Clinical decision support that reasons like a dermatologist: read a pigmented lesion by ABCDE and biopsy it right, step acne and psoriasis by severity, and catch the drug eruption that is turning into SJS/TEN — with the decision rule and exactly what would change it. Built for verified physicians.
Two real dermatology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
A changing pigmented lesion, asymmetric with irregular borders and color variation, 8 mm across — the approach?
Apply the ABCDE criteria — asymmetry, border irregularity, color variation, diameter over 6 mm and evolution — together with the ugly-duckling sign, and examine it with dermoscopy. A lesion that looks suspicious needs an excisional biopsy with a narrow margin to give an accurate Breslow depth; avoid a shave or partial biopsy of a suspected melanoma, which can under-stage it. Then let the Breslow thickness drive the wide local excision, sentinel-node discussion and staging.
Decision ruleABCDE + ugly-duckling + dermoscopy → excisional biopsy with narrow margin (not shave) for accurate Breslow; Breslow thickness drives wide local excision, sentinel node and staging.
Not established from this alone — the histology, the Breslow depth and the dermoscopy change the diagnosis and the excision.
A febrile patient on a new drug with painful dusky skin, targetoid lesions, mucosal erosions and a positive Nikolsky sign — the move?
This is Stevens-Johnson syndrome or toxic epidermal necrolysis, a dermatologic emergency. Stop the culprit drug at once — the single most important step — and transfer to burn-unit or intensive care for fluid, electrolyte and wound management as for a burn. Score severity with SCORTEN, involve ophthalmology and urology early for mucosal disease, and consider systemic immunomodulation such as cyclosporine or an etanercept-based regimen. Sepsis is the main threat.
Decision ruleSJS/TEN (dusky painful skin, targetoid lesions, mucosal erosions, Nikolsky positive) → stop the culprit drug immediately; burn/ICU-level supportive care; SCORTEN; ophthalmology + urology; consider immunomodulation.
Not established from this alone — the extent of detachment, the mucosal involvement and SCORTEN change the prognosis and the care.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Assess with the ABCDE criteria and the ugly-duckling sign, supported by dermoscopy, and take a history of change, itch or bleeding. When melanoma is a possibility, perform an excisional biopsy with a 1 to 3 mm margin down to fat to give a reliable Breslow depth; avoid a superficial shave that can transect the tumor. The confirmed Breslow thickness and ulceration then set the wide local excision margin, the sentinel-node discussion and staging.AAD · melanoma
Decision ruleABCDE + ugly-duckling + dermoscopy; excisional biopsy (1–3 mm margin, to fat) for accurate Breslow; Breslow + ulceration drive wide excision margin, sentinel node and staging.
Missing data: the histology, the Breslow depth and the ulceration change the surgery and the stage.
Match the regimen to severity. For comedonal and mild acne, a topical retinoid with benzoyl peroxide is the backbone. For moderate inflammatory acne, add a topical or oral antibiotic — always paired with benzoyl peroxide to limit resistance, and never as monotherapy — or hormonal therapy in appropriate patients. For severe, nodulocystic or scarring acne that fails these, oral isotretinoin is the definitive option, with its pregnancy-prevention and monitoring requirements.AAD · acne
Decision ruleMild → topical retinoid + benzoyl peroxide; moderate → add antibiotic (with benzoyl peroxide, never monotherapy) or hormonal therapy; severe/nodulocystic/scarring or refractory → isotretinoin with monitoring and pregnancy prevention.
Missing data: the severity, the scarring and the patient factors change the regimen.
Grade by body-surface area and the impact on function and quality of life, and screen for psoriatic arthritis. Limited plaque disease responds to topical corticosteroids and vitamin D analogues, with phototherapy for wider involvement. Moderate-to-severe disease — roughly more than 10 percent body-surface area, or disabling sites, or joint disease — warrants a systemic agent such as methotrexate or, increasingly first-line, a biologic targeting TNF, IL-17 or IL-23. Match the biologic to comorbidity.AAD · psoriasis
Decision ruleGrade by BSA + quality of life + screen for psoriatic arthritis; limited → topical steroid + vitamin D (phototherapy if wider); moderate-severe (BSA over 10%, disabling sites, or joint disease) → methotrexate or a biologic (TNF/IL-17/IL-23) by comorbidity.
Missing data: the surface area, the sites, joint disease and comorbidity change the escalation.
Distinguish a benign morbilliform drug rash from a life-threatening one by the danger signs: skin pain, dusky or targetoid lesions, blisters, a positive Nikolsky sign, mucosal erosions, fever and facial edema. These point to Stevens-Johnson syndrome, toxic epidermal necrolysis or DRESS. Stop the offending drug immediately, admit for burn-level supportive care, score SCORTEN, and bring in ophthalmology and urology for mucosal disease. Consider cyclosporine or a TNF inhibitor.AAD · SJS/TEN
Decision ruleDanger signs (skin pain, dusky/targetoid lesions, blisters, Nikolsky positive, mucosal erosions, fever, facial edema) → SJS/TEN or DRESS; stop the drug now; burn-level care; SCORTEN; ophthalmology + urology; consider immunomodulation.
Missing data: the mucosal involvement, the detachment area and SCORTEN change the management and prognosis.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist dermatology colleague across skin cancer, inflammatory disease, the undifferentiated rash, drug eruptions, infections and hair and nails — cited, non-directive, always with the decision rule.
Deep specialist agents for dermatopathology, dermatologic surgery and Mohs, pediatric dermatology and complex medical dermatology — each its own soul and knowledge base — plus your own uploaded materials.
From the biopsy technique to the drug that must stop today the margin is thin. Only one of these reasons like a dermatology colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the dermatology build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment dermatology opens — with your Founding Dermatologist offer.
One email at launch. No spam, ever.
It reasons in the frameworks you use — the ABCDE criteria, the acne and psoriasis severity ladders and the SJS/TEN danger signs — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in clinic and on consults. Access is gated to verified physicians.
Dermatopathology, dermatologic surgery and Mohs, pediatric dermatology and complex medical dermatology each have their own deep specialist agent on the Pro plan, on top of the full dermatology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited dermatology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
HeyHippocrates