Self-supervised pretraining followed by supervised fine-tuning has seen success in image recognition, especially when labeled examples are scarce, but has received limited attention in medical image analysis. This paper studies the effectiveness of self-supervised learning as a pre-training strategy for medical image classification. We conduct experiments on two distinct tasks: dermatology condition classification from digital camera images and multi-label chest X-ray classification, and demonstrate that self-supervised learning on ImageNet, followed by additional self-supervised learning on unlabeled domain-specific medical images significantly improves the accuracy of medical image classifiers. We introduce a novel Multi-Instance Contrastive Learning (MICLe) method that uses multiple images of the underlying pathology per patient case, when available, to construct more informative positive pairs for self-supervised learning. Combining our contributions, we achieve an improvement of 6.7% in top-1 accuracy and an improvement of 1.1% in mean AUC on dermatology and chest X-ray classification respectively, outperforming strong supervised baselines pretrained on ImageNet. In addition, we show that big self-supervised models are robust to distribution shift and can learn efficiently with a small number of labeled medical images.
Large language models (LLMs) are seen to have tremendous potential in advancing medical diagnosis recently, particularly in dermatological diagnosis, which is a very important task as skin and subcutaneous diseases rank high among the leading contributors to the global burden of nonfatal diseases. Here we present SkinGPT-4, which is an interactive dermatology diagnostic system based on multimodal large language models. We have aligned a pre-trained vision transformer with an LLM named Llama-2-13b-chat by collecting an extensive collection of skin disease images (comprising 52,929 publicly available and proprietary images) along with clinical concepts and doctors’ notes, and designing a two-step training strategy. We have quantitatively evaluated SkinGPT-4 on 150 real-life cases with board-certified dermatologists. With SkinGPT-4, users could upload their own skin photos for diagnosis, and the system could autonomously evaluate the images, identify the characteristics and categories of the skin conditions, perform in-depth analysis, and provide interactive treatment recommendations. Here, authors develop SkinGPT-4, an interactive dermatology diagnostic system that uses multimodal large language models and aligns a vision transformer with Llama-2-13b-chat. Evaluated by dermatologists, it offers autonomous diagnosis and treatment recommendations.
Background: Skin aging is a complex biological process influenced by intrinsic and extrinsic factors, leading to various aging manifestations. Defining facial aging is especially important for the selection of anti-aging products. Objectives: This study aimed to evaluate the relationship between the severity of aging features along with chronological age and perceived age, and to develop a method of determining perceived age by non-expert assessors. Materials and methods: A total of 308 Chinese females aged 15–65 years underwent expert aging features scoring, facial image acquisition, and age perception on acquired photographs. The facial characteristics and facial areas that influenced the age perception were collected by questionnaire. Subjects were grouped based on the deviation between their perceived and chronological age, and the facial aging features were compared among these groups. Results: The perceived age of Chinese women was on average 1.6 years older than their chronological age. The severities of aging features demonstrated strong correlations with perceived age, paralleling their correlations with chronological age. Nasolabial fold, marionette fold, tightness of facial contour, poor skin evenness, and poor skin radiance were common key factors for age perception. Additionally, various aging features demonstrated predominant uniqueness among different age ranges. Conclusions: Perceived age tends to exceed chronological age. The age perception is correlated to the manifestation of aging features. The method developed in this study to determine perceived age is applicable for evaluating the benefits of anti-aging products and delivering valuable guidance for skin care product development on targeting specific aging features and customizing strategies for consumer groups with older perceived age.
Mateusz Matwiejuk, Hanna Myśliwiec, Agnieszka Miklosz
et al.
