{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T14:00:43Z","timestamp":1767621643470,"version":"3.48.0"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Trichoscopy is an important diagnostic tool for hair and scalp disorders, but it requires significant expertise. Publicly available large language models (LLMs) are becoming more popular among both physicians and patients, yet their usefulness in trichology is unknown. We aimed to evaluate the diagnostic accuracy of four publicly available LLMs when interpreting trichoscopic images, as well as to compare their performance with that of dermatology residents, board-certified dermatologists, and trichology experts. Method: In this prospective comparative study, a preprocessed set of trichoscopic images was assessed in an online image-based survey. To reduced recognition bias from public image repositories, all images were structurally transformed while preserving diagnostic features. Fifteen dermatologists (five residents, four board-certified dermatologists, six trichology experts) provided a suspected diagnosis (SD), and up to three the differential diagnoses (DD). Four LLMs (ChatGPT-4o, Claude Sonnet 4, Gemini 2.5 Flash, and Grok-3) evaluated the images under the same conditions. Results: The overall diagnostic accuracy among 15 dermatologists was 58.1% (95% CI, 53.0\u201363.0) for SD and 68.3% (95% CI, 63.4\u201372.8) for SD + DD. Experts significantly outperformed residents and board-certified dermatologists. AI models achieved an accuracy of 18.2% (95% CI, 11.8\u201326.9) for SD and 44.4% (95% CI, 35.0\u201354.3) for SD + DD. Gemini 2.5 Flash performed best, with an accuracy of 62.5% for SD + DD. Agreement among dermatologists increased with experience (AC1 up to 0.65 for experts), while agreement among AI models was moderate to good (AC1 up to 0.70). Agreement between AI models and dermatologists was only slight to fair (AC1 = 0.06 for SD and 0.21 for SD + DD). All human-AI differences were statistically significant (p &lt; 0.001). Conclusions: In trichology, publicly available LLMs currently underperform compared to human experts, especially in providing a single correct diagnosis. These models require further development and specialized training before they can reliably assist with trichological diagnoses in routine care.<\/jats:p>","DOI":"10.3390\/diagnostics16010169","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T10:53:50Z","timestamp":1767610430000},"page":"169","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Publicly\u00a0Available Large Language Models for Trichoscopy: A Head-to-Head Comparison with Dermatologists"],"prefix":"10.3390","volume":"16","author":[{"given":"Basil","family":"Signer","sequence":"first","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Mokhtari","sequence":"additional","affiliation":[{"name":"ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8161-6138","authenticated-orcid":false,"given":"Simone","family":"Cazzaniga","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3336-167X","authenticated-orcid":false,"given":"Flurin","family":"Brand","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Caro","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Ente Ospedaliero Cantonale (EOC), Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre A.","family":"de Viragh","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9217-6086","authenticated-orcid":false,"given":"Kristine","family":"Heidemeyer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"},{"name":"Department of Dermatology, University Teaching and Research Hospital of the University of Lucerne, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aref","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4227-5443","authenticated-orcid":false,"given":"Matilde","family":"Iorizzo","sequence":"additional","affiliation":[{"name":"Private Dermatology Practice, 6500 Bellinzona, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5117-1551","authenticated-orcid":false,"given":"Alexandra","family":"Junge","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zora","family":"Martignoni","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal Edouard","family":"Reygagne","sequence":"additional","affiliation":[{"name":"Centre Sabouraud, H\u00f4pital St. Louis, 75010 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca Maria","family":"Piraccini","sequence":"additional","affiliation":[{"name":"Private Dermatology Practice, 40137 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3981-1527","authenticated-orcid":false,"given":"Michela","family":"Starace","sequence":"additional","affiliation":[{"name":"Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3378-4476","authenticated-orcid":false,"given":"Antonia","family":"Reimer-Taschenbrecker","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6062-9076","authenticated-orcid":false,"given":"Dominik","family":"Obrist","sequence":"additional","affiliation":[{"name":"ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seyed Morteza","family":"Seyed Jafari","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Marghoob, 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