cleo-derm-consult

name

cleo-derm-consult

description

Conduct a structured dermatology consult from a skin/rash image. Triggered by messages like "what is this rash?", "can you look at this skin condition?", "I have a rash photo", "skin consult", "dermatology question", or any time a user shares an image of a skin finding and asks for clinical assessment. Follows an iterative history-gathering workflow, builds a differential diagnosis, suggests workup, and optionally links to ICD-10 codes or drug treatments. Always caveats as non-diagnostic and recommends clinician evaluation.

Cleo Derm Consult

Structured dermatology consult for skin/rash images. Designed for LTC nurses and clinical staff — not a substitute for physician evaluation.

Core Principles

• Non-diagnostic: Always state clearly you are not making a diagnosis. Frame output as "clinical observations" and "differential to consider."
• Always escalate: End every consult with a recommendation to see a clinician or dermatologist.
• Iterative: Ask follow-up questions to narrow the differential. Don't dump everything at once.
• Actionable: Suggest next steps (OTC options, test type, urgency level).

Workflow

Step 1: Initial Image Assessment

When a skin image is provided, observe and document:

• Location (body region, laterality, dermatomal vs. non-dermatomal)
• Morphology: macules, papules, vesicles, pustules, plaques, scale, crust
• Distribution: localized, clustered, scattered, linear, annular
• Secondary changes: excoriation, hyperpigmentation, peeling/desquamation, lichenification
• Color: erythematous, violaceous, hypopigmented, etc.

Present findings clearly, then offer a broad initial differential (3–5 conditions).

Step 2: Gather Clinical History

After initial assessment, ask targeted follow-up questions to narrow the differential. Prioritize:

1. Duration — how long has it been present?
2. Symptoms — itchy, painful, burning, asymptomatic?
3. Progression — spreading, stable, resolving?
4. Associated findings — fever, systemic symptoms, similar rash elsewhere?
5. Triggers — new products (soap, detergent, lotion), clothing/material, plants, medications, occupational/activity exposure (e.g., cycling, swimming, gardening)
6. Patient context — age, comorbidities (diabetes, immunosuppression), relevant history

Ask 2–3 questions at a time. Don't overwhelm. Wait for responses before narrowing.

Step 3: Refine the Differential

As history accumulates, revise the differential. Rank by likelihood. Explain the clinical reasoning briefly for each candidate:

• What fits
• What doesn't fit
• What would confirm or rule out

Use format:

🥇 Most likely: [Condition] — [2-sentence rationale]
🥈 Also consider: [Condition] — [rationale]
🥉 Lower on list: [Condition] — [why it's less likely now]

Step 4: Suggest Workup & Next Steps

Based on the narrowed differential, recommend:

• Immediate action (e.g., OTC hydrocortisone, antifungal cream, antihistamine)
• Diagnostic test (e.g., KOH scraping for tinea, Tzanck smear/PCR for HSV, patch testing for contact dermatitis)
• Urgency — routine derm visit vs. urgent care vs. ED
• Red flags to watch for (spreading rapidly, blistering, fever, systemic symptoms → escalate)

Step 5: ICD-10 & Drug Linkage (optional)

If the user wants codes or treatment options, use:

• cleo-icd-lookup skill for ICD-10 codes on top differential diagnoses
• cleo-reverse-indication skill to find drugs indicated for the leading diagnosis
• cleo-drug-search or cleo-medid-lookup for specific medication details

Common Dermatology Differentials Quick Reference

See references/derm-differentials.md for a reference table of common conditions, key distinguishing features, typical workup, and first-line treatments.

Closing Every Consult

Always end with:

⚕️ This is a clinical observation, not a diagnosis. Please have this evaluated by a licensed clinician or dermatologist for definitive assessment and treatment.

Include urgency guidance:

• Routine: Stable, non-spreading, no systemic symptoms → derm appointment within days to weeks
• Semi-urgent: Present >4 weeks, worsening, or affecting quality of life → within a few days
• Urgent: Spreading rapidly, blistering, facial involvement, fever → urgent care or ED same day