Growth hormone (GH) is an ancestral hormone secreted from the anterior pituitary gland. In adulthood, it is essential to regulate metabolism. GH synthesis and secretion are regulated in a complex manner, primarily through the actions of hypothalamic neuropeptides (GHRH and somatostatin) that integrate hormonal, metabolic, and neurogenic signals. Currently, recombinant human GH is widely used to treat growth hormone deficiency (GHD) and numerous non-GHD disorders, such as short stature and catabolic conditions. Conversely, an excess of GH may lead to different and severe conditions, such as acromegaly, gigantism, Carney complex, McCune–Albright syndrome, neurofibromatosis, and multiple endocrine neoplasia type 1. In patients with growth hormone excess disorders or those treated with GH, skin manifestations are common and can include skin thickening, coarsened facial features, skin tags, oily skin, and excessive sweating. These dermatological changes result from the direct actions of GH and IGF-1 (insulin-like growth factor 1) on skin cells and appendages, leading to increased collagen synthesis and connective tissue expansion. This review focuses on the various skin symptoms associated with these disorders caused by GH excess. This narrative review summarizes recent findings on the management of skin lesions in GH-treated patients and in those with GH excess, highlighting the benefits, side effects, and limitations of current therapies.
Rubén Linares-Navarro, Iván Sanz-Muñoz, Iván Sanz-Muñoz
et al.
BackgroundThe recent Monkeypox (Mpox) outbreak has disproportionately affected men who have sex with men (MSM), amplifying stigma and discrimination. While prior research examined media portrayals and public perceptions, little is known about MSM’s direct experiences. To address this gap, we assess discrimination, stigma, and psychosocial impact across social and healthcare settings.MethodsA cross-sectional observational study was conducted using a structured, pilot-tested survey to assess discrimination against MSM in media, family, socio-occupational, and healthcare environments.ResultsAmong 115 MSM surveyed, 81.7% observed discriminatory comments in media, while discrimination was noted in workplaces (41.7%), by family/friends (45.2%), cohabitants (15.7%), and healthcare (34.8%). Stigma significantly impacted healthcare-seeking behavior, with 33% avoiding medical care due to fear of discrimination. Psychologically, 50.4% reported low mood/anxiety, and 72.7% of those frequently fearing Mpox also experienced these symptoms. The outbreak led 71.3% to alter sexual behavior, primarily reducing encounters (60%). Fear of Mpox was strongly associated with behavioral changes (p < 0.001).ConclusionThe Mpox outbreak has exacerbated stigma toward MSM, highlighting an urgent need for intervention. Authorities, media, and community leaders must disseminate accurate information and implement psychological support programs to mitigate stigma and its detrimental effects on MSM.
Abstract Fungal biofilms, as self-produced extracellular polymeric substances that resist antifungal agents and immune defense, represent a major cause of treatment failure and recurrent infections. Therefore, it is of great importance to eradicate fungal biofilms to achieve efficient therapy. This study develops a synergistic reactive oxygen species (ROS)-enhanced strategy to eradicate Candida albicans biofilms by designing ultrasound-light dual-responsive nanohybrids (UCNP@CR). The system integrates thulium-doped upconversion nanoparticles (UCNPs) with carbon nitride-coated surfaces (g-C3N4) and polypyridine ruthenium complex (Ru) photosensitizers. In treatment, the dense fungal biofilm can be effectively loosened under ultrasound stimulation while ultrasound simultaneously triggers ROS production of UCNP@CR, collectively promoting irreversible destruction of biofilm and inward penetration of photosensitizer. Moreover, UCNP@CR exhibits strong fungal adhesion, while its g-C3N4-mediated enhanced metal-to-ligand charge transfer (MLCT) process of Ru under near-infrared light irradiation amplifies ROS generation, which leads to efficient eradication of fungal biofilms. As in vivo experimental evidence, UCNP@CR exhibits excellent antifungal efficacy in treating fungal biofilm-infected wounds in immunosuppressed male mice under ultrasound-light stimulation. These findings establish the ultrasound-assisted, ROS-enhanced synergistic strategy as a promising approach against fungal biofilm infections and provide diverse perspective for managing other biofilm-related infectious diseases.
