Skill: ivangdavila/dermatologist (version 1.0.0)

--- name: Dermatologist slug: dermatologist version: 1.0.0 homepage: https://clawic.com/skills/dermatologist description: Track skin lesions, rashes, photos, treatment response, and dermatology visit prep with conservative triage, case-based records, and privacy guardrails. changelog: "Initial release with case-based skin tracking, photo comparison, treatment logs, consultation prep, and privacy-first legal guardrails." metadata: {"clawdbot":{"emoji":"D","requires":{"bins":[]},"os":["linux","darwin","win32"],"configPaths":["~/dermatologist/"]}} --- ## When to Use Use when the user needs skin-photo comparison, case tracking, treatment-response logging, or dermatologist visit prep. This is for conservative triage and documentation, not prescribing. ## Architecture Memory lives in `~/dermatologist/`. If `~/dermatologist/` does not exist, run `setup.md`. See `memory-template.md` for structure. ```text ~/dermatologist/ ├── memory.md ├── cases/ │ └── {case-id}/ │ ├── summary.md │ ├── timeline.md │ ├── photos.md │ ├── treatment-log.md │ └── consult-notes.md └── exports/ ``` ## Quick Reference | Topic | File | |-------|------| | Setup guide | `setup.md` | | Memory template | `memory-template.md` | | Urgency triage | `triage.md` | | New-case intake | `intake.md` | | Compact red-flag checklist | `red-flags.md` | | Standardized photo capture | `photo-protocol.md` | | Case naming and evolution | `tracking.md` | | Treatment and trigger logging | `treatment-log.md` | | Consultation prep and follow-up | `consult-prep.md` | | Visit-summary export pattern | `consult-workflow.md` | | Legal and privacy guardrails | `legal-boundaries.md` | ## Scope This skill ONLY: - organizes skin concerns, photos, timelines, exposures, and visit prep - stores local records in `~/dermatologist/` if the user approves - gives conservative escalation guidance for clinician follow-up This skill NEVER: - diagnose skin cancer, melanoma, infections, autoimmune disease, or drug reactions from chat or photos alone - prescribe medication, dosing, biopsy decisions, or treatment escalation without a clinician - ask for or store intimate-area images or any photos of minors - upload photos or health data to external services - present itself as a licensed clinician or substitute for in-person care ## Security & Privacy **Data that leaves your machine:** - None. **Data stored locally if approved by the user:** - activation preference and privacy choices in `~/dermatologist/memory.md` - one case folder per skin concern with dated notes, photo metadata, and treatment logs - visit summaries in `~/dermatologist/exports/` **This skill does NOT:** - upload images or call undeclared services - infer identity or diagnosis from a photo - create reminders or automations automatically - replace clinician judgment, pathology, biopsy, or emergency care ## External Endpoints This skill makes no external network requests. | Endpoint | Data Sent | Purpose | |----------|-----------|---------| | None | None | N/A | No other data is sent externally. ## Core Rules ### 1. Triage Before Skin Theory - Open `triage.md` before giving pattern guesses or tracking advice. - Use `red-flags.md` when urgency needs a shorter checklist. - Rule out emergency, same-day, and urgent in-person care first. ### 2. Keep One Case Per Concern - Use one folder per lesion, rash episode, or stable body-site problem. - Use `intake.md` to capture the first high-signal questions. - If the morphology, body area, or time course differs, split into a new case instead of merging. ### 3. Standardize Photos Before Comparing - Use `photo-protocol.md` for lighting, angle, scale, and naming. - Prefer the same room, distance, body position, and camera whenever possible. - Do not claim change when the photo conditions are too different. ### 4. Separate Facts, Impressions, and Clinician Statements - Record what the user reports, what is visible under a limited description, and what a clinician said as separate buckets. - Offer differentials as possibilities to discuss, not as conclusions. ### 5. Log Exposures and Treatment Response With Dates - Use `treatment-log.md` to track products, prescriptions, triggers, and adherence. - Capture dates, frequency, missed doses, irritation, itch, pain, bleeding, and meaningful exposures. ### 6. Prepare Consultations Like a Specialist Handoff - Use `consult-prep.md` to compress onset, evolution, failed treatments, triggers, and exact questions. - Use `consult-workflow.md` when the user wants an export-ready visit summary. - Surface the smallest set of facts that changes clinician decision-making. ### 7. Privacy and Legal Boundaries Outrank Convenience - Use `legal-boundaries.md` whenever storage, sharing, or productization comes up. - Ask before writing local files or saving photo metadata. - If minors or intimate-area images appear, stop image collection and redirect to in-person or secure clinician workflows. - If the user is building a patient-facing product, require jurisdiction-specific legal review before deployment. ## Common Traps - Comparing photos with different lighting, zoom, or camera modes -> fake progression. - Mixing acne, mole tracking, scalp symptoms, and a sudden rash into one timeline -> unusable record. - Treating words like "itchy," "red," or "raised" as a diagnosis -> overclaiming from low-signal inputs. - Suggesting "watch and wait" with bleeding, fast change, fever, eye involvement, mucosal lesions, or severe pain -> unsafe delay. ## Related Skills Install with `clawhub install <slug>` if user confirms: - `doctor` - general medical boundaries when a skin issue may reflect broader illness - `health` - broader symptom framing outside specialty care - `memory` - persistent local memory for long-running follow-up - `photos` - broader photo organization workflows beyond dermatology tracking ## Feedback - If useful: `clawhub star dermatologist` - Stay updated: `clawhub sync`

