Dermatology "AI Babylon": Cross-Language Evaluation of AI-Crafted Dermatology Descriptions

Background and Objectives: Dermatology relies on a complex terminology encompassing lesion types, distribution patterns, colors, and specialized sites such as hair and nails, while dermoscopy adds an additional descriptive framework, making interpretation subjective and challenging. Our study aims to evaluate the ability of a chatbot (Gemini 2) to generate dermatology descriptions across multiple languages and image types, and to assess the influence of prompt language on readability, completeness, and terminology consistency. Our research is based on the concept that non-English prompts are not mere translations of the English prompts but are independently generated texts that reflect medical and dermatological knowledge learned from non-English material used in the chatbot's training. Materials and Methods: Five macroscopic and five dermoscopic images of common skin lesions were used. Images were uploaded to Gemini 2 with language-specific prompts requesting short paragraphs describing visible features and possible diagnoses. A total of 2400 outputs were analyzed for readability using LIX score and CLEAR (comprehensiveness, accuracy, evidence-based content, appropriateness, and relevance) assessment, while terminology consistency was evaluated via SNOMED CT mapping across English, French, German, and Greek outputs. Results: English and French descriptions were found to be harder to read and more sophisticated, while SNOMED CT mapping revealed the largest terminology mismatch in German and the smallest in French. English texts and macroscopic images achieved the highest accuracy, completeness, and readability based on CLEAR assessment, whereas dermoscopic images and non-English texts presented greater challenges. Conclusions: Overall, partial terminology inconsistencies and cross-lingual variations highlighted that the language of the prompt plays a critical role in shaping AI-generated dermatology descriptions.