Background: Psoriasis is a chronic, inflammatory skin disease with autoimmune characteristics. Recent research has made significant progress in the field of psoriasis metabolomics. However, there is a lack of bibliometric analysis on metabolomics of psoriasis. The objective of this study is to utilize bibliometrics to present a comprehensive understanding of the knowledge structure and research hotspots in psoriasis within the field of metabolomics. Methods: We conducted a bibliometric analysis by searching the Web of Science Core Collection database for publications on metabolomics in psoriasis from 2011 to 2024. To perform this analysis, we utilized tools such as VOSviewers, CiteSpace, and the R package ''bibliometrix''. Results: A total of 307 articles from 47 countries, with the United States and China leading the way, were included in the analysis. The publications focusing on metabolomics in psoriasis have shown a steady year-on-year growth. The Medical University of Bialystok is the main research institution. The International Journal of Molecular Sciences emerges as the prominent journal in the field, while the Journal of Investigative Dermatology stands out as the highly co-cited publication. A total of 2029 authors contributed to these publications, with Skrzydlewska Elzbieta, Baran Anna, Flisiak Iwona, Murakami Makoto being the most prolific contributors. Notably, Armstrong April W. received the highest co-citation. Investigating the mechanisms of metabolomics in the onset and progression of psoriasis, as well as exploring therapeutic strategies, represents the primary focus of this research area. Emerging research hotspots encompass inflammation, lipid metabolism, biomarker, metabolic syndrome, obesity, and arthritis. Conclusion: The results of this study indicate that metabolism-related research is thriving in psoriasis, with a focus on the investigation of metabolic targets and interventions within the metabolic processes. Metabolism is expected to be a hot topic in future psoriasis research.
James Abbott, Jessica Corean, Ashley M. Snyder
et al.
Abstract Background Cutaneous hypersensitivity eruptions in chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) are a clinically and histologically heterogeneous group that can either precede, occur with, or follow the development of a hematologic malignancy. Therefore, establishing the diagnosis requires careful clinical and pathologic correlation and an understanding of the broad spectrum of presentations. Data is lacking on the correlation of skin disease with molecular/cytogenetic risk profiling of the tumor. Objectives The aims of this study were to characterize the clinical, histological, and genetic aberrations in recurrent cutaneous hypersensitivity reactions in patients with CLL/SLL. Methods A single site academic retrospective chart review of medical records, histopathology, molecular and cytogenetic data in CLL/SLL patients who developed biopsy‐proven cutaneous hypersensitivity reactions. Results Five hundred one new diagnoses of CLL/SLL with 73 patients requiring cutaneous biopsies for skin lesions or rashes were identified. With exclusion criteria, 20 biopsies were identified from 17 patients (mean age, 69.6 years, females = 9) with unexplained cutaneous eruptions. These were commonly pruritic, erythematous papules above the waist. Most biopsies had a prominent superficial, deep dermal eosinophilic infiltrate (85%), with a robust T‐cell predominant dermal infiltrate in 40%. Five out of 17 patients (29%) had a predominately folliculocentric CD4+ T‐cell infiltrate; all occurring on the head and neck. Overall, the prevalence of cutaneous hypersensitivity eruptions requiring biopsy was 3.4% (n = 17), and the prevalence of folliculocentric CD4+ T‐cell infiltrate was 1% (n = 5). Conclusion Cutaneous hypersensitivity reactions in CLL/SLL are heterogeneous; however, folliculotropic CD4+ T‐cell infiltrates may be seen in a small but distinct clinical subset of patients. Commonly tested cytogenetic aberrations in CLL/SLL do not appear to be correlated with the presence of cutaneous hypersensitivity reactions.