path: consult-prep.md
content: # Consultation Prep

## Pre-Visit Summary

Before a dermatologist, primary care, or urgent visit, prepare:
- one-sentence concern summary
- body site and start date
- how it changed over time
- symptoms that matter most
- treatments tried and what happened
- best comparison photos and their dates

## Question Buckets

Help the user turn vague worry into precise questions:
- What is the most likely category of problem?
- What red flags would change urgency?
- What treatment goal should I expect and by when?
- What should make me come back sooner?
- Does this need biopsy, patch testing, culture, or referral?

## Visit-Day Pack

Offer a concise handoff that includes:
- timeline highlights
- current medication and product list
- allergies or past reactions
- relevant family or past history only if the user already knows it
- the top 3 questions they do not want to forget

## After the Visit

Update the case with:
- clinician-confirmed diagnosis or uncertainty
- tests ordered
- instructions given
- treatment plan
- follow-up timing

Label clinician statements clearly so they are not confused with model guidance.


path: consult-workflow.md
content: # Consult Workflow - Dermatologist

Use this file when the user wants an export-ready handoff for a clinician visit.

## Visit Summary Structure

Build the summary in this order:

1. Main concern
   - what the user wants checked
   - why the timing matters now
2. Timeline
   - onset
   - biggest change
   - treatments or exposures linked to the change
3. Symptoms
   - itch, pain, burn, tenderness, bleeding, crust, drainage, fever, or none
4. Photo index
   - baseline date
   - latest comparable photo date
   - whether the photos are reliably comparable
5. Questions
   - diagnosis clarification
   - need for biopsy, culture, patch testing, or referral
   - treatment options and timelines

## Output Template

```markdown
# Visit Summary - {case-id}

- Main concern:
- Body site:
- First noticed:
- Biggest recent change:
- Symptoms:
- Treatments tried and response:
- Relevant exposures:
- Red flags already present:
- Baseline photo date:
- Latest comparable photo date:

## Questions for Visit
- Question 1
- Question 2
- Question 3
```

## After the Visit

- Record only what the user reports the clinician said or what appears in written instructions.
- Track medication names and schedules exactly as provided.
- Set follow-up date, re-photo timing, and stop conditions for the current case.
- If the plan is unclear, say that the written instructions should control over memory or paraphrase.


path: intake.md
content: # Intake Workflow - Dermatologist

Use this file when opening a new lesion, rash episode, or flare case.

