6 ms·

Using Deep Learning to Inform Differential Diagnoses of Skin Diseases

93 points by theafh 7y ago

specialist 7y ago
This is very cool. And much needed. I anticipate three other complimentary technologies which will help many, many people. (In case anyone is looking for medical startup ideas...) More sensor data from non visible light. Like the recent popularity of using ultraviolet light to see cumulative skin damage. Better ways to register and align (correct) photos, to better compare images taken over time, to better track progress of conditions over time. Eventually even full body scans. Some way to measure the thickness or depth of the various layers of skin. Think side scanning radar, but for skin. -- Source: I've had graft versus host disease greatly affecting my skin for nearly 30 years. It's been wicked hard to diagnose and monitor.
dylanz 7y ago
This is great to see, and I didn’t know that there was a shortage or dermatologists. Just a few months ago my entire body got all blotchy and I ended up having to go to a dermatologist to get a biopsy. It ended up being full body Granuloma Annulare which is both rare an incurable. With no other options, I’ll be trying to cure it with diet. That said, it couldn’t be diagnosed by sight alone. It looked very similar to many other skin diseases, and mine in particular comes in many different forms. I’ll obviously be following this research!
- n1000 7y ago
  I recommend you try Traditional Chinese Medicine (TCM). I had to drink the ugliest medicinal tea imaginable for a while, but after that my skin problems had miraculously disappeared.
  - sjg007 7y ago
    Do you know what the ingredients were? I know some people who have creams from a Chinese medicine doctor that seem to work for them.
    - n1000 7y ago
      Unfortunately not. But I remember there was some really weird stuff in there. Anything from minerals to insect skins. It is customised to whatever the diagnosis is.
  - jszymborski 7y ago
    Obligatory disclaimer that much of TCM is unstudied, and that which is isn't all that promising. https://nccih.nih.gov/health/whatiscam/chinesemed.htm https://nccih.nih.gov/health/whatiscam/chinesemed.htm
  - dylanz 7y ago
    This is definitely on my list in a few months if the diet changes I'm making haven't helped (I'm trying to stay in Ketosis for a few months). I studied Chinese martial arts for most of my life so some TCM treatments have worked for other things in my past.
- specialist 7y ago
  I'm sorry. FWIW, I got a lot of mileage out of Dr Terry Wahls' thesis about proper, adequate nutrition for mitigating autoimmune diseases. https://en.wikipedia.org/wiki/Terry_Wahls https://en.wikipedia.org/wiki/Terry_Wahls Also, scanning articles about granuloma annulare, I see light therapy is sometimes helpful. I've done both PUVA and UVB for my condition (GVHD). Both helped, differently, and may give you some relief, or at least get you over the hump. Alas, both are hard to sustain. As a lifelong patient who has been screwed multiple times by dermatologists, I strongly encourage everyone to 1) Never accept "no" or "I don't know" as an answer. Some one out there has answers for you. Keep searching. 2) Progress marches on and eventually help will arrive. Set up google news alerts for your health conditions (and misc possible treatment technologies). Stay current on the options. Because your doctor's won't be providing that service for you.
  - dylanz 7y ago
    That's all great advice, and ugh... sorry about the GVHD. Light therapy is definitely on my list and great point about setting up a Google News alert. Thank you for the comment!
n1000 7y ago
In my opinion we have a long way to go before we actually understand many many of the skin diseases. Dermatologists appear to me as the most clueless doctors out there. Their only weapons seem to be cortisol and biopsies. Maybe I was also just unlucky.
- SCUSKU 7y ago
  I live with a eczema with fluctuating severity and have to agree. I have been prescribed triamcinolone acetonide steroidal cream, which helps, but doesn't keep me from scratching. I am legitimately waiting for genetic editing to solve this problem for me.
  - bitL 7y ago
    Try sauna with multiple heat (~10 minute) - cold (1-2 minutes; immersed) cycles; some of my friends with various skin disorders reported significant improvement after 3 sessions and I could see myself their skin first dried on affected areas that then quickly recovered to almost perfect state after 3rd session. YMMV ofc.
    - lallysingh 7y ago
      Do you have more information on this? A link perhaps?
      - bitL 7y ago
        I don't see any medical journal report, however there seem to be many people discussing the same online; just a quick search led to this Reddit thread that describes what I saw on my friends (i.e. damaged skin peeling off with healthy one underneath): https://old.reddit.com/r/eczema/comments/6cci0h/infrared_sauna_holy_cow/ https://old.reddit.com/r/eczema/comments/6cci0h/infrared_sau... I believe the "cold shower" mentioned later is necessary for any effect; my friends usually spend 1-2 minutes immersed in cold water after a heat cycle (arguably both improved blood circulation and immunity boost).
- 7y ago
hypersoar 7y ago
My SO is a dermatologist. Her father is also a radiologist, which is probably the most obvious target for this sort of thing. When I asked her about it, she said that she's looking at the depth and height of things a lot, a dimension not really captured in a photograph. This study pit their AI against dermatologists getting the same photo and information, but I'm curious how it'd do against an in-person examination. Google doesn't appear to be claiming that they could replace dermatologists with AI entirely. Lest anyone's mind start leaping in that direction, here are a few more reasons why I think her job is safe for the foreseeable future. - Much of her work is full-body skin-checks. How able would an AI system be to provide instant feedback on everything sketchy it sees? How comfortable will people be with, rather than a doctor inspecting their entire body, having pictures taken of their entire body? - Her cases can get rather complicated. Skin problems can be caused or complicated by internal illnesses that need to be considered. This point, in particular, calls on her specialized training beyond what a GP would have. - There's a lot more to her work than diagnosing. She's also prescribing treatments, monitoring progress, performing surgeries, etc. - Her time is indeed very expensive (much to by benefit), and more so than a GP's. But there are a lot of challenges involved in deploying things in medicine, and our regulations are probably unprepared for diagnosis-by-computer. I expect it'll be quite a while before, say, a GP augmented by an AI is price-competitive with a board-certified dermatologist.
- catoc 7y ago
  Dermatologists and radiologists will not be replaced by AI any time soon - for precisely these reasons. Geoffrey Hinton personally saying "we should stop training radiologists" just reflects a complete lack of understanding about what a radiologist does.
  - ska 7y ago
    Your broad point is true, but radiology is an odd and relatively new specialty. It's not going away entirely any time soon but I think will be the most radically affected over the next 20 odd years.
    - 7y ago
doctoring 7y ago
This is great to see. A key part of medicine is generating an appropriate differential rather than identifying one true diagnosis (as they explain). A ranked list of diagnoses lets you appropriately incorporate new information (history, lab data, imaging, etc) and gives you a framework for exploring further (thinking about value of information and what additional data you'd need to narrow your list or increase your confidence). I think in dermatology, radiology, and pathology (and other visual diagnostic fields) this work is a huge boon, but the conceptual framework is the same for diagnostics based on laboratory, physical exam, genetic, or any other findings. I don't think ML is necessary in creating excellent decision support tools but is increasingly valuable as you include more and more disparate sources of information.
buybackoff 7y ago
My first thought is the context. They mention 26 cases and 45 metadata. What if one has 27th caused by 46th metadata item.. Just yesterday visited dermatologist for the first time in 9 years, had to ask him to give me his PC mouse to explain that my acute eczema is exactly on the region where my hand touches PC mouse and it started during the heatwave this year in Europe. The doctor prescribed a lot of common tests, because he had to do so formally. Yet it was clear for me and him what's going on, especialy when I had the same 9y ago and the old treatment works, but not very effective this time. But how AI could ever incorporate such rare contextual coincidences if the learning set is limited to a close set of conditions?
ape4 7y ago
Seems like asking "history of psoriasis?" is cheating

