Background: Artificial intelligence (AI) and convolutional neural networks (CNNs) represent rising trends in modern medicine. However, comprehensive data on the performance of AI practices in clinical dermatologic images are non‐existent. Furthermore, the role of professional data selection for training remains unknown.Objectives: The aims of this study were to develop AI applications for outlier detection of dermatological pathologies, to evaluate CNN architectures' performance on dermatological images and to investigate the role of professional pre‐processing of the training data, serving as one of the first anchor points regarding data selection criteria in dermatological AI‐based binary classification tasks of non‐melanoma pathologies.Methods: Six state‐of‐the‐art CNN architectures were evaluated for their accuracy, sensitivity and specificity for five dermatological diseases and using five data subsets, including data selected by two dermatologists, one with 5 and the other with 11 years of clinical experience.Results: Overall, 150 CNNs were evaluated on up to 4051 clinical images. The best accuracy was reached for onychomycosis (accuracy = 1.000), followed by bullous pemphigoid (accuracy = 0.951) and lupus erythematosus (accuracy = 0.912). The CNNs InceptionV3, Xception and ResNet50 achieved the best accuracy in 9, 8 and 6 out of 25 data sets, respectively (36.0%, 32.0% and 24.0%). On average, the data set provided by the senior physician and the data set provided in accordance with both dermatologists performed the best (accuracy = 0.910).Conclusions: This AI approach for the detection of outliers in dermatological diagnoses represents one of the first studies to evaluate the performance of different CNNs for binary decisions in clinical non‐dermatoscopic images of a variety of dermatological diseases other than melanoma. The selection of images by an experienced dermatologist during pre‐processing had substantial benefits for the performance of the CNNs. These comparative results might guide future AI approaches to dermatology diagnostics, and the evaluated CNNs might be applicable for the future training of dermatology residents.

Summary: Background and objectives: Due to the development of new anti‐psoriatic drugs in combination with improved structures for implementation throughout Germany, the medical care of psoriasis patients has markedly improved. In this study we investigated the real‐life utilization of the health care system and identified reasons for dissatisfaction in affected individuals.Patients and methods: This non‐interventional cross‐sectional study was conducted as an anonymous online survey from 12/2018 to 01/2019 in Germany. Participants with a self‐reported physician‐confirmed diagnosis of psoriasis and symptoms answered questions about their disease, its influence on daily life and their medical care.Results: 649 participants with a mean age of 42.5 ± 13.7 years and equal gender distribution (male: 50.2 %) were evaluated. 54.1 % received medical treatment at the time of the study, 45.9 % did not. Among the participants with medical care, 59.3 % were only moderately or less satisfied with their treatment. Reasons for dissatisfaction with the medication included lack of efficacy and side effects. Participants without medical treatment specified a physician’s lack of time as a main reason for not seeking medical help.Conclusions: Despite the availability of efficient therapeutic options in Germany, many individuals with psoriasis are not satisfied. This under‐treated group was identified as a new target population.

Background: Tinea capitis and tinea corporis are highly prevalent fungal skin infections, which globally are mainly caused by Microsporum canis and Trichophyton rubrum, respectively. While in the United States and Great Britain Trichophyton tonsurans is widely prevalent as a causative pathogen, it so far only plays a minor role in Germany.Objectives: Since the frequency of pathogenic species varies regionally and temporally, this study assesses the proportion of Trichophyton tonsurans infections in the dermatology department of a large university hospital in Germany from 2019 to 2022 and thoroughly characterises the affected patient population.Patients/Methods: This retrospective study at the Technical University of Munich analyses mycological culture results regarding the identified dermatophyte and infection site. Detailed patient and disease‐related information on Trichophyton tonsurans positive patients was obtained.Results: In 2022, 23 patients of 111 dermatophyte culture‐positive patients tested positive for Trichophyton tonsurans. This accounted for 20.7% and represented a tenfold increase from 2.1% in 2019. Contact sports were only practiced by 21.7% of patients, and no common hotspot or other linkage could be identified between the cases. Additionally, 47.8% of the patients received a systemic treatment, with 30.4% visiting the clinic more than three times. In 2022, 21.7% were diagnosed with a simultaneous infection of the capillitium and body, whereas this was only observed in 7.1% of cases in 2019 to 2021.Conclusions: This study suggests an increase of Trichophyton tonsurans infections via several routes of transmission.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke.Objectives: In this study, AD characteristics and its atopic comorbidities are compared in smoking and non‐smoking AD patients.Methods: TREATgermany is a non‐interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included in TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analysed comparing AD disease characteristics and comorbidities in smokers vs. non‐smokers.Results: Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n = 352; 38.8%) and non‐smokers, however, lesions’ intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to non‐smoking patients. Smokers reported a lower number of weeks with well‐controlled AD and more severe pruritus than non‐smokers. Total IgE levels were more elevated in smokers and they displayed a younger age at the initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well‐controlled AD and the greater pruritus remained different in smokers compared to non‐smokers. In addition, smoking patients with adult‐onset AD showed a 2.5 times higher chance of involvement of the feet.Conclusions: German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult‐onset AD.

Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease worldwide and displays many atopic, but also non‐atopic comorbidities. Among the latter, mental health disorders such as depression have been extensively studied. However, data on addictions are still rare.Objectives: The aim of this study was to assess the prevalence of different kinds of addictions in adult AD patients using a single‐centre approach.Methods: This non‐interventional cross‐sectional study was performed from 03/2020 to 05/2020 at the Department of Dermatology of a large German university hospital. Participants with a diagnosis of AD confirmed by a dermatologist answered questions about disease severity (patient‐oriented eczema measure, POEM), quality of life (Dermatology Life Quality Index, DLQI) and smoking habits. They were screened for problematic alcohol consumption, drug abuse, internet addiction and pathological gambling using internationally established and validated questionnaires.Results: 157 patients (56.1% female; mean age of 49.9 ± 20.4) with an average POEM of 13.7 ± 7.5 and DLQI of 6.1 ± 5.4 were evaluated. 14.1% were identified as regular smokers, 12.1% screened positive for alcohol dependency, 6.4% for drug use disorders, 4.5% for Internet addiction and 3.2% for pathological gambling. Co‐occurrences of different addictions were observed, and a positive correlation was noted between DLQI scores and smoking.Conclusions: In summary, this study hints at elevated positive screening rates for problematic alcohol consumption, drug use disorders, Internet addiction and problem gambling compared with the general population. Screening routinely for addictions may improve patient‐centred health care of AD patients.

Incidence of sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis has increased in recent years in the US and in European countries. In order to implement effective educational programs, the interests of target populations have to be identified. Since the internet is an important source of information-gathering on health issues, this study investigates web search data in large German cities related to STIs. Google Ads Keyword Planner was used to identify STI-related terms and their search volume in eleven German cities from June 2015 to May 2019. The data obtained were analyzed descriptively with regard to total search volumes, search volumes of specific thematic areas, and search volumes per 100,000 inhabitants. Overall, 741 terms with a total search volume of 5,142,560 queries were identified, with more than 70% of all search queries including a specific disease and “chlamydia” being the overall most often searched term (n = 1,196,160). Time courses of search behavior displayed a continuous interest in STIs with synchronal and national rather than regional peaks. Volumes of search queries lacked periodic patterns. Based on the findings of this study, a more open public discussion about STIs with linkage to increased media coverage and clarification of responsibilities among all STI-treating disciplines concerning management of STIs seem advisable.