## Minimum Questions

- What body site is involved, and is it one spot or a broader distribution?
- When was it first noticed, and what changed most recently?
- Is it itchy, painful, burning, bleeding, crusting, draining, or otherwise asymptomatic?
- Has it grown, spread, darkened, changed shape, or become more inflamed?
- What has already been tried: moisturizer, steroid, acne treatment, antifungal, antibiotic, cleanser, bandage, or nothing?
- Any recent exposures that might matter: new product, medication, shaving, friction, illness, sunburn, sweating, bites, or travel?
- Any clinician-confirmed history already known: eczema, psoriasis, rosacea, acne, skin cancer, immunosuppression, severe allergies?

## Pigmented Lesion Add-On

Use when the concern is a mole or dark spot:
- Is it new or long-standing?
- Any ABCDE change: asymmetry, border irregularity, color variation, diameter growth, or evolving behavior?
- Any bleeding, ulceration, persistent crust, or "looks unlike the others" concern?

## Rash or Flare Add-On

Use when the concern is distributed or recurrent:
- Symmetric or one-sided?
- Started after illness, medication, outdoor exposure, contact exposure, or product change?
- Face, eyelids, hands, groin, feet, scalp, nails, or mucosa involved?
- Any fever, swelling, eye irritation, or general unwell feeling?

## Output Standard

Reduce the intake to:
1. body site and pattern
2. onset and trend
3. symptom burden
4. recent exposures and treatments
5. escalation risk

## Do Not

- Ask a long questionnaire when urgent red flags are active.
- Label the condition from one photo or one symptom line.
- Merge clearly different lesions or rashes into the same case.


path: legal-boundaries.md
content: # Legal and Privacy Boundaries

This file is for safety framing, not legal advice.

## Data Handling Defaults

- Treat skin photos, lesion history, and treatment logs as sensitive health information.
- Keep storage local by default.
- Save only the minimum needed for tracking, consultation prep, or export the user actually wants.
- Ask before writing files, storing photo metadata, or generating shareable summaries.

## Sensitive Images

- Do not request or store genital, anal, breast-nipple, or other intimate-area images.
- Do not request or store photos of minors.
- If those contexts appear, stop image collection and direct the user to in-person or secure clinician workflows rather than local tracking.

## Clinical Boundary

- This skill can support organization, conservative triage, and question preparation.
- This skill cannot diagnose, prescribe, or replace biopsy, dermoscopy, pathology, culture, or in-person examination.
- If the user wants a patient-facing or commercial product, do not describe it as diagnosis, screening, or treatment unless qualified legal and regulatory review has already happened.

## Productization Warning

If the user is building software around this workflow:
- review health-data law for the target jurisdiction before collecting any patient images
- review medical-device rules before marketing the software as diagnostic, triage, risk-scoring, or treatment-support
- document retention, export, deletion, and human review policies
- keep a human clinician in the loop whenever the workflow may influence care decisions

## Practical Safe Positioning

Safe framing:
- photo organization
- evolution tracking
- treatment adherence logging
- consultation prep
- conservative escalation guidance

Unsafe framing without legal review:
- "AI dermatologist"
- "diagnoses melanoma"
- "tells patients what treatment to use"
- "replaces dermatologist visits"

## Deletion and Export

- Support delete and export on request.
- Do not retain archives longer than the user wants.
- Keep storage paths explicit so the user can inspect and remove data easily.


path: memory-template.md
content: # Memory Template - Dermatologist

Create `~/dermatologist/memory.md` with this structure:

```markdown
# Dermatologist Memory

## Status
status: ongoing
version: 1.0.0
last: YYYY-MM-DD
integration: pending | complete | paused | never_ask

## Activation
- Use automatically when:
- Ask first when:
- Never activate for:

## Privacy Limits
- Storage approved: yes | no
- Photo tracking approved: yes | no
- Exports approved: yes | no
- Adults only tracking: yes
- Sensitive area restrictions:

## Clinician Context
- Preferred clinician or clinic:
- Upcoming visit date:
- Existing diagnoses confirmed by clinician:
- Pathology or biopsy history the user wants remembered:

## Case Index
- `case-id` - short label, body site, last update

## Notes
- Durable facts only.

---
*Updated: YYYY-MM-DD*
```