93 points by theafh 7y ago

This is very cool. And much needed. I anticipate three other complimentary technologies which will help many, many people. (In case anyone is looking for medical startup ideas...) More sensor data from non visible light. Like the recent popularity of using ultraviolet light to see cumulative skin damage. Better ways to register and align (correct) photos, to better compare images taken over time, to better track progress of conditions over time. Eventually even full body scans. Some way to measure the thickness or depth of the various layers of skin. Think side scanning radar, but for skin. -- Source: I've had graft versus host disease greatly affecting my skin for nearly 30 years. It's been wicked hard to diagnose and monitor.

dylanz 7y ago

This is great to see, and I didn’t know that there was a shortage or dermatologists. Just a few months ago my entire body got all blotchy and I ended up having to go to a dermatologist to get a biopsy. It ended up being full body Granuloma Annulare which is both rare an incurable. With no other options, I’ll be trying to cure it with diet. That said, it couldn’t be diagnosed by sight alone. It looked very similar to many other skin diseases, and mine in particular comes in many different forms. I’ll obviously be following this research!

n1000 7y ago
I recommend you try Traditional Chinese Medicine (TCM). I had to drink the ugliest medicinal tea imaginable for a while, but after that my skin problems had miraculously disappeared.
- sjg007 7y ago
  Do you know what the ingredients were? I know some people who have creams from a Chinese medicine doctor that seem to work for them.
  - n1000 7y ago
    Unfortunately not. But I remember there was some really weird stuff in there. Anything from minerals to insect skins. It is customised to whatever the diagnosis is.
- jszymborski 7y ago
  Obligatory disclaimer that much of TCM is unstudied, and that which is isn't all that promising. https://nccih.nih.gov/health/whatiscam/chinesemed.htm https://nccih.nih.gov/health/whatiscam/chinesemed.htm
- dylanz 7y ago
  This is definitely on my list in a few months if the diet changes I'm making haven't helped (I'm trying to stay in Ketosis for a few months). I studied Chinese martial arts for most of my life so some TCM treatments have worked for other things in my past.
specialist 7y ago
I'm sorry. FWIW, I got a lot of mileage out of Dr Terry Wahls' thesis about proper, adequate nutrition for mitigating autoimmune diseases. https://en.wikipedia.org/wiki/Terry_Wahls https://en.wikipedia.org/wiki/Terry_Wahls Also, scanning articles about granuloma annulare, I see light therapy is sometimes helpful. I've done both PUVA and UVB for my condition (GVHD). Both helped, differently, and may give you some relief, or at least get you over the hump. Alas, both are hard to sustain. As a lifelong patient who has been screwed multiple times by dermatologists, I strongly encourage everyone to 1) Never accept "no" or "I don't know" as an answer. Some one out there has answers for you. Keep searching. 2) Progress marches on and eventually help will arrive. Set up google news alerts for your health conditions (and misc possible treatment technologies). Stay current on the options. Because your doctor's won't be providing that service for you.
- dylanz 7y ago
  That's all great advice, and ugh... sorry about the GVHD. Light therapy is definitely on my list and great point about setting up a Google News alert. Thank you for the comment!

