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

Dermatologic diseases impose a large and growing global burden, affecting billions and substantially reducing quality of life. While modern therapies can rapidly control acute symptoms, long-term outcomes are often limited by single-target paradigms, recurrent courses, and insufficient attention to systemic comorbidities. Traditional Chinese medicine (TCM) provides a complementary holistic approach via syndrome differentiation and individualized treatment, but practice is hindered by non-standardized knowledge, incomplete multimodal records, and poor scalability of expert reasoning. We propose DERM-3R, a resource-efficient multimodal agent framework to model TCM dermatologic diagnosis and treatment under limited data and compute. Based on real-world workflows, we reformulate decision-making into three core issues: fine-grained lesion recognition, multi-view lesion representation with specialist-level pathogenesis modeling, and holistic reasoning for syndrome differentiation and treatment planning. DERM-3R comprises three collaborative agents: DERM-Rec, DERM-Rep, and DERM-Reason, each targeting one component of this pipeline. Built on a lightweight multimodal LLM and partially fine-tuned on 103 real-world TCM psoriasis cases, DERM-3R performs strongly across dermatologic reasoning tasks. Evaluations using automatic metrics, LLM-as-a-judge, and physician assessment show that despite minimal data and parameter updates, DERM-3R matches or surpasses large general-purpose multimodal models. These results suggest structured, domain-aware multi-agent modeling can be a practical alternative to brute-force scaling for complex clinical tasks in dermatology and integrative medicine.