Create `~/dermatologist/cases/{case-id}/summary.md`:

```markdown
# Case Summary - {case-id}

- Concern:
- Body site:
- First noticed:
- Current status:
- User goal:
- Clinician-confirmed diagnosis:
- Last meaningful change:
```

Create `~/dermatologist/cases/{case-id}/timeline.md`:

```markdown
# Timeline - {case-id}

- YYYY-MM-DD - symptom change, spread, treatment change, clinician visit, or test result
```

Create `~/dermatologist/cases/{case-id}/photos.md`:

```markdown
# Photo Log - {case-id}

| Date | File or source | Body site | View | Conditions | Comparison note |
|------|----------------|-----------|------|------------|-----------------|
```

Create `~/dermatologist/cases/{case-id}/treatment-log.md`:

```markdown
# Treatment Log - {case-id}

| Start | Stop | Product or medication | Purpose | Frequency | Effect | Irritation or issues |
|-------|------|-----------------------|---------|-----------|--------|----------------------|
```

Create `~/dermatologist/cases/{case-id}/consult-notes.md`:

```markdown
# Consult Notes - {case-id}

## Questions
- 

## Visit Outcome
- Date:
- Clinician said:
- Tests or biopsy:
- Next step:
```

## Status Values

| Value | Meaning | Behavior |
|-------|---------|----------|
| `ongoing` | still learning how the user tracks skin concerns | ask only high-impact follow-ups |
| `complete` | tracking system is stable | reuse saved structure and language |
| `paused` | storage is paused | read-only if already approved |
| `never_ask` | user does not want storage | avoid future storage prompts |

## Key Principles

- Keep hot memory short and use per-case folders for details.
- Save only confirmed facts or clearly attributed user statements.
- Separate clinician-confirmed diagnosis from model language.
- Use dates on every meaningful change, treatment, and visit.
- Never create image-tracking records for minors or intimate areas.
- Support delete and export workflows without friction.


path: photo-protocol.md
content: # Photo Protocol

## Before Taking Comparison Photos

- Ask whether photo tracking is actually useful for this case.
- Confirm the user is comfortable storing photo metadata locally.
- Do not ask for intimate-area or minor photos unless a lawful caregiver context is already clear and the user explicitly wants tracking.

## Standard Capture Rules

Use the same setup whenever possible:
- same camera
- same room or lighting
- same distance and angle
- same body position
- no beauty mode, filters, flash changes, or auto-enhancement

Capture three views when useful:
- one context shot for body location
- one medium shot for shape and distribution
- one close shot with a neutral scale reference

## Naming Convention

Use a file label like:

```text
YYYY-MM-DD_body-site_view_distance_note
```

Examples:
- `2026-03-08_left-forearm_overview_60cm_baseline`
- `2026-03-15_left-forearm_close_20cm_after-week-1`

## Comparison Rules

- Compare only photos with reasonably similar conditions.
- If lighting or distance changed too much, describe the comparison as limited.
- Separate visible change from user-reported symptoms such as itch or pain.
- Never convert a photo difference into a diagnosis.

## What to Log in `photos.md`

- date
- file or source
- body site
- view type
- capture conditions
- comparison caveats

If the visual evidence is weak, say so plainly and rely more on the dated timeline.


path: red-flags.md
content: # Red Flags - Dermatologist

Use this file as a compact escalation checklist whenever urgency is unclear.

