ChatGPT in medicine: Evaluating psoriasis patient concerns

Dear Editor,

With the development of artificial intelligence technology, especially intelligent dialogue systems like ChatGPT, there has been widespread interest in their applications in the field of medicine. They can provide medical consultations and personalized advice to patients over the internet.

Psoriasis typically presents as localized or widespread scaly red patches or plaques and is an immune‐mediated chronic, recurrent, inflammatory, systemic disease influenced by the interplay between individual and environmental factors. Psoriasis itself and its comorbidities impose a significant burden on patients' physical, psychological, and social well‐being. ¹ Therefore, we aimed to assess whether ChatGPT's question‐and‐answer mode can accurately address patients’ concerns.

We selected 12 common questions and asked ChatGPT (ChatGPT‐3.5‐turbo, mode) for responses, recording the generated answers. Answers were independently subjectively rated by immunologists and dermatologists on a scale of 0–10 (10 being highly accurate, 8≤ score <10: fairly accurate; 6≤ score <8: average; score <6: inaccurate). The experts received no compensation.

Each answer had word counts and Flesch‐Kincaid readability levels. ChatGPT answers had an average word count of approximately 187.25 ± 81.39, and an average Flesch‐Kincaid Grade Level of 18.62 ± 7.66. The score averaged approximately 9.22 ± 0.86. Overall, ChatGPT's answers were satisfactory, with the exception of a slightly deficient response to question 5. Other answers fell into the fairly accurate range, with question 1 receiving a perfect score.

Question 5: Is psoriasis just an aesthetic issue?

While ChatGPT's response highlights the often‐overlooked psychological aspects, it's important to emphasize that psoriasis can also be associated with various comorbidities, ² including uveitis, cardiovascular metabolic diseases, inflammatory bowel diseases, and mental disorders. Additionally, psoriatic arthritis (PsA) is a progressive inflammatory condition related to psoriasis, occurring in up to 30% of psoriasis patients. ³ PsA exhibits diverse clinical manifestations, affecting not only the skin but also small joints of the hands and feet, such as interphalangeal, metacarpophalangeal, and metatarsophalangeal joints. It can also involve larger joints like the wrists, elbows, ankles, and knees. In some cases, sacroiliac joints and the spine can be affected, with peripheral arthritis, enthesitis, dactylitis, and axial arthritis being common presentations.

In general, ChatGPT's responses were quite accurate, although a few answers lacked precision. Possible reasons for this include:

1. ChatGPT relies on existing information and text, so it may not provide the most up‐to‐date information.

2. Patient questions can sometimes be unclear or inaccurate, making it challenging for ChatGPT to understand and respond effectively.

Our study found that ChatGPT can provide useful information and advice without misleading users. However, it cannot currently fully replace the professional judgment and clinical diagnosis of doctors. ⁴ With ongoing technological advancements and updates, we believe that ChatGPT has the potential to serve as a valuable assistant in relieving the burden on healthcare professionals.

