{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:24:01Z","timestamp":1790223841905,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Psoriasis is common, but diagnosis and early severity assessment can be delayed because of variable presentation and overlap with mimicking dermatoses. Multimodal large language models (LLMs) may assist image-based triage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate web-based multimodal LLMs for psoriasis identification, Physician Global Assessment (PGA) scoring, and treatment recommendation quality from clinical photographs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 303 standardized photographs from 160 patients (Semmelweis University, May 2022\u2013January 2025), including 163 psoriasis lesions and 140 mimickers. Reference diagnosis and PGA were assigned by two dermatologists with third-expert adjudication, treatment outputs were rated for appropriateness. ChatGPT-5, ChatGPT-4o, Gemini 2.5 Flash, and Claude Sonnet 4.5 received identical prompts for diagnosis and, when psoriasis was predicted, PGA and treatment; sessions were periodically reset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Diagnostic accuracy was highest for ChatGPT-5 (93.1%) and ChatGPT-4o (90.1%), followed by Claude (83.6%) and Gemini (61.5%). Among correctly identified psoriasis cases, PGA accuracy was 93.3% (ChatGPT-5), 92.9% (ChatGPT-4o), 82.7% (Gemini), and 78.1% (Claude). Appropriate treatment recommendations were most frequent for ChatGPT-5 (83.7%) and ChatGPT-4o (82.1%), then Claude (75.0%) and Gemini (53.2%); test\u2013retest agreement favored the OpenAI models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Under standardized conditions, general-purpose multimodal LLMs, especially ChatGPT-5 and ChatGPT-4o, showed strong performance for psoriasis recognition and reasonable support for PGA scoring and treatment suggestions, supporting potential use by primary care physicians when dermatology specialist access is limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1791488","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:46:00Z","timestamp":1778647560000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of multimodal large language models for psoriasis diagnosis, severity grading, and treatment recommendations from clinical photographs: ChatGPT shows superior performance compared to other large language models"],"prefix":"10.3389","volume":"13","author":[{"given":"Mehdi","family":"Boostani","sequence":"first","affiliation":[{"name":"Department of Dermatology, Roswell Park Comprehensive Cancer Center","place":["Buffalo, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Gisondi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Dermatology, University of Verona","place":["Verona, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bellinato","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Dermatology, University of Verona","place":["Verona, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Kiss","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Dermatooncology, Semmelweis University","place":["Budapest, Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos C.","family":"Zouboulis","sequence":"additional","affiliation":[{"name":"Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg","place":["Neuruppin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew","family":"Kuraitis","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Roswell Park Comprehensive Cancer Center","place":["Buffalo, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Dermatology, University of Minnesota","place":["Minneapolis, MN, United States"]},{"name":"Departments of Medicine and Dermatology, Minneapolis VA Health Care System","place":["Minneapolis, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00f3ra","family":"N\u00e1dudvari","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Dermatooncology, Semmelweis University","place":["Budapest, Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Banu","family":"Farabi","sequence":"additional","affiliation":[{"name":"Dermatology Department, Icahn School of Medicine, Mount Sinai Hospital","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balazs","family":"Hodosi","sequence":"additional","affiliation":[{"name":"Kings College Hospital London, Gulf Medical University","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Holl\u00f3","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Dermatooncology, Semmelweis University","place":["Budapest, Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert M.","family":"Wikonkal","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Dermatooncology, Semmelweis University","place":["Budapest, Hungary"]},{"name":"Central Hospital of Northern Pest\u2013Military Hospital","place":["Budapest, Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kende","family":"L\u0151rincz","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Dermatooncology, Semmelweis University","place":["Budapest, Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e1s","family":"Banv\u00f6lgyi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Dermatooncology, Semmelweis University","place":["Budapest, Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyorgy","family":"Paragh","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Roswell Park Comprehensive Cancer Center","place":["Buffalo, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Kiss","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Dermatooncology, Semmelweis 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consequences","volume":"153","author":"Quiroz-Vergara","year":"2017","journal-title":"Gac Med Mex"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1046\/j.1365-2230.2001.00834.x","article-title":"Psychological influences in psoriasis","volume":"26","author":"Griffiths","year":"2001","journal-title":"Clin Exp Dermatol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1111\/bjd.16116","article-title":"Psychological stress and psoriasis: a systematic review and meta-analysis","volume":"178","author":"Snast","year":"2018","journal-title":"Br J Dermatol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s13555-013-0031-0","article-title":"Psoriasis and psycho-dermatology","volume":"3","author":"Moon","year":"2013","journal-title":"Dermatol Ther"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"4194","DOI":"10.3390\/jcm12134194","article-title":"Assessment of frontal hemispherical lateralization in 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An exploratory diagnostic accuracy study","volume":"90","author":"Shifai","year":"2024","journal-title":"J Am Acad Dermatol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e1052","DOI":"10.1111\/jdv.20861","article-title":"Large language models in evaluating hidradenitis suppurativa from clinical images","volume":"39","author":"Boostani","year":"2025","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.18000","article-title":"Diagnosing actinic keratosis and squamous cell carcinoma with large language models from clinical images","author":"Boostani","year":"2025","journal-title":"Int J Dermatol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1111\/ijd.17729","article-title":"Diagnostic performance of GPT-4o and Gemini flash 2.0 in acne and rosacea","volume":"64","author":"Boostani","year":"2025","journal-title":"Int J Dermatol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1111\/jdv.15965","article-title":"Smart identification of psoriasis by images using convolutional neural networks: a case study in China","volume":"34","author":"Zhao","year":"2020","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"104924","DOI":"10.1016\/j.compbiomed.2021.104924","article-title":"A convolutional neural network trained with dermoscopic images of psoriasis performed on par with 230 dermatologists","volume":"139","author":"Yang","year":"2021","journal-title":"Comput Biol Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"965423","DOI":"10.3389\/fmed.2022.965423","article-title":"A deep learning-based approach toward differentiating scalp psoriasis and seborrheic dermatitis from dermoscopic images","volume":"9","author":"Yu","year":"2022","journal-title":"Front Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e44932","DOI":"10.2196\/44932","article-title":"Artificial intelligence\u2013based psoriasis severity assessment: real-world study and application","volume":"25","author":"Huang","year":"2023","journal-title":"J Med Internet Res"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2512","DOI":"10.1111\/jdv.18354","article-title":"Artificial intelligence for the automated single-shot assessment of psoriasis severity","volume":"36","author":"Okamoto","year":"2022","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.jdin.2025.08.008","article-title":"Diagnostic performance of multimodal large language models in distinguishing melanoma from nevi in clinical and dermoscopic images","volume":"23","author":"Boostani","year":"2025","journal-title":"JAAD Int"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1791488\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:46:06Z","timestamp":1778647566000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1791488\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":22,"alternative-id":["10.3389\/fmed.2026.1791488"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1791488","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"1791488"}}