RESUMO
BACKGROUND: The use of artificial intelligence (AI) algorithms for the diagnosis of skin diseases has shown promise in experimental settings but has not been yet tested in real-life conditions. OBJECTIVE: To assess the diagnostic performance and potential clinical utility of a 174-multiclass AI algorithm in a real-life telemedicine setting. METHODS: Prospective, diagnostic accuracy study including consecutive patients who submitted images for teledermatology evaluation. The treating dermatologist chose a single image to upload to a web application during teleconsultation. A follow-up reader study including nine healthcare providers (3 dermatologists, 3 dermatology residents and 3 general practitioners) was performed. RESULTS: A total of 340 cases from 281 patients met study inclusion criteria. The mean (SD) age of patients was 33.7 (17.5) years; 63% (n = 177) were female. Exposure to the AI algorithm results was considered useful in 11.8% of visits (n = 40) and the teledermatologist correctly modified the real-time diagnosis in 0.6% (n = 2) of cases. The overall top-1 accuracy of the algorithm (41.2%) was lower than that of the dermatologists (60.1%), residents (57.8%) and general practitioners (49.3%) (all comparisons P < 0.05, in the reader study). When the analysis was limited to the diagnoses on which the algorithm had been explicitly trained, the balanced top-1 accuracy of the algorithm (47.6%) was comparable to the dermatologists (49.7%) and residents (47.7%) but superior to the general practitioners (39.7%; P = 0.049). Algorithm performance was associated with patient skin type and image quality. CONCLUSIONS: A 174-disease class AI algorithm appears to be a promising tool in the triage and evaluation of lesions with patient-taken photographs via telemedicine.
Assuntos
Dermatologia , Dermatopatias , Telemedicina , Adulto , Inteligência Artificial , Feminino , Humanos , Masculino , Redes Neurais de Computação , Estudos Prospectivos , Dermatopatias/diagnósticoRESUMO
La dermatitis atópica (DA) es una enfermedad inflamatoria crónica de la piel, afecta entre el 1 y el 3% de la población adulta. Se presenta el caso de una mujer de 23 años con antecedentes de asma, rinitis alérgica y dermatitis atópica severa (DAS), con mala respuesta previa a múltiples tratamientos sistémicos, que consultó por exacerbación de su dermatitis y por lesiones papulares progresivas, compatibles con moluscos contagiosos. Destacaba una hiper-eosinofilia y niveles de IgE > 20.000. Por la severidad del cuadro y el estado de inmunosupresión asociado a infección viral extensa, se decide inicio de inmunoglobulina intravenosa (IgIV), con buena respuesta del cuadro cutáneo. Las terapias estándares para la DA se centran en el alivio sintomático y su eficacia clínica, es frecuentemente insuficiente. La IgIV es un tratamiento eficaz en algunas condiciones auto-inflamatorias dermatológicas; existen reportes limitados en el tratamiento de la DAS, principalmente en niños. Otros tratamientos utilizados para estos casos son interferón-gamma y el omalizumab; sin embargo, la evidencia actual es insuficiente y se requieren de más estudios, que demuestren su efectividad en el manejo de la DAS.
Background: atopic dermatitis (AD) is a chronic inflammatory skin disease that affects between 1 to 3% of adults. Case: we report a case of a 23-years old woman with history of asthma, allergic rhinitis and severe atopic dermatitis (SAD), with poor previous response to four systemic treatments. She consulted due to exacerbation of her AD and a four month-course of progressive papular lesions, compatible with molluscum contagiosum. Laboratory evaluation showed hypereosinophilia and IgE levels > 20.000. Because of the severity of the clinical condition and taking in consideration the patient´s immunosupression state, intravenous immunoglobulin (IVIg) 0,4 mg/kg/day was started for five days and three cycles, with good response of her cutaneous lesions. Discussion: the standard therapies for AD are mainly focused on symptomatic relief and its clinical efficacy is often insufficient. The treatment with IVIg is effective in some dermatological autoinflammatory diseases and there are few reports in this matter, especially in children. Other treatments available for these cases are interferon-gamma and omalizumab, but the actual evidence is insufficient and it is required more prospective studies to support their use.
