DERM-3R: A Resource-Efficient Multimodal Agents Framework for Dermatologic Diagnosis and Treatment in Real-World Clinical Settings

Jirui Dai; Zhendong Wang; Chongjing Wang; Yusha Bai; Ziwen Chen; Jihao Gu; Zhou Zhang; Changyong Luo

cs.AIMar 6, 2026

DERM-3R: A Resource-Efficient Multimodal Agents Framework for Dermatologic Diagnosis and Treatment in Real-World Clinical Settings

Authors: Jirui Dai, Zhendong Wang, Chongjing Wang, Yusha Bai, Ziwen Chen, Jihao Gu, Zhou Zhang, Changyong Luo, +2 more

Abstract

Skin diseases impose a substantial and growing global health burden. Modern dermatologic therapies control acute manifestations rapidly, but single-target treatment paradigms, recurrent disease courses, and neglected systemic comorbidities limit their long-term effectiveness. Traditional Chinese medicine (TCM) offers a complementary, holistic approach through syndrome differentiation and individualized treatment, yet its clinical practice is hindered by non-standardized knowledge, incomplete multimodal records, and the difficulty of scaling expert-driven reasoning. We propose DERM-3R, a resource-efficient multimodal agents framework that models TCM dermatologic diagnosis and treatment under limited data and computational resources. We decompose and redefine real-world dermatologic decision-making into three essential issues: fine-grained lesion recognition, multi-view lesion representation with specialist-level pathogenesis modeling, and holistic clinical reasoning for syndrome differentiation and treatment planning. DERM-3R comprises three collaborative agents, DERM-Rec, DERM-Rep, and DERM-Reason, each addressing one of these issues. Built on a lightweight multimodal large language model and fine-tuned by partial-parameter finetuning on 103 real-world TCM psoriasis cases, DERM-3R performs strongly across multiple dermatologic reasoning tasks. Automatic metrics, LLM-as-a-Judge assessments, and human doctors show that, despite extremely limited training data and parameter updates, DERM-3R matches or even surpasses hundred-billion-parameter general-purpose multimodal models such as GPT-5.1 and Gemini-3-Flash. Our results indicate that structured, domain-aware multi-agent modeling is an effective alternative to brute-force scaling for complex clinical tasks, offering a practical and scalable paradigm for multimodal AI in dermatology and integrative medicine.

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May 14, 2026

DermAgent: A Self-Reflective Agentic System for Dermatological Image Analysis with Multi-Tool Reasoning and Traceable Decision-Making

Dermatological diagnosis requires integrating fine-grained visual perception with expert clinical knowledge. Although Multimodal Large Language Models (MLLMs) facilitate interactive medical image analysis, their application in dermatology is hindered by insufficient domain-specific grounding and hallucinations. To address these issues, we propose DermAgent, a collaborative multi-tool agent that orchestrates seven specialized vision and language modules within a Plan-Execute-Reflect framework. DermAgent delivers stepwise, traceable diagnostic reasoning through three core components. First, it employs complementary visual perception tools for comprehensive morphological description, dermoscopic concept annotation, and disease diagnosis. Second, to overcome the lack of domain prior, a dual-modality retrieval module anchors every prediction in external evidence by cross-referencing 413,210 diagnosed image cases and 3,199 clinical guideline chunks. To further mitigate hallucinations, a deterministic critic module conducts strict post-hoc auditing via confidence, coverage, and conflict gates, automatically detecting inter-source disagreements to trigger targeted self-correction. Extensive experiments on five dermatology benchmarks demonstrate that DermAgent consistently outperforms state-of-the-art MLLMs and medical agent baselines across zero-shot fine-grained disease diagnosis, concept annotation, and clinical captioning tasks, exceeding GPT-4o by 17.6% in skin disease diagnostic accuracy and 3.15% in captioning ROUGE-L. Our code is available at https://github.com/YizeezLiu/DermAgent.

