Background/Objectives: AI models such as ChatGPT-4 have shown strong performance in dermatology; however, the diagnostic value of AI-generated clinical image descriptions remains underexplored. This study assesses whether ChatGPT-4’s image descriptions can support accurate dermatologic diagnosis and evaluates their potential integration into the Electronic Medical Record (EMR) system. Materials & Methods: In this Exploratory cross-sectional study, we analyzed images and descriptions from teledermatology consultations conducted between December 2023 and February 2024. ChatGPT-4 generated clinical descriptions for each image, which two senior dermatologists then used to formulate differential diagnoses. Diagnoses based on ChatGPT-4’s output were compared to those derived from the original clinical notes written by teledermatologists. Concordance was categorized as Top1 (exact match), Top3 (correct within top three), Partial, or No match. Results: The study included 154 image descriptions from 67 male and 87 female patients, aged 0 to 93 years. ChatGPT-4 descriptions averaged 74.3 ± 33.1 words, compared to 7.9 ± 3.0 words for teledermatologists. At least one of the two dermatologists achieved a Top 3 concordance rate of 82.5% using ChatGPT-4’s descriptions and 85.3% with teledermatologist descriptions. Conclusions: Preliminary findings highlight the potential integration of ChatGPT-4-generated descriptions into EMRs to enhance documentation. Although AI descriptions were longer, they did not enhance diagnostic accuracy, and expert validation remained essential.

Hidradenitis suppurativa is a chronic, inflammatory disease. Despite the limited literature on the use of the Er-YAG laser for deroofing in hidradenitis suppurativa, its mechanism is similar to that of the carbon dioxide laser, suggesting that it could be a useful alternative treatment. This study aims to assess the efficacy of Er-YAG laser treatment for hidradenitis suppurativa lesions and identify potential factors associated with treatment success. Medical records of 94 patients with Hurley Stage II or III disease who underwent Er-YAG laser treatment were retrospectively reviewed. The laser was used to incise the skin and subcutaneous fat, followed by vaporization to remove diseased apocrine glands. Wound healing was achieved through secondary intention. Posttreatment follow-up was scheduled at 8 weeks to assess remission and at 6 months to assess recurrence. Complete remission was achieved in 87% of patients at 8 weeks, and 94% of these patients were disease-free at 6 months. Patients reported high satisfaction. Significant negative associations with outcomes were found for obesity (body mass index >= 30) and Hurley Stage III disease. Er-YAG laser deroofing is effective for hidradenitis suppurativa. Obesity and Hurley Stage III patients should be aware of their reduced success rates.

Background/Objective: Condyloma acuminatum, also known as genital warts, results from infections of the basal epithelium or mucous membranes by human papillomavirus (HPV). These lesions can significantly impact patients’ quality of life. Recent advances in laser technology, particularly ablative lasers such as CO2 and Erbium–YAG (Er:YAG), have introduced new treatment opportunities. The Er:YAG laser has gained recognition as a safe and effective treatment for viral warts. This study aimed to evaluate the efficacy of Er:YAG laser treatment of male genital warts and to identify risk factors that might influence its effectiveness. Methods: A retrospective chart review of 102 patients who underwent Er:YAG laser wart removal between January 2019 and April 2024 was conducted. Results: Of the 102 patients, 61 (60%) achieved complete response by the 12-month follow-up visit. The response rates were significantly lower when there was a high number of sessions required for complete response, long duration between wart onset and laser treatment, high number of warts treated, positive smoking status, concurrent immunosuppressed state, or active metabolic disease. Conclusions: The Er:YAG laser is an effective method for treating recalcitrant warts. Various factors were shown to influence its efficacy.

Artificial intelligence (AI), especially large language models (LLMs) like ChatGPT, has disrupted different medical disciplines, including dermatology. This review explores the application of ChatGPT in dermatological diagnosis, emphasizing its role in natural language processing (NLP) for clinical data interpretation, differential diagnosis assistance, and patient communication enhancement. ChatGPT can enhance a diagnostic workflow when paired with image analysis tools, such as convolutional neural networks (CNNs), by merging text and image data. While it boasts great capabilities, it still faces some issues, such as its inability to perform any direct image analyses and the risk of inaccurate suggestions. Ethical considerations, including patient data privacy and the responsibilities of the clinician, are discussed. Future perspectives include an integrated multimodal model and AI-assisted framework for diagnosis, which shall improve dermatology practice.

