ABSTRACT
Chronic urticaria is a chronic skin disease that affects up to 1% of the general population worldwide, with chronic spontaneous urticaria accounting for more than two-thirds of all chronic urticaria cases. The Urticaria Activity Score (UAS) is a dynamic severity assessment tool that can be incorporated into daily clinical practice, as well as clinical trials for treatments. The UAS helps in measuring disease severity and guiding the therapeutic strategy. However, UAS assessment is a time-consuming and manual process, with high interobserver variability and high dependence on the observer. To tackle this issue, we introduce Automatic UAS, an automatic equivalent of UAS that deploys a deep learning, lesion-detecting model called Legit.Health-UAS-HiveNet. Our results show that our model assesses the severity of chronic urticaria cases with a performance comparable to that of expert physicians. Furthermore, the model can be implemented into CADx systems to support doctors in their clinical practice and act as a new end point in clinical trials. This proves the usefulness of artificial intelligence in the practice of evidence-based medicine; models trained on the consensus of large clinical boards have the potential of empowering clinicians in their daily practice and replacing current standard clinical end points in clinical trials.
ABSTRACT
BACKGROUND: Hidradenitis suppurativa (HS) is a painful chronic inflammatory skin disease that affects up to 4% of the European adult population. International Hidradenitis Suppurativa Severity Score System (IHS4) is a dynamic scoring tool that was developed to be incorporated into the doctor's daily clinical practice and clinical studies. This helps measure disease severity and guides the therapeutic strategy. However, IHS4 assessment is a time-consuming and manual process, with high inter-observer variability and high dependence on the observer's expertise. MATERIALS AND METHODS: We introduce the Automatic International Hidradenitis Suppurativa Severity Score System (AIHS4), an automatic equivalent of IHS4 that deploys a deep learning model for lesion detection, called Legit.Health-IHS4net, based on the YOLOv5 architecture. AIHS4 was trained on Legit.Health-HS-IHS4, a collection of HS images manually annotated by six specialists and processed by a novel knowledge unification algorithm. RESULTS: Our results show that, with the current dataset size, our tool assesses the severity of HS cases with a performance comparable to that of the most expert physician. Furthermore, the model can be implemented into CADx systems to support doctors in their clinical practice and act as a new endpoint in clinical trials. CONCLUSION: Our work proves the potential usefulness of artificial intelligence in the practice of evidence-based dermatology: models trained on the consensus of large clinical boards have the potential to empower dermatologists in their daily practice and replace current standard clinical endpoints.
Subject(s)
Hidradenitis Suppurativa , Adult , Humans , Hidradenitis Suppurativa/diagnosis , Hidradenitis Suppurativa/therapy , Artificial Intelligence , Severity of Illness Index , Observer Variation , Quality of LifeABSTRACT
Children who suffer from scarring alopecia, especially in areas such as the eyebrows which are an important part in facial mimicry, are at risk of social stigmatization. Inexpensive, painless and non-permanent options are available for online purchase, which can be useful in such infants and children. Dermatologists should be aware of the availability of these product and could offer advice in this regard.
Subject(s)
Eyebrows , Tattooing , Alopecia/etiology , Child , Face , HumansABSTRACT
BACKGROUND: The diagnosis of photoallergic contact dermatitis (PACD) is confirmed by photopatch testing (PPT). In Spain, the latest recommendation on which allergens to test in PPT dates from 1995. METHODS: In the last 4 years, we studied 455 patients with epicutaneous tests and performed PPT on 33 of those patients (7.3%). RESULTS: The most prevalent allergens in PPT were as follows: non-steroidal anti-inflammatory drugs (NSAIDs) (46%), fragrances (21%), and solar filters (18%). DISCUSSION: In our country, the most common photoallergens continue to be NSAIDs (ketoprofen). The increasingly common use of sunscreens has led to a growing involvement of solar filters in PACD, which can be also contained in other cosmetics. In our experience, PACD due to fragrances is nonetheless at least similar in frequency. CONCLUSIONS: The PPT battery must adapt to the prescription, use, and exposure habits of each country. We propose a diagnostic model to guide which allergens to test in PPT, which in our experience should also include fragrances.
Subject(s)
Dermatitis, Photoallergic , Allergens , Dermatitis, Photoallergic/diagnosis , Dermatitis, Photoallergic/epidemiology , Dermatitis, Photoallergic/etiology , Humans , Patch Tests , Sunscreening Agents , Ultraviolet RaysABSTRACT
Atypical fibroxanthoma is a rare mesenchymal skin tumor of intermediate malignancy that typically occurs on sun-damaged skin of elderly patients. Histologically, it is composed of pleomorphic cells with hyperchromatic nuclei and abundant cytoplasm, commonly arranged in a spindle cell pattern. Different histologic variants have been described during the past years. We present a case of atypical fibroxanthoma containing a dense inflammatory infiltrate, which in conjunction with the existence of immunoblast-like and Reed-Sternberg-like neoplastic cells could be misinterpreted as a lymphoid neoplasm. Immunohistochemical studies revealed strong positivity of tumor cells for CD10 and negativity for cytokeratins, p63, p40, S100, SOX10, ERG, actin, desmin, B and T-cell markers, BCL6, CD15, and CD30. The inflammatory infiltrate contained a mixed reactive T- and B-cell population with negative T-cell receptor and immunoglobulin heavy rearrangements. We discuss the differential diagnosis of this entity in which clinical, immunohistochemical, and molecular features are essential to avoid the diagnosis of a lymphoproliferative disease.
Subject(s)
Neoplasms, Fibrous Tissue/pathology , Pseudolymphoma/pathology , Skin Neoplasms/pathology , Aged, 80 and over , Biomarkers, Tumor/analysis , Biomarkers, Tumor/genetics , Biopsy , Diagnosis, Differential , Gene Rearrangement, T-Lymphocyte , Genes, Immunoglobulin Heavy Chain , Genes, T-Cell Receptor , Humans , Immunohistochemistry , Male , Neoplasms, Fibrous Tissue/genetics , Neoplasms, Fibrous Tissue/immunology , Polymerase Chain Reaction , Predictive Value of Tests , Pseudolymphoma/genetics , Pseudolymphoma/immunology , Skin Neoplasms/genetics , Skin Neoplasms/immunologyABSTRACT
No disponible
Subject(s)
Humans , Female , Pregnancy , Adult , Hidradenitis/diagnosis , Galactorrhea/diagnosis , Breast/abnormalities , Postpartum Period , Diagnosis, DifferentialSubject(s)
Breast/abnormalities , Hidradenitis/diagnosis , Adult , Axilla , Female , Humans , PregnancyABSTRACT
No disponible
