Dermatology Online Journal

ChatGPT is a publicly available chatbot released by OpenAI. Its usefulness in responding to medical questions has been assessed in several specialties, but there is limited literature in dermatology. This study seeks to understand how well ChatGPT4 can provide accurate diagnoses and appropriate workup suggestions for clinical vignettes describing common dermatologic conditions. Ten vignettes were input into ChatGPT4 representing presentations of common dermatologic conditions, written from the perspective of a physician not board-certified in dermatology. ChatGPT4 was asked to identify the top five most likely diagnoses and its recommended workup for each vignette. Responses were assessed quantitatively by calculating the percentage of correct diagnoses, with accurate diagnoses defined by three board-certified dermatologists, and qualitatively using Likert scales describing the accuracy of diagnoses and appropriateness of workups scored by eleven board-certified dermatologists. Overall, 52% of ChatGPT4's diagnoses were accurate and 62% of its recommended workup suggestions were deemed completely correct by board-certified dermatologists. ChatGPT4 was better at recommending an appropriate workup than identifying accurate diagnoses across vignettes. ChatGPT4 was able to accurately diagnose and workup common dermatologic conditions in slightly more than half of cases. ChatGPT4 was better at determining an appropriate workup than an accurate diagnosis.Keywords: artificial intelligence, ChatGPT, dermatology, diagnosis, OpenAI, workup

Dogs are susceptible to a diverse spectrum of dermatologic conditions, several of these skin disorders are analogous to dermatologic conditions occurring in humans. Pool toes appears on the plantar surface of the feet and toes; it is an aquatic pool-associated frictional dermatosis that results from repeated rubbing of the feet and toes against the rough cement at the bottom of the pool or its border. A frictional dermatosis that can develop on the uncalloused paw pads of puppies, resulting from repeated rubbing of the paws against ambient temperature, not heated, paved road is pavement paws. Neither pool toes nor pavement paws result from contact with a hot surface; these dermatoses are distinctive from beach feet, a thermal-associated superficial burn to the skin resulting from the hot temperature of the sand that contacts that the plantar feet and toes. In conclusion, similar to pool toes, the pathogenesis of pavement paws is a frictional dermatosis that can develop on the uncallused paw pads of puppies resulting from repeated rubbing of the paws against ambient temperature, not heated, pavement.

We present a 44-year-old man with metastatic clear cell renal cell cancer undergoing treatment with nivolumab immunotherapy. Three months post-initiation, he developed symmetric recurrent nodules and boils in intertriginous areas, diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft. The progressive course, lesion symmetry and location, worsening with nivolumab infusions, and biopsy findings supported the diagnosis. Hidradenitis suppurativa pathogenesis involves immune dysregulation marked by elevated IL17 and neutrophil-dominated inflammation [1]. Immune checkpoint inhibitors, including anti-PD1 agents like nivolumab, are linked to immune-related adverse events related to widespread T cell activation, potentially increasing IL17 signaling associated with HS [2,3]. Clinicians should be aware of, and observant for anti-PD1-induced HS, a rare immune-related adverse event, in patients undergoing immune checkpoint inhibitor therapy.

Fibroelastolytic papulosis (FEP) is an acquired cutaneous disorder of elastin that encompasses both white fibrous papulosis of the neck (WFPN) and pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis (PDE). Although FEP is a benign acquired disorder, it shares overlapping clinical features with pseudoxanthoma elasticum (PXE), a genetic disorder with systemic manifestations. We report two cases of FEP, including the WFPN and PXE-like PDE variants, in elderly women. In one case, a woman in her 70s with hyperlipidemia and chronic kidney disease presented with white-to-yellow, smooth, monomorphic papules coalescing into plaques on the posterior neck and bilateral antecubital fossa. A punch biopsy and elastic stain revealed a loss of elastic fibers in the papillary dermis. Based on these findings, we diagnosed our patient with PXE-like PDE. In another case, a woman in her 60s with no significant medical history similarly presented with skin-colored, smooth monomorphic papules on the posterior and anterior neck. A punch biopsy was also performed and an elastic stain showed a loss of elastic fibers in the papillary dermis, confirming the diagnosis of WFPN. Although rare, FEP is an important entity for dermatologists to recognize and differentiate from PXE given the potential for systemic complications in PXE.

Syphilis is a sexually transmitted infection with manifestations that can mimic other diseases, leading to misdiagnosis. Annular syphilis is a rare atypical secondary syphilitic lesion that seldomly involves the face. Human immunodeficiency virus (HIV) coinfection can increasingly lead to atypical manifestations of syphilis and complicate the diagnosis. Herein, we describe a 29-year-old man with a diagnosis of annular secondary syphilis and HIV coinfection. He had clinical manifestations of annular erythematous papules and plaques with white scales at the edges, distributed and scattered on the face, neck, and upper back. The skin lesions went undetected on several visits and were misdiagnosed owing to similarities with other dermatoses. Serological examination showed positive Treponema pallidum particle agglutination assay and venereal disease research laboratory test titer 1/512, confirming syphilis infection. Results from the histopathological examination supported the diagnosis of secondary syphilis. Positive anti-HIV rapid test results indicated concurrent HIV infection. He was treated for syphilis and given antiretroviral therapy, and showed a good response as demonstrated by improvement of the lesions and serological titers. This case highlights the importance of recognizing the possibility of annular secondary syphilis and HIV coinfection which can have atypical manifestations.

Macular amyloidosis is a variant of primary localized cutaneous amyloidosis in which amyloid protein is believed to be derived from keratinocytes. The care of this variant generally focuses on addressing the associated symptoms without the need to assess for underlying disease. However, an increasing number of cases of primary localized cutaneous amyloidosis have been reported in association with systemic diseases, particularly autoimmune diseases. A few cases of biphasic primary localized cutaneous amyloidosis have been reported in association with chronic hepatitis C infection. Herein, we report an unusual patient, a 38-year-old man with widespread macular amyloidosis concurrently presenting with dual hepatitis B virus and hepatitis C virus infections. Collecting similar cases can further validate this uncommon association.