Die Integration von künstlicher Intelligenz, insbesondere ChatGPT, in das Gesundheitswesen verändert die medizinische Diagnostik und kann für die Teledermatologie vorteilhaft sein. Die vorliegende explorative Studie verglich die von einem ChatGPT‐4‐basierten Chatbot erstellte Bildbeschreibung und Differentialdiagnose mit jener menschlicher Teledermatologen (TDs). In dieser retrospektiven Studie wurden 154 teledermatologische Konsultationen (Dezember 2023 ‐ Februar 2024) mit der Leistung von ChatGPT‐4 bei Bildbeschreibungen und Diagnosen verglichen. Die diagnostische Übereinstimmung wurde als „Top1“ (exakte Übereinstimmung mit den Diagnosen der TDs), „Top3“ (korrekte Diagnose innerhalb einer der drei Top‐Diagnosen) oder „Partiell“ (ähnliche, aber nicht identische Diagnosen) klassifiziert. Die Bildbeschreibungen wurden nach Qualitätsparametern (Lage, Farbe, Größe, Morphologie und Umgebung) und nach Genauigkeit (Ja, Nein und Partiell) bewertet und verglichen. Von 154 Fällen erreichte ChatGPT‐4 in 108 (70,8%) eine Top1‐Diagnoseübereinstimmung, in 137 (87,7%) eine Top3‐Übereinstimmung, in vier (2,6%) eine partielle Übereinstimmung und in 15 (9,7%) Fällen keine Diagnoseübereinstimmung. Die Qualität der Bildbeschreibungen von ChatGPT‐4 übertraf die der TDs bei allen fünf Parametern deutlich. Die Beschreibungen von ChatGPT‐4 waren in 130 (84,4%) Fällen korrekt, in 22 (14,3%) Fällen partiell korrekt und in zwei (1,3%) Fällen nicht korrekt. Die vorläufigen Ergebnisse dieser Studie zeigen, dass ChatGPT‐4 das Potenzial zur Generierung korrekter Bildbeschreibung und Differentialdiagnosis hat und wie vielversprechend die Integration von künstlicher Intelligenz in asynchrone Teledermatologie‐Workflows ist.

ABSTRACT Background Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease, primarily affecting the elderly. The role of interleukin‐13 (IL‐13) in BP pathogenesis remains unclear, particularly regarding its potential as a therapeutic target. Objectives To evaluate differences in serum IL‐13 levels between idiopathic and drug‐induced BP patients and healthy controls, and to investigate correlations between IL‐13 levels, disease severity, mucosal involvement, and prognosis. Methods This retrospective cohort study included 42 BP patients diagnosed between 2008 and 2023 at a dermatology referral center, along with 12 healthy controls and four pemphigus vulgaris patients. Serum IL‐13 levels were measured using ELISA. The primary outcomes were IL‐13 levels and their association with disease etiology, eosinophil counts, mucosal involvement, and the need for adjuvant therapy. Results Serum IL‐13 levels were lower in BP patients ( n = 42, mean 62.46 pg/mL ± 16.53) compared to healthy controls ( n = 12, mean 87.83 pg/mL ±8.87, p < 0.0001) and pemphigus patients ( n = 4, mean 87.6 pg/mL ± 5.16, p = 0.013). Idiopathic BP patients exhibited higher IL‐13 levels than Dipeptidyl peptidase‐4 (DPP4) ‐induced BP patients (67.01 pg/mL ± 14.3 vs. 57.36 pg/mL ± 21, p = 0.0104). No significant correlation was found between IL‐13 levels and mucosal involvement ( p = 0.338), eosinophil counts (Pearson correlation coefficient = 0.18, p = 0.253), the need for adjuvant therapy ( p = 0.32), or prognosis ( p = 0.45). Higher eosinophil levels correlated with the need for adjuvant therapy ( p = 0.027). Conclusions Serum IL‐13 levels are lower in BP patients compared to healthy controls, and in DPP4‐induced BP compared to idiopathic BP, suggesting a complex role of IL‐13 in BP pathogenesis. IL‐13 levels did not correlate with disease severity or prognosis, indicating that IL‐13 may not be a reliable marker for BP severity or outcome. Further research is needed to clarify IL‐13's role in BP and to guide therapeutic strategies.