Lorenz Julius Kuhls,1 Jeta Demiri,1 Adam Weidlich,1 Susanne Weidlich,1 Janin Trinkaus,1 Kerstin Steinbrink,2 Matthias Augustin,3 Athanasios Tsianakas1 1Department of Dermatology and Allergology, Fachklinik Bad Bentheim, Bad Bentheim, Germany; 2Department of Dermatology, University Hospital Münster, Münster, Germany; 3Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyCorrespondence: Athanasios Tsianakas; Lorenz Julius Kuhls, Department of Dermatology and Allergology, Fachklinik Bad Bentheim, Bad Bentheim, 48455, Germany, Tel/Fax +49 5922 74-52 10, Email A.tsianakas@fk-bentheim.de; L.Kuhls@fk-bentheim.dePurpose: During the COVID-19 pandemic, infections could also be detected among the staff and patients of the dermatological hospital Bad Bentheim (Germany). This retrospective analysis aims to better understand the impact of the pandemic on health care workers. The results could help improve future pandemic plans and measures to protect health care workers.Patients and Methods: In 2020, the whole staff (460 participants) of the dermatological hospital Bad Bentheim had been offered the option to be tested with respect to the antibody status on SARS-CoV-2 (IgG, IgM). The data were collected by means of a blood sample and subsequent questionnaires (22 questions for employees with positive SARS-CoV-2 serology) regarding disease severity, symptoms, disease duration, chains of infection, psychological and physical burden. Both groups were divided by positive or negative serology and data analysis was performed using an independent t-test.Results: It was shown that a COVID-19 Infection clinically presented itself as a respiratory tract infection, differed significantly in severity and duration, but also the long-term consequences in employees with proven COVID-19 disease (n=14, 3.7%) from the employees with non-COVID-19 respiratory diseases (33.6% of the seronegative employees). In addition, there was a significant psychological impairment and burden of COVID-19-affected employees. Our study showed unique insights into infection chains, disease courses, disease severity, symptoms and a significant psychological impairment and burden of COVID-19-affected employees among the COVID-19 positive staff.Conclusion: Our study shows deep insights into infection chains, disease courses, disease severity and symptoms among the COVID-19 positive staff and led to change of behavior with the disease itself and among the health care professionals. This knowledge has the potential to positively influence the handling of similar future events.Plain Language Summary: Due to the nature of the Corona pandemic with massive effects, especially in the environment of health care facilities, we provide a detailed insight into the stresses on employees in a dermatological acute and rehabilitation clinic. To recognize their stress and to monitor the maintenance and quality of patient care, it is important to focus especially on the effects of an infection with SARS-CoV-2 of these employees and to analyze them. This revealed insights into the disease trajectories of staff infected with COVID-19 with significant differences compared to healthy individuals. Starting with physical symptoms and ending with psychological stress.Keywords: COVID-19, SARS-CoV-2, immunoassay, infection chain, hospital staff
Elena Campione, Sara Mazzilli, Monia Di Prete
et al.
Psoriasis vulgaris is a chronic inflammatory skin disease characterized by well-demarcated scaly plaques. Oxidative stress plays a crucial role in the psoriasis pathogenesis and is associated with the disease severity. Dimethyl fumarate modulates the activity of the pro-inflammatory transcription factors. This is responsible for the downregulation of inflammatory cytokines and an overall shift from a pro-inflammatory to an anti-inflammatory/regulatory response. Both steps are necessary for the amelioration of psoriatic inflammation, although additional mechanisms have been proposed. Several studies reported a long-term effectiveness and safety of dimethyl fumarate monotherapy in patients with moderate-to-severe psoriasis. Furthermore, psoriasis is a chronic disease often associated to metabolic comorbidities, as obesity, diabetes, and cardiovascular diseases, in which glutathione-S transferase deregulation is present. Glutathione-S transferase is involved in the antioxidant system. An increase of its activity in psoriatic epidermis in comparison with the uninvolved and normal epidermal biopsies has been reported. Dimethyl fumarate depletes glutathione-S transferase by formation of covalently linked conjugates. This review investigates the anti-inflammatory role of dimethyl fumarate in oxidative stress and its effect by reducing oxidative stress. The glutathione-S transferase regulation is helpful in treating psoriasis, with an anti-inflammatory effect on the keratinocytes hyperproliferation, and in modulation of metabolic comorbidities.