Yize Liu, Siyuan Yan, Ming Hu +5

AIM for Health Lab, Faculty of Information Technology, Monash University, Melbourne, Australia · Faculty of Information Technology, Monash University, Melbourne, Australia · University College London, Institute of Ophthalmology, London, United Kingdom

Medical Image Analysis LLM Agent Orchestration Tool-Using Vision-Language Agents Medical VLMs Explainable Medical Image Analysis

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Jul 2, 2026

MMIR-TCM: Memory-Integrated Multimodal Inference and Retrieval for TCM Clinical Decision Support

Traditional Chinese Medicine (TCM) diagnosis, particularly through tongue inspection, faces persistent challenges in subjectivity and reproducibility. The application of multimodal artificial intelligence to TCM clinical tasks, such as syndrome differentiation and prescription generation, is significantly hampered by the semantic gap between visual tongue features and textual reasoning, as well as the lack of large-scale, standardized datasets. To address these challenges, we introduce MMIR-TCM, a novel framework that emulates the diagnostic process of TCM experts by integrating multimodal large language model(MLLM) with memory-augmented segmentation and retrieval-augmented generation (RAG). Employing a three-stage architecture, MMIR-TCM integrates a training-free Memory-SAM module for robust tongue extraction, a fine-tuned Qwen3-VL model for structured tongue diagnosis generation, and a Qwen3-based RAG component for evidence-grounded clinical decision support generation. The framework was developed and validated using MedTCM, a new large-scale multimodal dataset that we introduce specifically for advanced TCM research. To properly evaluate our framework's clinical accuracy, which existing metrics fail to capture, we also developed TDEU, a domain-specific evaluation metric incorporating semantic understanding and diagnostic importance. Our comprehensive experiments demonstrate that MMIR-TCM significantly outperforms leading models, including GPT-4o and Gemini 2.5 Flash.

Lihui Luo, Joongwon Chae, Ziyan Chen +13

Institute of Biopharmaceutics and Health Engineering, Tsinghua Shenzhen International Graduate School, Shenzhen, 518000, China · Chinese Medicine Guangdong Laboratory, Zhuhai, 519000, China · XiaoMing TCM Hospital, Shenzhen, 518000 China +3

Multimodal RAG Medical Diagnosis Medical VLMs

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Mar 27, 2026

SkinGPT-X: A Self-Evolving Collaborative Multi-Agent System for Transparent and Trustworthy Dermatological Diagnosis

While recent advancements in Large Language Models have significantly advanced dermatological diagnosis, monolithic LLMs frequently struggle with fine-grained, large-scale multi-class diagnostic tasks and rare skin disease diagnosis owing to training data sparsity, while also lacking the interpretability and traceability essential for clinical reasoning. Although multi-agent systems can offer more transparent and explainable diagnostics, existing frameworks are primarily concentrated on Visual Question Answering and conversational tasks, and their heavy reliance on static knowledge bases restricts adaptability in complex real-world clinical settings. Here, we present SkinGPT-X, a multimodal collaborative multi-agent system for dermatological diagnosis integrated with a self-evolving dermatological memory mechanism. By simulating the diagnostic workflow of dermatologists and enabling continuous memory evolution, SkinGPT-X delivers transparent and trustworthy diagnostics for the management of complex and rare dermatological cases. To validate the robustness of SkinGPT-X, we design a three-tier comparative experiment. First, we benchmark SkinGPT-X against four state-of-the-art LLMs across four public datasets, demonstrating its state-of-the-art performance with a +9.6% accuracy improvement on DDI31 and +13% weighted F1 gain on Dermnet over the state-of-the-art model. Second, we construct a large-scale multi-class dataset covering 498 distinct dermatological categories to evaluate its fine-grained classification capabilities. Finally, we curate the rare skin disease dataset, the first benchmark to address the scarcity of clinical rare skin diseases which contains 564 clinical samples with eight rare dermatological diseases. On this dataset, SkinGPT-X achieves a +9.8% accuracy improvement, a +7.1% weighted F1 improvement, a +10% Cohen's Kappa improvement.

Zhangtianyi Chen, Yuhao Shen, Florensia Widjaja +6

School of Data Science, The Chinese University of Hong Kong, Shenzhen · Department of Dermatology, Tianjin Institute of Integrative Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China · Department of Dermatology, Beijing AnZhen Hospital, Capital Medical University, Beijing 100029, China..

Medical Diagnosis Skin Lesion Classification Multi-Agent LLM Systems Medical VLMs Explainable Medical Image Analysis Rare Disease Diagnosis

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