Questions and ChatGPT's answers	WC	FKG	Score
What is the cause of psoriasis?
The exact cause of psoriasis is not clear, but there are several key factors associated with its development. Here are the possible causes and related factors of psoriasis: 1. Genetic Factors: Psoriasis has a familial tendency, indicating a role for genetic factors in its onset. If there are family members with psoriasis, the individual's risk of developing the condition may increase 2. Immune System Abnormalities: Psoriasis is considered an immune‐mediated disease, where the immune system becomes abnormal and attacks one's own skin cells, leading to inflammation and rapid skin cell growth. Aberrant immune system activity plays a significant role in the pathogenesis of psoriasis	252	17	10
3. Environmental Factors: Certain environmental factors may trigger or exacerbate psoriasis symptoms, including infections, trauma, stress, medication exposure, and weather conditions, among others 4. Immunosuppressive Medications: Some immunosuppressive drugs, commonly used to treat other conditions (such as post‐organ transplant immunosuppression), can also lead to or worsen psoriasis 5. Lifestyle Factors: Lifestyle habits, such as smoking, alcohol consumption, and obesity, may be associated with an increased risk of developing psoriasis It is important to note that the etiology of psoriasis is complex and may vary due to individual differences. While we have an understanding of some related factors, a complete understanding of the exact cause of psoriasis still requires further research and exploration. Treatment approaches for psoriasis typically involve medication and lifestyle management to alleviate symptoms and control the condition. If you suspect you have psoriasis or need treatment advice, it is advisable to consult with a healthcare professional
What dietary considerations should psoriasis patients be aware of?
Psoriasis patients should pay attention to the following dietary considerations: 1. Anti‐Inflammatory Foods:** Incorporate foods that have anti‐inflammatory properties into your diet. These include fruits and vegetables, especially those rich in antioxidants like berries, spinach, and kale 2. Omega‐3 Fatty Acids: Foods high in omega‐3 fatty acids, such as fatty fish (salmon, mackerel, sardines), flaxseeds, and walnuts, may help reduce inflammation 3. Whole Grains: Choose whole grains like brown rice, quinoa, and whole wheat over refined grains, as they provide more nutrients and fiber. Limit Processed Foods: Reduce your intake of processed foods, sugary snacks, and beverages, as they can contribute to inflammation 5. Alcohol and Smoking: Minimize alcohol consumption and avoid smoking, as both can worsen psoriasis symptoms 6. Hydration: Stay well‐hydrated by drinking plenty of water, as adequate hydration is important for skin health	258	15	9.4
7. Food Triggers: Some individuals may have specific food triggers that exacerbate their psoriasis symptoms. Pay attention to your body's response to different foods and consider keeping a food diary to identify potential triggers 8. Weight Management: Maintain a healthy weight through a balanced diet and regular physical activity, as obesity can worsen psoriasis 9. Consult a Dietitian: Consider consulting a registered dietitian who specializes in psoriasis or autoimmune conditions for personalized dietary recommendations It's important to note that while diet can play a role in managing psoriasis, it is not a substitute for medical treatment. Always follow the guidance of your healthcare provider in managing your psoriasis, and consult with a healthcare professional or dietitian before making significant dietary changes
What are the clinical manifestations of psoriasis?
The clinical manifestations of psoriasis can vary from person to person, but typically include the following aspects: a. Plaque Psoriasis: This is the most typical symptom of psoriasis, characterized by red, scaly patches on the skin. These patches often have well‐defined borders and are covered with white scales. They can appear on various parts of the body, with common locations being the scalp, knees, elbows, lower back, and legs b. Itching and Pain: Some psoriasis patients may experience severe itching and skin pain. These symptoms can negatively impact quality of life, leading to sleep disturbances and psychological stress c. Psoriatic Arthritis: Approximately 30% of psoriasis patients may develop psoriatic arthritis, characterized by joint pain, swelling, and stiffness, typically affecting fingers, toes, knees, and wrist joints, among others d. Dry Skin and Cracking: The skin of psoriasis patients can become dry and prone to cracking and flaking e. Abnormal Nails:Around 50% of psoriasis patients may experience nail abnormalities, such as thickening, deformity, changes in color, and the development of pits f. Involvement of Special Areas: Psoriasis can sometimes affect special areas such as the scalp, face, genital area, and oral mucosa, presenting as hair loss, redness, scales, and ulcers, among other symptoms	241	24.8	9.6
It's important to note that the clinical manifestations of psoriasis can vary from person to person, and the severity of symptoms can also differ. Therefore, the diagnosis and treatment of psoriasis should be evaluated and guided by healthcare professionals
What are the commonly used medications for the treatment of psoriasis?