Background: Patients with chronic spontaneous urticaria often exhibit psychiatric comorbidities including depression that contribute to the impairment of their quality of life. How CSU and depression are linked isn't well-understood. Substance P has been shown to be increased in patients with CSU and is held to contribute to the pathogenesis of depression.Methods: We measured disease activity in 30 CSU patients without depression and 30 CSU patients with depression by using the urticaria activity score. The severity of depression was assessed with the Beck Depression Inventory. We measured SP levels in these patients as well as in 30 healthy control subjects. In patients with comorbid depression, we correlated SP levels with CSU disease activity and the severity of depression.Results: In CSU patients, disease activity and the severity of depression were positively linked. UAS7 values were higher in CSU patients with comorbid depression as compared to those without (p < 0.05). SP levels were higher in CSU patients with depression than in those without (p < 0.001), but was similar in all CSU patients compared to healthy controls. SP levels weren't correlated with UAS7 values in CSU patients with depression, whereas they were weakly but significantly correlated with BDI scores (p < 0.05).Conclusion: Our results suggest that, in CSU patients with comorbid depression, CSU disease activity affects the severity of depression. CSU patients with high disease activity should be explored for comorbid depression.
Saqib Ali, Saqlain Bin Syed Gilani, Juzer Shabbir
et al.
Optical coherence tomography (OCT) is a non-invasive investigative technique that is used to obtain high-resolution three-dimensional (3D) images of biological structures. This method is useful in diagnosing diseases of specific organs like the eye, where a direct biopsy cannot be conducted. Since its inception, significant advancements have been made in its technology. Apart from its initial application in ophthalmology for retinal imaging, substantial technological innovations in OCT brought by the research community have enabled its utilization beyond its original scope and allowed its application in many new clinical areas. This review presents a summary of the clinical applications of OCT in the field of medicine (ophthalmology, cardiology, otology, and dermatology) and dentistry (tissue imaging, detection of caries, analysis of dental polymer composite restorations, imaging of root canals, and diagnosis of oral cancer). In addition, potential advantages and disadvantages of OCT are also discussed.
Caroline Beutner,1 Susann Forkel,1 Sidhi Gupta,1 Thomas Fuchs,1 Michael P Schön,1,2 Johannes Geier,2,3 Timo Buhl1,2 1Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany; 2Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany; 3Information Network of Departments of Dermatology (IVDK), University of Göttingen, Göttingen, GermanyCorrespondence: Caroline BeutnerDepartment of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Georg August University, Robert Koch-Str. 40, Göttingen D-37075, GermanyTel +495513966402Email caroline.beutner@med.uni-goettingen.deIntroduction: The prevalence of airway allergies in Europe has increased from 23% to 31% in recent years. Polysensitization is associated with the development and severity of relevant allergies, particularly allergic asthma.Objective: We investigated age- and sex-dependent monosensitization and polysensitization profiles as well as patterns of sensitization using skin prick test (SPT) reactivity to the most common aeroallergens.Patients and Methods: From 1998 to 2017, SPTs were retrospectively analyzed in 2886 symptomatic patients, referred to the University Medical Center Göttingen, located in central Germany. The major aeroallergen groups early flowering tree pollen, grass pollen, and house dust mites were evaluated in this study. Wheal diameters ≥ 2 mm were considered positive during the entire study period.Results: Polysensitization to the most common aeroallergen groups increased significantly over 20 years. Boys and young men displayed the most remarkable rise in total sensitization rates in our study group over time.Discussion: Our patient-based study demonstrates a continuing increase in polysensitization rates over the last 20 years, with boys and young men being most frequently affected. Our data—without being a population-based study—suggest a scenario with climbing rates of allergic rhinitis and asthma.Keywords: aeroallergens, polysensitization, sensitization pattern, skin prick test
Bullous skin diseases are a group of dermatoses characterized by blisters and bullae in the skin and mucous membranes. The etiology and pathogenesis of bullous skin diseases are not completely clear. The most common are pemphigus and bullous pemphigoid (BP). Autoantibodies play critical roles in their pathogenesis. Abnormalities in the adhesion between keratinocytes in patients with pemphigus leads to acantholysis and formation of intra-epidermal blisters. Anti-desmoglein autoantibodies are present both in the circulation and skin lesions of patients with pemphigus. The deficient adhesion of keratinocytes to the basement membrane in BP patients gives rise to subepidermal blisters. Autoantibodies against the components of hemidesmosome can be detected in BP patients. Many novel therapeutics based on knowledge of the pathogenesis have emerged in recent years. Keywords: Tolerance, Autoimmune skin diseases, Bullous pemphigoid, Autoantibody, Immunosuppression