Advancement and independent validation of a deep learning-based tool for automated scoring of nail psoriasis severity using the modified nail psoriasis severity index

Kemenes S, Liu C, Schlereth M, Noversa de Sousa R, Minopoulou I, Fenzl P, Corte G, Yalcin-Mutlu M, Höner M, Sagonas I, Coppers B, Liphardt AM, Simon D, Kleyer A, Folle L, Sticherling M, Schett G, Maier A, Fagni F (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Frontiers in Medicine Frontiers Media

Book Volume: 12

Article Number: 1574413

DOI: 10.3389/fmed.2025.1574413

Abstract

Objective: To improve and validate a convolutional neural network (CNN)-based model for the automated scoring of nail psoriasis severity using the modified Nail Psoriasis Severity Index (mNAPSI) with adequate accuracy across all severity classes and without dependency on standardized conditions. Methods: Patients with psoriasis (PsO), psoriatic arthritis (PsA), and non-psoriatic controls including healthy individuals and patients with rheumatoid arthritis were included for training, while validation utilized an independent cohort of psoriatic patients. Nail photographs were pre-processed and segmented and mNAPSI scores were annotated by five expert readers. A CNN based on Bidirectional Encoder representation from Image Transformers (BEiT) architecture and pre-trained on ImageNet-22k was fine-tuned for mNAPSI classification. Model performance was compared with human annotations by using area under the receiver operating characteristic curve (AUROC) and other metrics. A reader study was performed to assess inter-rater variability. Results: In total, 460 patients providing 4,400 nail photographs were included in the training dataset. The independent validation dataset included 118 further patients who provided 929 nail photographs. The CNN demonstrated high classification performance on the training dataset, achieving mean (SD) AUROC of 86% ± 7% across mNAPSI classes. Performance remained robust on the independent validation dataset, with a mean AUROC of 80% ± 9%, despite variability in imaging conditions. Compared with human annotation, the CNN achieved a Pearson correlation of 0.94 on a patient-level, which remained consistent in the validation dataset. Conclusion: We developed and validated a CNN that enables the automated, objective scoring of nail psoriasis severity based on mNAPSI with high reliability and without need of image standardization. This approach has potential clinical utility for enabling a standardized time-efficient assessment of nail involvement in the psoriatic disease and possibly as a self-reporting tool.

Authors with CRIS profile

Stephan Kemenes Medizinische Fakultät Chang Liu Lehrstuhl für Informatik 5 (Mustererkennung) Maja Schlereth Department Artificial Intelligence in Biomedical Engineering (AIBE) Pauline Fenzl Department of Medicine 3 – Rheumatology and Immunology Michael Höner Department of Dermatology Birte Coppers Medizinische Fakultät Anna-Maria Liphardt Medizinische Fakultät Lukas Folle Lehrstuhl für Informatik 5 (Mustererkennung) Michael Sticherling Professur für Dermatologie Georg Schett Lehrstuhl für Innere Medizin III Andreas Maier Lehrstuhl für Informatik 5 (Mustererkennung) Filippo Fagni Department of Medicine 3 – Rheumatology and Immunology

Additional Organisation(s)

Sonderforschungsbereich 1483/1 - Empathokinästhetische Sensorik - Sensortechniken und Datenanalyseverfahren zur empathokinästhetischen Modellbildung und Zustandsbestimmung (SFB EmpkinS)

Related research project(s)

Bewegungsmuster der Hand aus empathokinästhetischen Sensordaten als diagnostische Größe für Krankheitsaktivität bei Patienten mit rheumatischen Erkrankungen (EmpkinS D01) Empatho-Kinaesthetic Sensor Technology (SFB 1483 EmpkinS) July 1, 2021 - June 30, 2025

Involved external institutions

Charité - Universitätsmedizin Berlin DE Germany (DE)

How to cite

APA:

Kemenes, S., Liu, C., Schlereth, M., Noversa de Sousa, R., Minopoulou, I., Fenzl, P.,... Fagni, F. (2025). Advancement and independent validation of a deep learning-based tool for automated scoring of nail psoriasis severity using the modified nail psoriasis severity index. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1574413

MLA:

Kemenes, Stephan, et al. "Advancement and independent validation of a deep learning-based tool for automated scoring of nail psoriasis severity using the modified nail psoriasis severity index." Frontiers in Medicine 12 (2025).

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