The commonly used medication treatment options for psoriasis include: a. Topical Steroids: *These medications are applied directly to the affected skin to help reduce inflammation and itching b. Topical Vitamin D Analogues: These drugs help normalize the growth of skin cells and reduce inflammation when applied topically c. Topical Calcineurin Inhibitors: These medications modulate the immune response and aid in controlling inflammation when applied to the skin d. Coal Tar: Coal tar preparations have been used for many years to alleviate inflammation, itching, and scaling in psoriasis e. Salicylic Acid: This medication helps remove scales and promote the shedding of skin cells f. Systemic Medications: In severe cases of psoriasis, systemic medications may be prescribed, including methotrexate, cyclosporine, and biologics such as TNF‐α inhibitors and IL‐17 inhibitors It's important to note that the choice of medication depends on several factors, including the severity and location of psoriasis, previous treatment responses, and the overall health of the patient. Treatment should be personalized by healthcare professionals based on individual circumstances	168	40.3	8.6
Is psoriasis just unsightly?
Psoriasis is not just a cosmetic concern; it is a chronic autoimmune disease. While its primary symptoms manifest on the skin, such as red patches, scales, and itching, it can also have significant implications for a patient's overall health and quality of life Psoriasis can trigger psychological issues, such as anxiety, depression, and diminished self‐esteem. Patients may feel embarrassed, ashamed, and socially inhibited due to the skin lesions. Persistent itching and discomfort can also affect sleep quality and daily life. Additionally, psoriasis is associated with an increased risk of other conditions, including arthritis, cardiovascular diseases, and metabolic syndrome	148	14.4	6.8
Therefore, psoriasis is more than just a matter of appearance; it is a chronic condition that requires careful management and can have many adverse effects on a patient's overall health and life. Seeking early medical attention and proactive treatment is crucial in alleviating symptoms and improving the quality of life
Can psoriasis be cured?
Psoriasis cannot be completely cured at present, but its symptoms can be controlled and long‐term remission can be maintained through treatment and management. The effectiveness of treatment varies from person to person, and some individuals may require more time and effort to manage their symptoms. Here are some common treatment methods used to manage psoriasis: 1. Topical Treatments: These include topical steroids, vitamin D analogs, calcineurin inhibitors, etc., which are used to reduce skin inflammation and symptoms 2. Phototherapy: This includes UVB (Ultraviolet B) therapy and PUVA (Psoralen plus Ultraviolet A) therapy, which can help reduce inflammation and promote normal skin cell growth 3. Systemic Medications: Such as methotrexate, cyclosporine, and biologics, used to treat severe psoriasis symptoms, including psoriatic arthritis 4. Lifestyle Management: Maintaining a healthy lifestyle, including moderate exercise, a balanced diet, avoiding smoking, and limiting alcohol intake, can help improve symptoms While psoriasis cannot be completely cured, the majority of patients can achieve significant relief through active treatment and management, reducing symptoms, improving quality of life, and lowering other risks associated with the condition. Treatment should be tailored by healthcare professionals based on individual circumstances. If you have psoriasis or suspect you have the condition, please consult a medical expert for the most appropriate treatment advice	209	16.7	9.4
Is psoriasis contagious?
No, psoriasis is not contagious. It is a non‐infectious autoimmune skin condition, which means you cannot contract it from or transmit it to other people through physical contact or exposure	30	10.7	9.4
Can psoriasis skin lesions recover?
The skin lesions of psoriasis can recover, but the speed and extent of recovery vary from person to person. The treatment goal for psoriasis is to control symptoms, reduce inflammation, and promote normal skin regeneration Treatment methods typically include topical and systemic approaches. Topical treatments involve the use of topical medications such as topical corticosteroids, vitamin D analogs, and keratolytics to alleviate symptoms and improve the appearance of the skin. Systemic treatments are usually reserved for more severe cases of psoriasis and may include oral medications, phototherapy, and biologics While psoriasis can be controlled and improved, it is a chronic condition that may experience periods of recurrence. After treatment, some patients may enjoy extended periods of remission, while others may experience frequent exacerbations. Therefore, psoriasis management is a long‐term process that requires close collaboration with a healthcare provider and the adoption of appropriate self‐care measures to manage the condition	149	18	9
Is psoriasis hereditary?
Yes, psoriasis can have a hereditary component, meaning it can run in families. Having a family member with psoriasis can increase an individual's risk of developing the condition, but it is not the sole factor in its development. The exact inheritance pattern and genetic factors involved in psoriasis are complex and not fully understood	54	13.7	9.8
