SkinGPT-R1: Adapter-Only Dual Distillation for Efficient Dermatology Reasoning

We present SkinGPT-R1, a dermatology focused vision language model that makes diagnostic chain of thought reasoning explicit, step by step, and verifiable. To support skin specific reasoning, we build DermCoT, a corpus of standardized dermatologic chain of thought narratives that combines 10,000 DermEval filtered training cases with 3,000 dermatologist scored certified cases, and we define DermEval as a physician aligned six dimensional evaluator and DermBench as the corresponding benchmark for dermatologic chain of thought quality. On DermBench, across 14 general, reasoning, and medical vision language models, SkinGPT-R1 achieves an average score of 4.031 out of 5 over the six clinician defined dimensions, ranks 1st among all systems, and improves the average score over Vision-R1 by about 41%. On three dermatology classification benchmarks, SkinGPT-R1 delivers stable accuracy gains over Vision-R1 and remains competitive among strong vision language models. Ablation results further show that DermCoT based chain of thought supervision provides substantial improvements over the base model and that adding dermatology aware visual distillation yields consistent additional gains in both narrative quality and recognition.

CoTBox-TTT: Grounding Medical VQA with Visual Chain-of-Thought Boxes During Test-time Training

Medical visual question answering could support clinical decision making, yet current systems often fail under domain shift and produce answers that are weakly grounded in image evidence. This reliability gap arises when models attend to spurious regions and when retraining or additional labels are impractical at deployment time. We address this setting with CoTBox-TTT, an evidence-first test-time training approach that adapts a vision-language model at inference while keeping all backbones frozen. The method updates only a small set of continuous soft prompts. It identifies question-relevant regions through a visual chain-of-thought signal and encourages answer consistency across the original image and a localized crop. The procedure is label free, and plug and play with diverse backbones. Experiments on medical VQA show that the approach is practical for real deployments. For instance, adding CoTBox-TTT to LLaVA increases closed-ended accuracy by 12.3% on pathVQA.

Towards Trustworthy Dermatology MLLMs: A Benchmark and Multimodal Evaluator for Diagnostic Narratives

Multimodal large language models (LLMs) are increasingly used to generate dermatology diagnostic narratives directly from images. However, reliable evaluation remains the primary bottleneck for responsible clinical deployment. We introduce a novel evaluation framework that combines DermBench, a meticulously curated benchmark, with DermEval, a robust automatic evaluator, to enable clinically meaningful, reproducible, and scalable assessment. We build DermBench, which pairs 4,000 real-world dermatology images with expert-certified diagnostic narratives and uses an LLM-based judge to score candidate narratives across clinically grounded dimensions, enabling consistent and comprehensive evaluation of multimodal models. For individual case assessment, we train DermEval, a reference-free multimodal evaluator. Given an image and a generated narrative, DermEval produces a structured critique along with an overall score and per-dimension ratings. This capability enables fine-grained, per-case analysis, which is critical for identifying model limitations and biases. Experiments on a diverse dataset of 4,500 cases demonstrate that DermBench and DermEval achieve close alignment with expert ratings, with mean deviations of 0.251 and 0.117 (out of 5), respectively, providing reliable measurement of diagnostic ability and trustworthiness across different multimodal LLMs.