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Huang K, Wu X, Li Y, Lv C, Yan Y, Wu Z, Zhang M, Huang W, Jiang Z, Hu K, Li M, Su J, Zhu W, Li F, Chen M, Chen J, Li Y, Zeng M, Zhu J, Cao D, Huang X, Huang L, Hu X, Chen Z, Kang J, Yuan L, Huang C, Guo R, Navarini A, Kuang Y, Chen X, Zhao S. Artificial Intelligence-Based Psoriasis Severity Assessment: Real-world Study and Application. J Med Internet Res 2023; 25:e44932. [PMID: 36927843 PMCID: PMC10131673 DOI: 10.2196/44932] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/04/2023] [Accepted: 02/04/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Psoriasis is one of the most frequent inflammatory skin conditions and could be treated via tele-dermatology, provided that the current lack of reliable tools for objective severity assessments is overcome. Psoriasis Area and Severity Index (PASI) has a prominent level of subjectivity and is rarely used in real practice, although it is the most widely accepted metric for measuring psoriasis severity currently. OBJECTIVE This study aimed to develop an image-artificial intelligence (AI)-based validated system for severity assessment with the explicit intention of facilitating long-term management of patients with psoriasis. METHODS A deep learning system was trained to estimate the PASI score by using 14,096 images from 2367 patients with psoriasis. We used 1962 patients from January 2015 to April 2021 to train the model and the other 405 patients from May 2021 to July 2021 to validate it. A multiview feature enhancement block was designed to combine vision features from different perspectives to better simulate the visual diagnostic method in clinical practice. A classification header along with a regression header was simultaneously applied to generate PASI scores, and an extra cross-teacher header after these 2 headers was designed to revise their output. The mean average error (MAE) was used as the metric to evaluate the accuracy of the predicted PASI score. By making the model minimize the MAE value, the model becomes closer to the target value. Then, the proposed model was compared with 43 experienced dermatologists. Finally, the proposed model was deployed into an app named SkinTeller on the WeChat platform. RESULTS The proposed image-AI-based PASI-estimating model outperformed the average performance of 43 experienced dermatologists with a 33.2% performance gain in the overall PASI score. The model achieved the smallest MAE of 2.05 at 3 input images by the ablation experiment. In other words, for the task of psoriasis severity assessment, the severity score predicted by our model was close to the PASI score diagnosed by experienced dermatologists. The SkinTeller app has been used 3369 times for PASI scoring in 1497 patients from 18 hospitals, and its excellent performance was confirmed by a feedback survey of 43 dermatologist users. CONCLUSIONS An image-AI-based psoriasis severity assessment model has been proposed to automatically calculate PASI scores in an efficient, objective, and accurate manner. The SkinTeller app may be a promising alternative for dermatologists' accurate assessment in the real world and chronic disease self-management in patients with psoriasis.
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Affiliation(s)
- Kai Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | | | - Yixin Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Chengzhi Lv
- Department of Dermatology, Dalian Dermatosis Hospital, Liaoning, China
| | | | | | - Mi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Weihong Huang
- Mobile Health Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Zixi Jiang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Kun Hu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Mingjia Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Fangfang Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Jing Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yongjian Li
- Department of Dermatology, Second Affiliated Hospital of Nanhua University, Hengyang, Hunan, China
| | - Mei Zeng
- Department of Dermatology, Shaoyang Central Hospital, Shaoyang, Hunan, China
| | - Jianjian Zhu
- Department of Dermatovenerology, The First People's Hospital Of Changde City, Changde, Hunan, China
| | - Duling Cao
- Department of Dermatology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Xing Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | | | - Xing Hu
- Department of Dermatology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Zeyu Chen
- State Key Laboratory of High Performance Complex Manufacturing, College of Mechanical and Electrical Engineering, Central South University, Changsha, Hunan, China
| | - Jian Kang
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lei Yuan
- China Mobile (Chengdu) Industrial Research Institute, Chengdu, Sichuan, China
| | - Chengji Huang
- China Mobile (Chengdu) Industrial Research Institute, Chengdu, Sichuan, China
| | - Rui Guo
- China Mobile (Chengdu) Industrial Research Institute, Chengdu, Sichuan, China
| | - Alexander Navarini
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Yehong Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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