BACKGROUND AND OBJECTIVES:Integration of artificial intelligence in healthcare, particularly ChatGPT, is transforming medical diagnostics and may benefit teledermatology. This exploratory study compared image description and differential diagnosis generation by a ChatGPT-4 based chatbot with human teledermatologists. PATIENTS AND METHODS:This retrospective study compared 154 teledermatology consultations (December 2023-February 2024) with ChatGPT-4's performance in image descriptions and diagnoses. Diagnostic concordance was classified as "Top1" (exact match with the teledermatologist's diagnoses), "Top3" (correct diagnosis within one the top three diagnoses), and "Partial" (similar but not identical diagnoses). Image descriptions were rated and compared for quality parameters (location, color, size, morphology, and surrounding area), and accuracy (Yes, No, and Partial). RESULTS:Out of 154 cases, ChatGPT-4 achieved a Top1 diagnostic concordance in 108 (70.8%), Top3 concordance in 137 (87.7%), partial concordance in four (2.6%), and was discordant in 15 (9.7%) cases. The quality of ChatGPT-4's image descriptions significantly surpassed teledermatologists in all five parameters. ChatGPT-4's descriptions were accurate in 130 (84.4%), partially accurate in 22 (14.3%), and inaccurate in two (1.3%) cases. CONCLUSIONS:The preliminary findings of this study indicate that ChatGPT-4 demonstrates potential in generating accurate image descriptions and differential diagnoses. These results highlight the promise of integrating artificial intelligence into asynchronous teledermatology workflows.

Background: Papilledema, an ophthalmic finding associated with increased intracranial pressure, is often induced by dermatological medications, including corticosteroids, isotretinoin, and tetracyclines. Early detection is crucial for preventing irreversible optic nerve damage, but access to ophthalmologic expertise is often limited in rural settings. Artificial intelligence (AI) may enable the automated and accurate detection of papilledema from fundus images, thereby supporting timely diagnosis and management. Objective: The primary objective of this study was to explore the diagnostic capability of ChatGPT-4o, a general large language model with multimodal input, in identifying papilledema from fundus photographs. For context, its performance was compared with a ResNet-based convolutional neural network (CNN) specifically fine-tuned for ophthalmic imaging, as well as with the assessments of two human ophthalmologists. The focus was on applications relevant to dermatological care in resource-limited environments. Methods: A dataset of 1094 fundus images (295 papilledema, 799 normal) was preprocessed and partitioned into a training set and a test set. The ResNet model was fine-tuned using discriminative learning rates and a one-cycle learning rate policy. GPT-4o and two human evaluators (a senior ophthalmologist and an ophthalmology resident) independently assessed the test images. Diagnostic metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen’s Kappa, were calculated for each evaluator. Results: GPT-4o, when applied to papilledema detection, achieved an overall accuracy of 85.9% with substantial agreement beyond chance (Cohen’s Kappa = 0.72), but lower specificity (78.9%) and positive predictive value (73.7%) compared to benchmark models. For context, the ResNet model, fine-tuned for ophthalmic imaging, reached near-perfect accuracy (99.5%, Kappa = 0.99), while two human ophthalmologists achieved accuracies of 96.0% (Kappa ≈ 0.92). Conclusions: This study explored the capability of GPT-4o, a large language model with multimodal input, for detecting papilledema from fundus photographs. GPT-4o achieved moderate diagnostic accuracy and substantial agreement with the ground truth, but it underperformed compared to both a domain-specific ResNet model and human ophthalmologists. These findings underscore the distinction between generalist large language models and specialized diagnostic AI: while GPT-4o is not optimized for ophthalmic imaging, its accessibility, adaptability, and rapid evolution highlight its potential as a future adjunct in clinical screening, particularly in underserved settings. These findings also underscore the need for validation on external datasets and real-world clinical environments before such tools can be broadly implemented.