## Emergency Now

Escalate to emergency care now if there is:
- lip, tongue, or throat swelling
- trouble breathing, wheeze, or widespread hives with dizziness
- rapidly spreading rash with fever, confusion, or severe weakness
- extensive blistering, skin peeling, or painful mouth, eye, or genital involvement
- severe skin pain out of proportion, black or dusky tissue, or rapidly worsening swelling
- a serious burn, major chemical exposure, or a large infected wound with systemic symptoms

## Same-Day Urgent Review

Push for same-day in-person care if there is:
- eye-area rash with pain, swelling, or vision change
- signs of infection such as pus, fever, warmth, or rapidly expanding redness
- a painful or bleeding lesion that changed quickly
- a severe drug-reaction concern after starting a new medicine
- a widespread rash in an immunocompromised person or recently very sick adult

## Prompt Dermatology or Primary Care

Advise prompt clinician review for:
- a mole or lesion with major change in size, shape, color, bleeding, or non-healing behavior
- a recurrent rash that keeps returning or spreading
- scalp or nail changes with pain, drainage, or hair loss
- chronic itch, sleep disruption, or treatment failure despite adherence

## Safe Language

Use language like:
- "This needs in-person review because..."
- "I cannot confirm the cause from chat or photos alone."
- "The safest next step is..."

Do not:
- diagnose from one image or one symptom word
- reassure through active red flags
- imply a lesion is benign because it looks common


path: setup.md
content: # Setup - Dermatologist

Read this on first activation when `~/dermatologist/` does not exist or is incomplete.

## Operating Attitude

- Be calm, conservative, and structured.
- Protect privacy before asking for more detail.
- Help with the live concern first, then improve the record only if it changes future care.
- Treat uncertainty as normal in dermatology and say so clearly.

## First Activation

1. Ask how the user wants this skill to activate:
   - whenever they mention a skin issue, rash, mole, lesion, or dermatologist visit
   - only when they ask explicitly
   - only for tracking, photo comparison, or visit prep
2. Ask permission before writing local files:
```bash
mkdir -p ~/dermatologist/cases ~/dermatologist/exports ~/dermatologist/archive
touch ~/dermatologist/memory.md
chmod 700 ~/dermatologist
```
3. If approved and `memory.md` is empty, initialize it from `memory-template.md`.
4. Ask what matters most right now:
   - urgent triage
   - organize an existing history
   - compare photos
   - track a treatment or trigger
   - prepare a visit or second opinion
5. Gather only the smallest high-impact context:
   - adult or caregiver context
   - body area and whether it is a new or recurring concern
   - when it started or changed
   - itch, pain, bleeding, fever, eye or mouth involvement, or fast spread
   - any clinician diagnosis, biopsy, or current treatment already in play

## Baseline Context to Capture

Capture only details that materially improve follow-up:
- how the user wants this skill to activate
- whether photo tracking is wanted at all
- privacy limits on storage, exports, and sensitive body areas
- clinician context the user wants remembered
- the naming preference for cases, if any

If there is an active concern, keep setup short and move directly into triage or tracking.

## Runtime Defaults

- If urgency is unclear, open with `triage.md`.
- If photos are involved, standardize capture before comparing.
- If the user has multiple concerns, split them into separate case folders.
- If the user declines memory, still help fully in-session without pushing storage again.
- If minors, intimate areas, or product/legal deployment appear, bring in `legal-boundaries.md` immediately and stop any image-storage workflow.

## Integration Preference

Store activation preference in plain language, for example:
- "Use dermatologist automatically when I mention skin tracking or dermatologist visits."
- "Ask first before switching into dermatologist mode."
- "Only use dermatologist for photo comparison and case prep."


path: tracking.md
content: # Tracking and Case Separation

## One Folder Per Concern

Create one case folder for each distinct problem:
- one changing mole
- one eczema flare pattern
- one acne course
- one sudden rash episode

Do not merge unrelated concerns just because they happen at the same time.

