anxiety was the most commonly perceived risk (19 40%). Patients perceived both more accurate diagnosis (33 69%) and less accurate diagnosis (41 85%) to be the greatest strength and weakness of AI, respectively. The dominant theme that emerged was the importance of symbiosis between humans and AI (45 94%). Seeking biopsy was the most common response to conflict between human and AI clinical decision-making (32 67%). Overall, 36 patients (75%) would recommend AI to family members and friends.
In this qualitative study, patients appeared to be receptive to the use of AI for skin cancer screening if implemented in a manner that preserves the integrity of the human physician-patient relationship.
Despite high use of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear.
To identify all CAM therapies studied for treatment of AA. Outcomes of ...interest included disease course and psychologic well-being.
PubMed and Embase were searched to identify English articles containing original data investigating CAM in individuals with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria.
Of 1015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective noncontrolled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low-quality evidence for improvement of psychologic and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated.
Inconsistent or poorly reported study methodology and nonstandardized outcomes limit the conclusions that can be made from these studies.
This work serves to inform physician treatment of patients with AA seeking CAM while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA.
Little is known about the prevalence and magnitude of stigmatizing attitudes of the general public toward individuals with acne.
To explore the degree of stigma toward individuals with acne and ...whether these attitudes vary based on characteristics of the individuals with acne or of the survey participants.
In this cross-sectional internet survey study, 4 stock portraits of adults that varied in sex (male/female) and skin tone (light/dark) were digitally enhanced to have acne (mild/severe). One of these 12 images was randomly presented to survey participants, who subsequently answered questions regarding stigmatizing attitudes with respect to the pictured individual, such as desire for social distance and stereotype endorsement. The survey was administered to a convenience sample of adult respondents in the US who were volunteers on the ResearchMatch platform.
Prevalence and magnitude of stigma toward individuals with acne.
The survey was completed by 1357 respondents (65.7% completion rate) (mean SD age, 42.4 14.3 years; 918 67.7% female, 439 32.4% male). Compared to those with no acne, for those with severe acne, participants reported less comfort being friends (adjusted coefficient 95% CI, -0.28 -0.47 to -0.10; P = .003), hiring (-0.33 -0.51 to -0.15; P < .001), having physical contact (-0.26 -0.45 to -0.08; P = .006), dating (-0.44 -0.74 to -0.14; P = .004), and posting a photograph together on social media (-0.50 -0.70 to -0.30; P < .001). Compared to those with no acne, participants were more likely to rate individuals with severe acne as having poor hygiene (adjusted coefficient 95% CI, -1.04 -1.46 to -0.82; P < .001) and being unattractive (-0.89 -1.12 to -0.67; P < .001), unintelligent (-0.42 -0.63 to -0.22; P < .001), unlikable (-0.36 -0.56 to -0.15; P < .001), immature (-0.52 -0.74 to -0.30; P < .001), and untrustworthy (-0.40 -0.61 to -0.18; P < .001). There was evidence that the effect size of the association of acne with desire to social distance was greater for individuals with dark skin.
This survey study demonstrates that stigmatizing attitudes toward patients with acne existed across a variety of social and professional scenarios, with severe acne and acne in darker skin tone being associated with a greater degree of stigma. These findings highlight the need to identify approaches to reduce stigmatizing attitudes in the community and for adequate access to care, which might prevent negative downstream effects related to these stigmatizing attitudes.
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