LETTER

RESEARCH LETTER

A deep learning-based smartphone We further developed an online system to host a

platform for cutaneous lupus
erythematosus classification
assistance: Simplifying the diagnosis
of complicated diseases
To the Editor: Cutaneous lupus erythematosus (CLE)
can be divided into different subtypes including
acute cutaneous LE, subcutaneous LE, and discoid
LE. These subtypes of CLE are easily confused with
other skin diseases,1 which leads to inappropriate or
delayed treatment. Convolutional neural networks
(CNNs) have shown great power for automatic
analysis of clinical images.2 However, data concern-
ing CLE are limited.3 Here, we report our develop-
ment of a smartphone-based platform to assist CLE
diagnosis and classification.
Our dataset consists of 3007 patient cases with
9241 dermatologist-labeled clinical images (acute
cutaneous LE, subcutaneous LE, discoid LE, rosacea,
psoriasis, erythema annulare centrifugum, and
healthy subjects) from 3 hospitals in China.
Experimental results showed that our model
achieved the best performance in comparison
to 3 state-of-the-art CNN models, including SE-
ResNeXt101-32x4d, SE-ResNet101, and Inception-
v3 models, and had advantages in the
high-sensitivity range, according to the receiver
operating characteristic curves. The area under the
curve for our CNN model, SE-ResNeXt101-32x4d,
SE-ResNet101, and Inception-v3 was 0.973, 0.968,
0.965, and 0.964, respectively. Our model also
had an overall accuracy of 90.67% 6 0.13%
(mean 6 standard deviation) with a sensitivity of
92.51% 6 0.22% and a specificity of 90.37% 6 0.04%
(Table I).
contest in which doctors competed against our CNN
model. A total of 197 relatively challenging cases
within the disease distribution of acute cutaneous LE
(33 cases), discoid LE (23 cases), subcutaneous LE
(29 cases), psoriasis (52 cases), erythema annulare
centrifugum (17 cases), and rosacea (43 cases) were
randomly chosen from the clinical database. Of the
197 cases, 98 could not be diagnosed by clinical
images alone. Doctors were given multiple choice
questions to select a single answer. A total of 688
licensed doctors participated in this competition and
a total of 7459 diagnoses were collected and verified
by the online system.
The accuracy of our CNN was similar to that of the
professors and/or associate professors in derma-
tology (70.39% vs 69.20 6 16.68%) who participated,
and the CNN outperformed other dermatologists and
nondermatologists. Because doctors used the avail-
able history for their judgments during the online
competition, we also included separate accuracy
results in Table II. In the cases with available history,
the accuracy of professors and/or associate profes-
sors in dermatology was also similar to that of our
CNN (68.89 6 19.19% vs 71.56%).
Our smartphone application (not restricted to
LE) is available to all doctors in China for free.
More than 8000 doctors have used this application
to assist their diagnostic process more than 60,000
times. As a step for future development, our CNN
model could be trained using a dataset that
combines images, laboratory test results, disease
history, and the results of histologic analysis. Such
a hybrid data set might give rise to a more precise
diagnosis. Given that our system achieves a

Table I. Performance of convolutional neural networks for the validation task

Se-ResNeXt-101 Se-ResNet-101 Inception-v3 Our CNNs model
Category Acc Sen Spe Acc Sen Spe Acc Sen Spe Acc Sen Spe
Psoriasis 0.8797 0.9705 0.8530 0.8785 0.9605 0.8544 0.8845 0.9538 0.8642 0.8743 0.9857 0.8415
Rosacea 0.9262 0.9879 0.8993 0.9240 0.9854 0.8972 0.9099 0.9793 0.8795 0.9329 0.9900 0.9080
EAC 0.9680 0.8658 0.9714 0.9661 0.8893 0.9687 0.9725 0.8893 0.9753 0.9773 0.8993 0.9799
ACLE 0.7985 0.8794 0.7778 0.7900 0.8688 0.7698 0.7807 0.8804 0.7550 0.7817 0.9317 0.7432
SCLE 0.8705 0.6178 0.8928 0.8533 0.6072 0.8750 0.8595 0.6045 0.8821 0.8837 0.6059 0.9082
DLE 0.8807 0.7969 0.8893 0.8790 0.7488 0.8922 0.8805 0.7523 0.8936 0.9043 0.7899 0.9160
Healthy 0.9859 1.000 0.9851 0.9857 0.9982 0.9849 0.9866 1.000 0.9857 0.9930 1.000 0.9925
Total 0.9014 0.9108 0.8998 0.8967 0.9010 0.8960 0.8963 0.9002 0.8957 0.9067 0.9251 0.9037

Acc, Accuracy; ACLE, acute cutaneous lupus erythematosus; DLE, discoid lupus erythematosus; EAC, erythema annulare centrifugum;
SCLE, subcutaneous lupus erythematosus; Sen, sensitivity; Spe, specificity. The best model performance is shown in bold.

