Was not provided for this article.

Multimodal large language models are increasingly used for dermatologic queries, but whether Fitzpatrick skin type (FST) labels affect diagnostic accuracy is unknown. We evaluated 656 biopsy-confirmed photographs from the Diverse Dermatology Images (DDI) dataset under no-FST, DDI-concordant FST, and two DDI-discordant FST conditions using ChatGPT 5.2 Edu and Gemini 3.1 Pro browser configurations (5248 evaluations). Confirmed malignant diagnosis omission from the top three differential diagnoses (“lethal miss”) was a prespecified exploratory outcome. Gemini had higher ordinal accuracy than ChatGPT (odds ratio 2.32; 95% confidence interval 2.01–2.67; false discovery rate-adjusted p < 0.001). No FST prompt condition significantly improved accuracy over no-FST prompting; an equal-image-weighted sensitivity analysis yielded similar results. Among malignant images eligible for extreme discordance, extreme DDI-discordant prompting was associated with more ChatGPT lethal misses than no-FST prompting (paired odds ratio 5.0; p = 0.043); Gemini showed no significant paired shift (p = 1.00). Post hoc binary malignancy detection showed low no-FST specificity for ChatGPT (42.5%) and Gemini (22.9%), indicating frequent overcalling. Gemini showed lower no-FST accuracy for malignant FST V–VI images than for FST I–II and III–IV images. FST prompting provided no measurable diagnostic benefit. Neither configuration supports autonomous dermatologic use.

Was not provided for this article.

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary cicatricial alopecias with no FDA-approved treatments and a limited evidence base for any intervention. Alopecia areata (AA), while better studied, similarly lacks a well-tolerated, locally acting non-pharmacologic option. The 308 nm excimer laser is established in inflammatory dermatoses, yet its role in hair loss conditions has not been systematically characterized. This review provides an updated appraisal of the AA evidence base and the first systematic appraisal of excimer therapy in LPP and FFA. Methods: We searched PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane CENTRAL and synthesized findings narratively, given substantial heterogeneity across included studies. Results: In total, 33 studies reporting 634 unique patients met the inclusion criteria across AA subtypes (patchy/localized, totalis, universalis, ophiasic, and pediatric), LPP, and FFA. Most evidence (30/33 studies, 613/634 patients) pertains to AA, where excimer therapy produced meaningful hair regrowth in a large proportion of patients. Cicatricial data was more limited (3/33 studies, 21/634 patients). LPP data suggest improvement in inflammatory symptoms; FFA results were mixed. Adverse effects were mild and transient, primarily erythema and hyperpigmentation. Conclusions: The use of 308 nm excimer therapy may be a well-tolerated non-pharmacologic option when pharmacologic therapy is contraindicated, poorly tolerated, or inadequately effective, though limited evidence, especially for LPP and FFA, warrants further investigation across these and other conditions not yet studied.