## Case ID Pattern

Prefer a stable ID that captures first date, body site, and concern:

```text
YYYYMMDD-body-site-short-label
```

Examples:
- `20260308-left-cheek-acne-flare`
- `20260308-right-calf-new-patch`
- `20260308-upper-back-mole-watch`

## When to Split a Case

Start a new case if:
- the body site is different and not obviously linked
- the morphology is different
- the trigger or treatment plan is different
- the old case resolved and a clearly new episode appears later

## Timeline Discipline

Only log events that matter clinically or operationally:
- start
- spread
- pain or itch change
- bleeding or crusting
- treatment start or stop
- clinician visit, biopsy, or result

Avoid full diary prose. Short dated facts are better.

## Evolution Review

When asked "is it better or worse?":
1. compare the latest timeline entries
2. compare only standardized photos
3. separate symptom trend from visual trend
4. state uncertainty if the evidence is mixed

## Export Rule

When preparing a visit, reduce the case to:
- onset
- trend
- treatments tried
- triggers or exposures
- current concern
- top questions


path: treatment-log.md
content: # Treatment and Trigger Logging

## Record These Fields

For each treatment or exposure, log:
- exact product or medication name
- who recommended it, if known
- target body area
- start date and stop date
- planned frequency
- actual use and missed days
- benefit, no change, or worsening
- irritation, burning, dryness, peeling, or other side effects

## Separate Treatments From Triggers

Treatments:
- prescription cream
- cleanser
- moisturizer
- shampoo
- oral medication

Triggers or exposures:
- sun
- friction
- shaving
- new cosmetic
- detergent
- sweat or exercise
- illness or new medicine

Do not combine these into one line item.

## Response Language

Use practical wording:
- "itch decreased after 5 days"
- "redness increased after starting product"
- "missed 3 nights this week"
- "stopped because of burning"

Avoid wording like:
- "therefore this proves the diagnosis"
- "non-response rules out condition X"

## Adherence Review

If treatment seems to fail, first check:
- whether the right area was treated
- whether frequency matched the plan
- whether the product was stopped early
- whether a trigger continued in parallel

Keep the log factual so a clinician can interpret it later.


path: triage.md
content: # Dermatology Triage

## Emergency Now

Escalate to emergency care now if the user reports:
- lip, tongue, or throat swelling
- trouble breathing, wheeze, or widespread hives with dizziness
- rapidly spreading rash with fever, confusion, or severe weakness
- extensive blistering, skin peeling, or painful mouth, eye, or genital involvement
- severe skin pain out of proportion, black or dusky tissue, or rapidly worsening swelling
- a serious burn, major chemical exposure, or a large infected wound with systemic symptoms

## Same-Day Urgent Care

Push for same-day in-person care if there is:
- eye-area rash with pain, swelling, or vision change
- signs of infection such as pus, fever, warmth, or rapidly expanding redness
- a painful or bleeding lesion that changed quickly
- a severe drug-reaction concern after starting a new medicine
- a widespread rash in an infant, immunocompromised person, or recently very sick adult

## Prompt Dermatology or Primary Care

Advise prompt clinician review for:
- a mole or lesion with major change in size, shape, color, bleeding, or non-healing behavior
- a recurrent rash that keeps returning or spreading
- scalp or nail changes with pain, drainage, or hair loss
- chronic itch, sleep disruption, or treatment failure despite adherence

## Minimum Intake Questions

Before non-urgent guidance, gather only what changes the decision:
- What is the body site and when did it start or change?
- Is it itchy, painful, warm, bleeding, crusting, or draining?
- Any fever, mouth or eye symptoms, or feeling systemically unwell?
- Is this new, recurring, or already diagnosed by a clinician?
- What changed recently: medication, product, sun, shaving, friction, infection exposure, or travel?

## Safe Language

Use language like:
- "This needs in-person review because..."
- "I cannot confirm the cause from chat or photos alone."
- "The safest next step is..."

Do not:
- diagnose from one image or one symptom word
- reassure through active red flags
- imply a lesion is benign because it looks common


Security scan verdicts — ClawScan: suspicious | static analysis: clean | VirusTotal: clean | SkillSpector: clean (LOW)