J AM ACAD DERMATOL n 2021 1

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n 2021

Table II. Accuracy of humans versus our convolutional neural network model for diagnosis and classification
lupus erythematosus images during an online competition (%)
Dermatologists Nondermatologists
Associate/ Associate/
Resident, Attending, Professors, Resident, Attending, Professors, Our CNNs
n = 232 n = 124 n = 81 n = 170 n = 60 n = 21 model
All cases 58.15 6 19.45 62.50 6 19.68 69.20 6 16.58 42.89 6 18.87 40.57 6 20.22 49.36 6 20.64 70.39
Cases with 58.94 6 20.25 66.03 6 19.58 68.89 6 19.19 44.82 6 20.97 40.71 6 20.42 55.92 6 23.44 71.56
history
Cases 58.33 6 20.82 60.46 6 20.41 67.77 6 17.65 42.59 6 21.31 42.55 6 21.72 41.30 6 20.74 69.26
without
history

The best performance is shown in bold.

comparable or apparently superior performance to
dermatologists in diagnosing and classifying CLE
and other skin diseases, we are certain that
smartphones enabled with CNN-based Apps will
continue to benefit doctors in real-world clinical
dermatology, rheumatology, and health care
practices.
Haijing Wu, PhD,a Heng Yin, PhD, MD,a Haipeng
Chen, MPH,b Moyuan Sun, MPH,b Xiaoqing Liu,
PhD,b Yizhou Yu, PhD,b,c Yang Tang, MPH,d Hai
Long, PhD, MD,a Bo Zhang, MD,a Jing Zhang,
PhD, MD,a Ying Zhou, PhD, MD,a Yaping Li,
PhD, MD,a Guiyuing Zhang, PhD, MD,a Peng
Zhang, PhD, MD,a Yi Zhan, PhD, MD,a Jieyue
Liao, PhD MD,a Shuaihantian Luo, PhD, MD,a
Rong Xiao, PhD, MD,a Yuwen Su, PhD, MD,a
Juanjuan Zhao, MBA,d Fei Wang, Bsc,d Jing
Zhang, MPH,d Wei Zhang, MBA,d Jin Zhang,
PhD, MD,d Kai Hu, PhD,e Limei Yuan, PhD,
MD,f Danqi Deng, PhD, MD,f Yunsheng Liang,
PhD, MD,g Bin Yang, PhD, MD,g and Qianjin
Lu, PhD, MDa,h
From the Department of Dermatology, Second
Xiangya Hospital, Central South University, Hu-
nan Key Laboratory of Medical Epigenomics,
Changsha, Hunan, Chinaa; Deepwise AI Lab,
Beijing, Chinab; Department of Computer Sci-
ence, The University of Hong Kong, Hong Kongc;
Guanlan Networks (Hangzhou) Co, Ltd, Hang-
zhou, Zhejiang, Chinad; Key Laboratory of
Intelligent Computing and Information Process-
ing of Ministry of Education, Xiangtan Univer-
sity, Xiangtan, Hunan, Chinae; Second
Affiliated Hospital of Kunming Medical Univer-
sity, Kunming, Chinaf; Dermatology Hospital of
Southern Medical University, Guangzhou, Chi-
nag; and Institute of Dermatology, Chinese
Academy of Medical Sciences and Peking Union
Medical College, Najing, China.h
Drs Wu and Yin contributed equally to this article.
Funding sources: This work was supported by the
Key Research and Development Program of Hu-
nan province (2018XK2304), the Hunan Talent
Young Investigator (No. 2019RS2012), and
Hunan Outstanding Young Investigator
(No. 2020JJ2055).
IRB approval status: Not applicable.
Reprints not available from the authors.
Correspondence to: Qianjin Lu, PhD, MD,
Department of Dermatology, Second Xiangya
Hospital, Central South University, Hunan Key
Laboratory of Medical Epigenomics, Changsha,
Hunan, China
E-mail: qianlu5860@csu.edu.cn
Yizhou Yu, PhD, Department of Computer Science,
The University of Hong Kong, Hong Kong
E-mail: yizhouy@acm.org
Haijing Wu, PhD, Department of Dermatology,
Second Xiangya Hospital, Central South
University, Hunan Key Laboratory of Medical
Epigenomics, Changsha, Hunan, China
E-mail: chriswu1010@csu.edu.cn
Conflicts of interest
None disclosed.
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https://doi.org/10.1016/j.jaad.2021.02.043