Can individuals with psoriasis have children?
Individuals with psoriasis can typically have children, but there are some factors to consider when planning for pregnancy. Psoriasis may have some effects on pregnancy and the breastfeeding period. Here are some considerations: a. Consultation with a Doctor: It's advisable to consult with your doctor before planning for pregnancy. Your doctor can provide personalized advice and guidance based on your specific condition b. Medication Treatment: If you are taking medications for psoriasis, it's important to understand the impact of these medications on pregnancy and the fetus. Some medications may pose risks to the fetus, and your doctor can help you choose safer treatment options based on your situation	196	20	9.8
c. Pregnancy Management: Psoriasis may change during pregnancy, with some pregnancy hormones potentially suppressing the condition while others might exacerbate it. Your doctor can monitor your condition and provide appropriate management strategies d. Genetic Risk: If you or your partner have psoriasis, it's important to understand the genetic risk and consider seeking advice from genetic specialists or dermatologists regarding genetic counseling or testing recommendations Everyone's situation is unique, so it's best to consult with a healthcare provider for a comprehensive evaluation and decision‐making based on your individual circumstances
How should individuals with psoriasis care for themselves in their daily lives?
The care of psoriasis is a continuous and comprehensive process. Here are some recommendations to help you better care for your skin and manage the condition in your daily life: a. Keep the Skin Clean: Use mild, non‐irritating cleansers and bathing products, and avoid excessive cleansing and friction on the skin. Use lukewarm water, not hot water, for bathing b. Maintain Skin Moisture: Use moisturizers to help retain skin moisture and reduce dryness and itching. Choose moisturizers with natural ingredients that are low in irritants, and try to avoid additives and fragrances c. Avoid Irritants: Avoid using overly harsh skincare products, chemicals, and hot water immersion. Avoid excessive rubbing and scrubbing of the skin d. Daily Care: Trim your nails regularly to keep them clean and avoid scratching the skin. Use soft bedding to minimize friction on the skin e. Seek Medical Advice: Schedule regular skin examinations, follow up with your doctor, and undergo treatment and management as advised by your healthcare provider f. Manage Stress: Learn to cope with and reduce stress, as stress can exacerbate the condition. Manage personal stress through exercise, rest, and relaxation techniques g. Food and Diet: Aim to maintain a healthy diet with adequate nutrients and hydration. Some individuals may notice that certain foods affect their condition, so personalized dietary adjustments can be tried	258	15.8	9.8
Please remember that these are general recommendations and should not substitute for specific guidance from a doctor. Everyone's condition and needs are different, so it's advisable to consult with a healthcare provider or dermatologist for personalized care plans
How can individuals with psoriasis manage their emotions?
Adjusting emotions is crucial for individuals with psoriasis to manage their condition and improve their quality of life. Here are some methods to help you manage your emotions: a. Seek Support: Share your feelings and experiences with family, friends, or support groups. Seeking understanding and support from others can alleviate emotional burdens b. Learn to Relax: Try relaxation techniques such as deep breathing, meditation, and progressive muscle relaxation. These techniques can help alleviate anxiety and stress, enhancing emotional balance c. Foster a Positive Lifestyle: Develop a healthy lifestyle, including adequate sleep, a balanced diet, and regular exercise. These healthy habits can improve both physical and mental well‐being d. Find Enjoyable Activities: Explore hobbies and activities you enjoy, such as reading, painting, or listening to music. These activities can help divert your attention and relax your mind. e. Seek Professional Support: If you find it challenging to control your emotions or if the psychological burden becomes overwhelming, consider seeking professional psychological counseling or therapy. Professionals can provide more in‐depth support and guidance f. Build a Positive Self‐Image: Psoriasis may have a negative impact on self‐image, so learn to accept and love your body. Cultivate a positive self‐image, focusing on your inner worth and qualities g. Face Challenges Positively: Approach life's challenges with a positive attitude, accept the presence of the disease, and seek flexible coping strategies. Look for problem‐solving strategies and the ability to adapt and change It's important to remember that managing emotions takes time and continuous practice. If emotional issues persist or become severe, it is advisable to seek professional help, such as support from a psychologist or psychiatrist. They can provide more specific and personalized guidance to help you cope with emotional challenges	284	17	9

CONFLICT OF INTEREST STATEMENT

The authors have declared that no conflict of interest exists.

DATA AVAILABILITY STATEMENT

Data is available on request from the authors.