Vision transformer-based diagnosis of psoriasis and eczema in whole-slide histology

Rivera Monroy LC, Petzold A, Sari M, Breininger K, Maier A, Vera González J, Erdmann M, Schliep S, Drexler K, Nieaxbel D, Schreml S, Hayani KM, Aebischer V, Braun SA, Schmidle P, Metze D, Sticherling M, Berking C, Koch E, Heppt M (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Virchows Archiv Springer Verlag (Germany)

DOI: 10.1007/s00428-026-04445-x

Abstract

Psoriasis and eczema are chronic inflammatory skin diseases with overlapping histopathological features, which often lead to diagnostic uncertainty even among experienced dermatopathologists. To address this challenge, we developed a computer-assisted diagnostic framework that combines the Virchow foundation model, pretrained on 1.5 million whole-slide images, with multi-instance learning (MIL) to classify psoriasis and eczema from digitized histopathology slides. Using an internal dataset (n = 40) and an external validation cohort (n = 40), equally balanced between both conditions and annotated by board-certified dermatopathologists, our best-performing configuration (Virchow + CLAM) achieved 85% accuracy, a macro-averaged F1 score of 0.80, and an AUC of 0.81 on the external cohort. This substantially outperformed baseline convolutional neural networks, which reached 61% accuracy, and models relying solely on pretrained feature extractors without MIL, which achieved an average accuracy of 68.8%. In a reader study on the same external cohort, individual dermatopathologist accuracies ranged from 47.5 to 70.0%, with a majority-vote consensus accuracy of 62.5%; our method outperformed both the average individual reader and the consensus under histology-only conditions. Furthermore, the model generates attention heatmaps that provide supportive visual context by highlighting regions associated with model predictions. Importantly, this study is designed as a methodological proof-of-concept conducted under controlled, histology-only conditions and is not intended for direct clinical deployment. Rather than demonstrating clinical readiness, it illustrates the potential of domain-specific foundation models combined with MIL for addressing diagnostically challenging inflammatory dermatoses.

Authors with CRIS profile

Luis Carlos Rivera Monroy Department of Dermatology Anne Petzold Department of Dermatology Melissa Sari Medizinische Fakultät Katharina Breininger Department Artificial Intelligence in Biomedical Engineering (AIBE) Andreas Maier Lehrstuhl für Informatik 5 (Mustererkennung) Julio Vera González Department of Dermatology Michael Erdmann Department of Dermatology Stefan Schliep Department of Dermatology Michael Sticherling Department of Dermatology Carola Berking Lehrstuhl für Haut- und Geschlechtskrankheiten Elias Koch Department of Dermatology Markus Heppt Department of Dermatology

Involved external institutions

Dermpath München DE Germany (DE) Queen's University CA Canada (CA) Universitätsklinikum Regensburg DE Germany (DE) Westfälische Wilhelms-Universität (WWU) Münster DE Germany (DE) Universität Regensburg DE Germany (DE) Universitätsklinikum Münster DE Germany (DE)

How to cite

APA:

Rivera Monroy, L.C., Petzold, A., Sari, M., Breininger, K., Maier, A., Vera González, J.,... Heppt, M. (2026). Vision transformer-based diagnosis of psoriasis and eczema in whole-slide histology. Virchows Archiv. https://doi.org/10.1007/s00428-026-04445-x

MLA:

Rivera Monroy, Luis Carlos, et al. "Vision transformer-based diagnosis of psoriasis and eczema in whole-slide histology." Virchows Archiv (2026).

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