Leflunomide can be used in management of psoriatic disease. Leflunomide's active metabolite, teriflunomide, is used in the treatment of multiple sclerosis and has unexpectedly been rarely reported to induce pustular psoriasis. In this report, we present a patient with multiple sclerosis who developed inverse psoriasis after starting teriflunomide.

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, although it has many clinicopathological variants. Zosteriform MF is an extremely rare variant characterized by dermatomal distribution. To date, only six patients with zosteriform MF have been reported. We report a 57-year-old man with tumor-stage zosteriform MF localized on the left T4, T7-8, and bilateral L4 dermatomes for seven years after the first visit. Local skin-target therapy radiotherapy effectively led to complete remission, which was maintained with a combination of oral etretinate (30mg/day) and narrow-band ultraviolet B phototherapy. No other reports exist of zosteriform MF occurring in multiple dermatomes. We reviewed the literature to add to our understanding of the nature of rare variants of MF and discuss therapeutic options for zosteriform MF.

Sarcoidosis is a disease characterized by immunological granuloma formation in various organs. Cutaneous manifestations occur in about 25% of patients with rare cases showing ulcerative sarcoidosis, that can be debilitating if not treated promptly. This article presents a patient with isolated ulcerative sarcoidosis and reviews existing literature. A 44-year-old woman presented with a non-healing ulcer on her right gluteal area. A skin biopsy confirmed sarcoidosis with non-necrotizing granulomas. Systemic involvement of sarcoidosis was ruled out. Treatment involved topical corticosteroids and intralesional corticosteroid injections, resulting in complete healing. This case emphasizes the importance of considering ulcerative sarcoidosis in non-healing wounds and the efficacy of corticosteroid treatment.

Bullous pemphigoid is an autoimmune blistering disease that is characterized by pruritus, cutaneous urticarial plaques, and tense bullae, with mucosal involvement. On histopathology, a subepidermal blister is predominantly evident with eosinophilic inflammatory infiltrates in the upper dermis. In a few bullous dermatoses, milia can manifest at the scar of blistering lesions or in non-lesional skin. Milia are classically associated with epidermolysis bullosa acquisita, porphyria cutanea tarda, and mucous membrane pemphigoid. We report a case of bullous pemphigoid with milia manifesting within healing blistering lesions.

Mycosis fungoides (MF) is characterized by a clonal proliferation of skin-homing mature T cells with special predilection for involving the epidermis. Folliculotropic and syringotropic MF typically present with erythematous papules, patches, and plaques, with punctate accentuation that is folliculocentric in the former. We report a 67-year-old woman, with an extensive history of allergic contact dermatitis, who was referred to the Mohs surgery clinic with a large pink plaque extending from the nasal bridge to the right upper medial cheek concerning for basal cell carcinoma. An outside punch biopsy showed benign basaloid follicular neoplasm. The patient was found to also have indurated erythematous plaques of the bilateral upper arms and erythematous scaly patches of bilateral arms and legs, abdomen, lateral trunk, buttocks, and groin. Owing to concern for possible cutaneous lymphoma, punch biopsies were performed which revealed the diagnosis of folliculotropic and syringotropic MF. Of note, folliculotropic and syringotropic MF are often, but not uniformly, characterized by a more aggressive disease course. This case highlights the importance of a high index of suspicion and awareness of all clinical and histopathologic pitfalls to avoid misdiagnosis of MF.

Atypical fibroxanthoma and pleomorphic dermal sarcoma are on a spectrum of cutaneous tumors that present as ulcerated lesions in older adults. We present an 84-year-old man with pleomorphic dermal sarcoma, initially presenting as a bleeding lesion of the cheek that progressed to an eroded nodule.

Minoxidil is a vasodilator medication known for its ability to promote hair growth. Although it was first introduced as an oral drug to treat hypertension, minoxidil was observed to have the important side-effect of increasing hair growth. This led to the development of a topical formulation as a 2% concentration solution for the treatment of female androgenic alopecia (AGA) and 5% for treating male AGA, which is considered as a first line U.S. Food and Drug Administration (FDA)-approved treatment for AGA in addition to oral 5-alpha-reductase inhibitor (finasteride). The mechanism by which minoxidil promotes hair growth is not fully understood but can be related to increasing blood flow owing to its vasodilator effects. Androgenic alopecia is characterized by the gradual conversion of terminal hairs into vellus hairs. Alterations in the hair cycle include reduced duration of the anagen phase and increased duration of the telogen phase, resulting in shorter hairs and eventual balding. Side effects of topical minoxidil include irritant and allergic contact dermatitis, pruritus, and facial hypertrichosis, which are more often seen with the use of 5% solutions rather than 2%. Herein, we report a 24-year-old woman who developed severe ear and face hypertrichosis after using a topical 5% minoxidil solution. She later had spontaneous resolution of her hypertrichosis three months after stopping it.

The University of California, Davis, School of Medicine, Department of Dermatology, is recruiting for two academic dermatologists in the Clinical X series or Health Sciences Clinical Professor (HSCP) series at the Assistant, Associate, or Full Professor level based on experience and qualifications. These positions are for general medical dermatologists. Expectations of the Clinical X series are to engage in teaching, research, service, and clinical work, while expectations of the faculty in the HSCP series are primarily clinical and include teaching, service, and scholarly and/or creative activity.

Additionally, based on the qualifications and experience a candidate may be considered for the departmental directorships.

The appointments may be made up to 100%.