n1000 7y ago

In my opinion we have a long way to go before we actually understand many many of the skin diseases. Dermatologists appear to me as the most clueless doctors out there. Their only weapons seem to be cortisol and biopsies. Maybe I was also just unlucky.

SCUSKU 7y ago
I live with a eczema with fluctuating severity and have to agree. I have been prescribed triamcinolone acetonide steroidal cream, which helps, but doesn't keep me from scratching. I am legitimately waiting for genetic editing to solve this problem for me.
- bitL 7y ago
  Try sauna with multiple heat (~10 minute) - cold (1-2 minutes; immersed) cycles; some of my friends with various skin disorders reported significant improvement after 3 sessions and I could see myself their skin first dried on affected areas that then quickly recovered to almost perfect state after 3rd session. YMMV ofc.
  - lallysingh 7y ago
    Do you have more information on this? A link perhaps?
    - bitL 7y ago
      I don't see any medical journal report, however there seem to be many people discussing the same online; just a quick search led to this Reddit thread that describes what I saw on my friends (i.e. damaged skin peeling off with healthy one underneath): https://old.reddit.com/r/eczema/comments/6cci0h/infrared_sauna_holy_cow/ https://old.reddit.com/r/eczema/comments/6cci0h/infrared_sau... I believe the "cold shower" mentioned later is necessary for any effect; my friends usually spend 1-2 minutes immersed in cold water after a heat cycle (arguably both improved blood circulation and immunity boost).
7y ago

hypersoar 7y ago

My SO is a dermatologist. Her father is also a radiologist, which is probably the most obvious target for this sort of thing. When I asked her about it, she said that she's looking at the depth and height of things a lot, a dimension not really captured in a photograph. This study pit their AI against dermatologists getting the same photo and information, but I'm curious how it'd do against an in-person examination. Google doesn't appear to be claiming that they could replace dermatologists with AI entirely. Lest anyone's mind start leaping in that direction, here are a few more reasons why I think her job is safe for the foreseeable future. - Much of her work is full-body skin-checks. How able would an AI system be to provide instant feedback on everything sketchy it sees? How comfortable will people be with, rather than a doctor inspecting their entire body, having pictures taken of their entire body? - Her cases can get rather complicated. Skin problems can be caused or complicated by internal illnesses that need to be considered. This point, in particular, calls on her specialized training beyond what a GP would have. - There's a lot more to her work than diagnosing. She's also prescribing treatments, monitoring progress, performing surgeries, etc. - Her time is indeed very expensive (much to by benefit), and more so than a GP's. But there are a lot of challenges involved in deploying things in medicine, and our regulations are probably unprepared for diagnosis-by-computer. I expect it'll be quite a while before, say, a GP augmented by an AI is price-competitive with a board-certified dermatologist.

catoc 7y ago
Dermatologists and radiologists will not be replaced by AI any time soon - for precisely these reasons. Geoffrey Hinton personally saying "we should stop training radiologists" just reflects a complete lack of understanding about what a radiologist does.
- ska 7y ago
  Your broad point is true, but radiology is an odd and relatively new specialty. It's not going away entirely any time soon but I think will be the most radically affected over the next 20 odd years.
  - 7y ago

doctoring 7y ago

This is great to see. A key part of medicine is generating an appropriate differential rather than identifying one true diagnosis (as they explain). A ranked list of diagnoses lets you appropriately incorporate new information (history, lab data, imaging, etc) and gives you a framework for exploring further (thinking about value of information and what additional data you'd need to narrow your list or increase your confidence). I think in dermatology, radiology, and pathology (and other visual diagnostic fields) this work is a huge boon, but the conceptual framework is the same for diagnostics based on laboratory, physical exam, genetic, or any other findings. I don't think ML is necessary in creating excellent decision support tools but is increasingly valuable as you include more and more disparate sources of information.

buybackoff 7y ago

My first thought is the context. They mention 26 cases and 45 metadata. What if one has 27th caused by 46th metadata item.. Just yesterday visited dermatologist for the first time in 9 years, had to ask him to give me his PC mouse to explain that my acute eczema is exactly on the region where my hand touches PC mouse and it started during the heatwave this year in Europe. The doctor prescribed a lot of common tests, because he had to do so formally. Yet it was clear for me and him what's going on, especialy when I had the same 9y ago and the old treatment works, but not very effective this time. But how AI could ever incorporate such rare contextual coincidences if the learning set is limited to a close set of conditions?

ape4 7y ago

Seems like asking "history of psoriasis?" is cheating