Cited by 119Cutaneous Melanoma Detection and ManagementDermatology and Skin DiseasesArtificial Intelligence in Healthcare and Education

Systematic Review of Deep Learning Image Analyses for the Diagnosis and Monitoring of Skin Disease

Open access
Choy, Shern Ping, Kim, Byung Jin, Paolino, Alexandra, Tan, Wei Ren, Lim, Sarah Man Lin, Seo, Jessica, Tan, Sze Ping, Francis, Luc +7 more·2023·npj Digital Medicine

Abstract

Skin diseases affect one-third of the global population, posing a major healthcare burden. Deep learning may optimise healthcare workflows through processing skin images via neural networks to make predictions. A focus of deep learning research is skin lesion triage to detect cancer, but this may not translate to the wider scope of >2000 other skin diseases. We searched for studies applying deep learning to skin images, excluding benign/malignant lesions (1/1/2000-23/6/2022, PROSPERO CRD42022309935). The primary outcome was accuracy of deep learning algorithms in disease diagnosis or severity assessment. We modified QUADAS-2 for quality assessment. Of 13,857 references identified, 64 were included. The most studied diseases were acne, psoriasis, eczema, rosacea, vitiligo, urticaria. Deep learning algorithms had high specificity and variable sensitivity in diagnosing these conditions. Accuracy of algorithms in diagnosing acne (median 94%, IQR 86-98; n = 11), rosacea (94%, 90-97; n = 4), eczema (93%, 90-99; n = 9) and psoriasis (89%, 78-92; n = 8) was high. Accuracy for grading severity was highest for psoriasis (range 93-100%, n = 2), eczema (88%, n = 1), and acne (67-86%, n = 4). However, 59 (92%) studies had high risk-of-bias judgements and 62 (97%) had high-level applicability concerns. Only 12 (19%) reported participant ethnicity/skin type. Twenty-four (37.5%) evaluated the algorithm in an independent dataset, clinical setting or prospectively. These data indicate potential of deep learning image analysis in diagnosing and monitoring common skin diseases. Current research has important methodological/reporting limitations. Real-world, prospectively-acquired image datasets with external validation/testing will advance deep learning beyond the current experimental phase towards clinically-useful tools to mitigate rising health and cost impacts of skin disease.

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Crossref · 10.1038/s41746-023-00914-8

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  • Key technical hurdles include standardizing image quality across photo acquisition methods, addressing confounding factors and artifacts in images, and developing representative datasets that span diverse patient populations.

    “Key technical hurdles include standardizing image quality across photo acquisition methods, addressing confounding factors and artifacts in images, and developing representative datasets that span diverse patient populations (Choy et al, 2023; Daneshjou et al, 2022)”

    From Artificial intelligence–enabled precision medicine for inflammatory skin diseases (2026) · cites this paper as Choy et al, 2023

    The Discussion calls for high-quality images from well-phenotyped cohorts and describes underrepresentation of some skin types and bias toward particular phenotypes and locations. That supports the need for more representative datasets. The passages do not identify standardizing image quality across acquisition methods or addressing image artifacts and confounders as specific hurdles. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • The accuracy of deep learning achieves optimal outcomes in skin disease diagnosis.

    “The accuracy of deep learning is confirmed to achieve optimal outcomes in skin disease diagnosis [48]”

    From Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives (2025) · cites this paper as [48]

    The Results report high diagnostic accuracy for several commonly studied skin diseases, supporting the claim's core point. But the Discussion describes the findings as encouraging rather than optimal, notes low accuracy for externally tested algorithms diagnosing skin infections, and highlights variable sensitivity and methodological limitations. The claim overstates how consistently well deep learning performs across skin diseases. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • The finding that acne, psoriasis and atopic dermatitis were the most studied diseases was consistent with previous findings.

    “which was consistent with previous findings.14”

    From Assessing the performance of artificial intelligence models in evaluating inflammatory skin disease severity: a systematic review and meta-analysis (2025) · cites this paper as [14]

    Table 1 (Results, General study characteristics; page unavailable) lists acne (30 studies), psoriasis (27), and eczema (22) as the three most studied disease categories, supporting the overall comparison. It labels the third category eczema, not specifically atopic dermatitis, so the narrower identification is not established by our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • A recent review included 64 studies, of which 52 focused on detection and 12 on severity assessment.

    “with a recent review including 64 studies, of which 52 were focused on detection and 12 concentrated on severity assessment.14”
  • An earlier review by Choy et al. noted the highest accuracy in psoriasis (93-100%, n=2) and the lowest in acne (67-86%, n=4), but lacked a meta-analysis for direct comparisons.

    “An earlier review of deep learning image analyses by Choy et al. noted the highest accuracy in psoriasis (93–100%, n = 2) and the lowest in acne (67–86%, n = 4), but lacked a meta-analysis for direct comparisons.14”

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Research works printed but not linked: 1

  1. [27]Page M. J. H. J. & Sterne J. A. C. Chapter 13: Assessing risk of bias due to missing results in a synthesis. in Cochrane Handbook for Systematic Reviews of Interventions version 63 (updated February 2022) Ch. 13 (Cochrane, 2022).

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Authors
Choy, S. P., Kim, B. J., Paolino, A., Tan, W. R., Lim, S. M. L., Seo, J., Tan, S. P., Francis, L., Tsakok, T., Simpson, M., Barker, J. N. W. N., Lynch, M. D., Corbett, M. S., Smith, C. H., & Mahil, S. K.
Affiliations
  • King's College London (GB)
  • St George’s University Hospitals NHS Foundation Trust (GB)
  • Maidstone and Tunbridge Wells NHS Trust (GB)
  • Imperial College London (GB)
  • Barking, Havering And Redbridge University Hospitals NHS Trust (GB)
  • University of York (GB)
Corresponding author
Mahil, Satveer K.
Venue
npj Digital Medicine
Published
2023-09-27
Volume
6
Issue
1
Pages
180-180
ISSN
2398-6352 (ISSN-L)
OpenAlex
W4387104519
Cited by
105
References
29
Citations by year
2026: 35 · 2025: 43 · 2024: 25 · 2023: 2
FWCI
3.40
Type
journal article
Language
en
Open access
Locations
  • npj Digital Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion, public-domain)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • DH | National Institute for Health Research (NIHR302258)
  • Psoriasis Association (PhD Studentship)
  • RCUK | Medical Research Council ([MR/R001839/1])
Topics
  • Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
Keywords
deep learning, dermatological diagnosis, skin lesion image analysis, acne, psoriasis, atopic dermatitis, rosacea, vitiligo, urticaria, disease severity classification, diagnostic accuracy, risk of bias, external validation, skin type, dermatology

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