Onychomycosis is a highly prevalent and persistent nail disorder primarily caused by dermatophytes. The effectiveness of current topical and systemic antifungals is limited by the extent and severity of the infection, patient demographics and health status, hepatic toxicity, drug interactions and low compliance. Laser therapy is a promising modality for safe and cost-effective removal of mycotic nail. This prospective study assessed the performance of a multi-series long-pulsed Nd:YAG 1064 nm regimen (30-40 J/cm2 , 1 Hz) in the treatment of 213 mycotic nails in 31 patients. Pain and discomfort were scored at each treatment session and mycological and clinical cure rates were determined 3 months after the last treatment session. Patients presented with mostly severe (mean SCIO score: 21.9 ± 8.9), T. rubrum-positive (87.1%) infections. Most (61%) had a family history of onychomycosis and a significant proportion had comorbidities, including hypertension (38.7%), hyperlipidemia (35.5%) and/or diabetes (12.9%). Treatment was well tolerated and there were no reports of nail deformity or burns. By 3 months post-treatment, mycological cure was achieved by 4 (12.9%) and visual improvements were noted for 10 (32.3%) patients, including 3 (9.7%) with moderate to significant improvements. Clinical response correlated with baseline SCIO ≤ 20 (OR: 0.9 [0.13-6.52]), family history of onychomycosis (OR: 0.27 [0.04-1.50]) and comorbidities (OR: 0.44 [0.05-3.74]). In conclusion, Nd:YAG 1064 nm laser is safe and effective for the management of mild-to-moderate onychomycosis in diverse populations. Further studies will be necessary to adjust treatment parameters to patient and nail profiles and to determine the impact of combined laser and topical therapies.

Methacrylate allergy is a common cause of allergic contact dermatitis, and its incidence has surged over the past decade. Consequently, the primary sensitizing agent, 2-hydroxyethyl methacrylate, was recently added to the European Baseline Series of contact allergens. This study aimed to assess the added value of testing for allergens included in the (Meth)Acrylate Series - Nails, in addition to 2-hydroxyethyl methacrylate, as well as to characterize patients who may benefit from more extensive testing. A retrospective analysis of medical records of patch-tested patients was conducted between June 2013 and July 2022. Among the 3,828 patients who underwent patch testing, 396 were tested with the (Meth)Acrylate Series - Nails; 153 (38.6%) of those patients tested positive for at least 1 acrylate. The most common hapten was 2-hydroxyethyl methacrylate (85.6%), followed by hydroxypropyl methacrylate (85.0%) and ethylene glycol dimethacrylate (80.4%). In our study, 22/153 patients (14.4%) would have been missed if tested only for 2-hydroxyethyl methacrylate. The analysis showed that including hydroxypropyl methacrylate and ethylene glycol dimethacrylate improved detection rate to 98%, rendering the use of the entire tray unnecessary in most cases.

Background: Viral warts are the result of keratinocyte infection caused by the human papillomavirus (HPV), usually represent as benign growths of epithelial tissue. Those afflicted often experience a notable decline in their quality of life due to these lesions, which can also lead to functional issues and physical discomfort. Laser technology has introduced novel approaches in treating viral warts, especially ablative lasers such as CO2 and Erbium-YAG (Er:YAG) lasers. Er:YAG laser gained recognition as a safe and effective method for addressing viral warts. Nevertheless, different recurrence rates have been reported in medical literature following treatment using Er:YAG laser, ranging from 24% to 71%. This study aimed to evaluate the recurrence rate and the risk factors that might affect it following successful treatment of warts using an Er:YAG laser. Methods: A retrospective chart review analysis of all 245 patients who underwent an Er:YAG laser wart removal between January 2019 and July 2023 was conducted. The main outcomes measures were response rate and number of sessions required to get complete clearance. Results: There was an overall complete resolution rate of 71.6% at 12 months follow-up. Four parameters were found to affect the response rate: the number of sessions until complete response, duration of the wart present before the laser treatment, smoking, and periungual wart location. Conclusion: Er:YAG laser is an effective method for treating recalcitrant warts, and different risk factors were proven to effect its efficacy.

