Enhanced Diagnosis of Generalized Pustular Psoriasis With the Legit.Health Device as a Diagnosis Support Tool: Multireader Multicase Study.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare, chronic, systemic inflammatory disease with an unpredictable and heterogeneous clinical course characterized by chronic symptoms and periods of flaring. GPP presents diagnostic challenges due to its rarity and high similarity to other dermatologic diseases. OBJECTIVE: This study aimed to assess the performance of Legit.Health, a medical device powered by artificial intelligence software, in assisting health care practitioners (HCPs) in identifying GPP. METHODS: The medical device used in this study includes a deep neural network for skin disease recognition trained on thousands of images of over 200 skin conditions (classified based on the International Classification of Diseases, 11th Revision). The sensitivity and specificity of the algorithm for the differential diagnosis of GPP were assessed. Due to the scarcity of GPP-related images, the medical device was fine-tuned using a dataset that included 4397 new GPP images. Thereafter, 15 HCPs (n=11, 73.3% primary care practitioners and n=4, 26.7% dermatologists) prospectively reviewed a total of 100 images of 15 visually similar skin conditions virtually in a clinical setting. After their diagnostic prediction, Legit.Health provided a prompt giving them the top 5 possible skin conditions to assist them with their choice. RESULTS: Legit.Health demonstrated high accuracy in identifying GPP, with top-1, top-3, and top-5 sensitivity and specificity of 0.80, 0.86, and 0.90 and 0.99, 0.99, and 0.96, respectively. Results showed a notable increase in the diagnostic accuracy of the HCPs with assistance from Legit.Health (P<.001), with an increase in GPP diagnostic accuracy of 22.97% overall, 24.24% for primary care practitioners, and 19.45% for dermatologists. CONCLUSIONS: This improvement highlights the potential of Legit.Health in assisting HCPs in diagnosing rare diseases such as GPP, particularly in primary care settings where expertise may be limited, thereby improving patient outcomes.