Abstract
OBJECTIVES: Pustular psoriasis (PP) is one of the most severe and chronic skin conditions. Its treatment is difficult, and measurements of its severity are highly dependent on clinicians' experience. Pustules and brown spots are the main efflorescences of the disease and directly correlate with its activity. We propose an automated deep learning model (DLM) to quantify lesions in terms of count and surface percentage from patient photographs. METHODS: In this retrospective study, two dermatologists and a student labeled 151 photographs of PP patients for pustules and brown spots. The DLM was trained and validated with 121 photographs, keeping 30 photographs as a test set to assess the DLM performance on unseen data. We also evaluated our DLM on 213 unstandardized, out-of-distribution photographs of various pustular disorders (referred to as the pustular set), which were ranked from 0 (no disease) to 4 (very severe) by one dermatologist for disease severity. The agreement between the DLM predictions and experts' labels was evaluated with the intraclass correlation coefficient (ICC) for the test set and Spearman correlation (SC) coefficient for the pustular set. RESULTS: On the test set, the DLM achieved an ICC of 0.97 (95% confidence interval [CI], 0.97-0.98) for count and 0.93 (95% CI, 0.92-0.94) for surface percentage. On the pustular set, the DLM reached a SC coefficient of 0.66 (95% CI, 0.60-0.74) for count and 0.80 (95% CI, 0.75-0.83) for surface percentage. CONCLUSIONS: The proposed method quantifies efflorescences from PP photographs reliably and automatically, enabling a precise and objective evaluation of disease activity.