Pigmentation disorders are conditions that affect the color of a person’s skin [...]

Back grounds and objectiveInfantile hemangiomas (IH) are common benign tumors of infancy. Most IH either involute spontaneously or respond to treatment with systemic Beta- blockers, but unfortunately not in all cases. In poor responses or in cases of contra indications for pharmacological treatment, laser treatment poses a very good solution. MethodsAs a search strategy and study selection we searched the MEDLINE database via PubMed starting 1982 to June 2022 using a key terms related to interventions for IH (e.g., infantile hemangioma, laser, Beta blockers). ResultsIn this article, we reviewed the published data regarding the use of energy-based devices in treatment of children with IH, and noted our experience over the course of treating dozens of cases over the years. ConclusionThere are many laser systems used for the treatment of hemangioma and vascular tumors. These laser systems are of different wavelengths and penetration depths, however, they operate by similar mechanisms and in some cases two or more lasers can be applied during the course of treating these lesions.

Melasma is a commonly occurring pigmented skin condition that can significantly affect one’s appearance, described as symmetric hyperpigmentation that presents as irregular brown to gray-brown macules on various facial areas, such as the cheeks, forehead, nasal bridge, and upper lip, along with the mandible and upper arms. Due to its complex pathogenesis and recurrent nature, melasma management is challenging and the outcomes following treatment are not always deemed satisfactory. Solely treating hyperpigmentation may prove ineffective unless paired with regenerative techniques and photoprotection, since one of the main reasons for recurrence is sun exposure. Hence, the treatment protocol starts with addressing risk factors, implementing stringent UV protection, and then treatment using different strategies, like applying topical treatments, employing chemical peels, laser and light therapies, microneedling, and systemic therapy. This review aims to provide a summary of the effectiveness and safety of the frequently employed laser and light therapies for treating melasma, focusing on laser therapy as a treatment for melasma.

Infantile hemangioma (IH) is a common benign tumor in infants. While most cases exhibit a self-limiting nature, some require medical treatment to avoid complications. Propranolol is the first-line therapy for IH, it has a high success rate, and is safe to use. Unfortunately, some patients might experience rebound growth after propranolol discontinuation. Currently, it is unclear which factors predict this phenomenon. This study aimed to identify factors affecting the rebound growth of IH after propranolol cessation. We also aimed to identify predictors for an excellent response to oral propranolol. We performed a retrospective cohort study using clinical data from all patients referred to our clinic with IH and placed on systemic oral propranolol between January 2009 to December 2023 in the dermatology outpatient clinic of Rambam Healthcare Campus. Out of a total of 552 patients with IH, 301 received oral propranolol for at least 6 months. A relapse phenomenon was observed in 38 (12.6

BackgroundViral warts are common infectious skin disease induced by human papillomavirus (HPV). Lasers have been used for warts treatment in recent years with variable success rates. ObjectiveThis study aimed to prospectively evaluate combined treatment with Er:YAG laser and long-pulsed Nd:YAG laser compared to Er:YAG laser for the treatment of recalcitrant warts after one session. Materials and MethodsThis study included 240 lesions from 24 patients. All the lesions were diagnosed clinically as recalcitrant warts after failure of topical treatment and cryotherapy. About 120 lesions underwent a combined therapy of Er:YAG and long-pulsed (LP) Nd:YAG lasers, and the remaining 120 lesions underwent Er:YAG laser therapy only. The clearance rate was evaluated 5 weeks after and classified by three-graded evaluation: complete response, partial response and poor response. ResultsThe clearance rate in the combined Er:YAG + LP Nd:YAG lasers group was, statistically significant, higher than that of the Er:YAG laser group (p = 0.008). The complete response rate was 48% (58 of 120 warts) for the Er:YAG +LP Nd:YAG lasers group and only 29% (35 of 120 warts) for the Er:YAG laser group. ConclusionThe combination of Er:YAG and long-pulsed Nd:YAG lasers is more effective than Er:YAG laser alone in treating recalcitrant warts after single session.

Background: Hidradenitis suppurativa (HS) is characterised by inflamed lesions that typically appear in apocrine-rich flexural areas. Although studies have reported clinical and epidemiological data from western countries, data from the Middle East are scarce. The aim of this study is to characterise the differences in the clinical characteristics of patients with HS of Arab and Jewish ancestry and review the clinical characteristics, the course of the disease, the comorbidities, and the response to treatment. Methods: This is a retrospective study. We collected clinical and demographic data from patient files between 2015–2018 at the Rambam Healthcare Campus dermatology clinic—a tertiary hospital located in the north of Israel. Our results were compared to those of a previously published Israeli control group registered in Clalit Health Services. Results: Of the 164 patients with HS, 96 (58.5%) were men and 68 (41.5%) were women. The average age at diagnosis was 27.5 years and the average latency between the onset and diagnosis of the disease was 4 years. We found a higher adjusted prevalence of HS in Arab patients (56%) than in their Jewish counterparts (44%). Gender, smoking, and obesity, as well as axilla and buttock lesions, were risk factors for severe HS, with no differences between ethnicities. No differences were documented in comorbidities and in response to adalimumab, with a high overall response rate of 83%. Conclusions: Our findings revealed differences between Arab and Jewish patients with HS in terms of incidence and gender predominance, while no differences were documented in comorbidities and response to adalimumab.

Infantile hemangiomas (IH) are common benign tumors of infancy. Most IH involute, either spontaneously, or secondary to pharmacological treatment with systemic propranolol. Propranolol treatment mostly leads to regression of hemangiomas with satisfactory aesthetic results, but unfortunately not in all cases. To assess the safety and efficacy of long pulsed Nd:YAG 1064 nm laser in treating patients with residual infantile hemangioma after systemic propranolol treatment. This is an open-label prospective cohort study. 30 patients with focal residual IH that had sub-optimal responses to systemic propranolol treatment were enrolled in the study. The patients were treated with 1 to 3 sessions with long pulsed Nd:YAG 1064 nm laser. The maximal response of the IH was assessed using a 4-point scale evaluation scale system. Of the 30 patients enrolled, 18 patients exhibited a great response (> 76% improvement), 10 patients had a good response (> 51–75% improvement), while only 2 patients showed a moderate response (< 50% improvement) to the treatment. No patients had an unsatisfactory response. No serious side effects were observed, and only minor side effects were reported. The treatment with long pulsed Nd:YAG 1064 nm laser for residual IH, which were resistant to systemic propranolol treatment, is safe and effective. Thus, we suggest its use as a second-line treatment for patients with sub-optimal aesthetic results following systemic propranolol.

Mycosis fungoides is a rare cutaneous lymphoma in the paediatric population. The aim of this study was to examine the epidemiological, clinical, and histologi-cal characteristics, as well as the treatment modalities and response to therapy of paediatric patients with mycosis fungoides. This retrospective cohort study re-viewed the records of 37 paediatric patients treated at Rambam Medical Center, Israel, between 2013 and 2021. Extracted data included epidemiology, clinical presentation, histological reports, infiltrate clona-lity status, treatment modalities and response to th-erapy. The mean follow-up period was 60 months. All patients were diagnosed with stage IA or IB disease. Folliculotropic mycosis fungoides was the most preva-lent variant (49%). Most patients were treated with phototherapy (90%), with a response rate of 85%, and a complete response rate of 55% after the first course. There were no significant differences in re-sponse to phototherapy between the folliculotropic or other variants (p= 0.072). Similarly, delayed diagno-sis, atopic diathesis, clonality, phototherapy type or number of treatments, were not associated with re-sponse to therapy, while protracted phototherapy was associated with prolonged remission. In conclusion, mycosis fungoides in the paediatric population is an indolent disease with a favourable prognosis and po-tentially prolonged response to phototherapy.