SkinFlow: Efficient Information Transmission for Open Dermatological Diagnosis via Dynamic Visual Encoding and Staged RL

General-purpose Large Vision-Language Models (LVLMs), despite their massive scale, often falter in dermatology due to "diffuse attention" - the inability to disentangle subtle pathological lesions from background noise. In this paper, we challenge the assumption that parameter scaling is the only path to medical precision. We introduce SkinFlow, a framework that treats diagnosis as an optimization of visual information transmission efficiency. Our approach utilizes a Virtual-Width Dynamic Vision Encoder (DVE) to "unfold" complex pathological manifolds without physical parameter expansion, coupled with a two-stage Reinforcement Learning strategy. This strategy sequentially aligns explicit medical descriptions (Stage I) and reconstructs implicit diagnostic textures (Stage II) within a constrained semantic space. Furthermore, we propose a clinically grounded evaluation protocol that prioritizes diagnostic safety and hierarchical relevance over rigid label matching. Empirical results are compelling: our 7B model establishes a new state-of-the-art on the Fitzpatrick17k benchmark, achieving a +12.06% gain in Top-1 accuracy and a +28.57% boost in Top-6 accuracy over the massive general-purpose models (e.g., Qwen3VL-235B and GPT-5.2). These findings demonstrate that optimizing geometric capacity and information flow yields superior diagnostic reasoning compared to raw parameter scaling.

LaFFi: Leveraging Hybrid Natural Language Feedback for Fine-tuning Language Models

Fine-tuning Large Language Models (LLMs) adapts a trained model to specific downstream tasks, significantly improving task-specific performance. Supervised Fine-Tuning (SFT) is a common approach, where an LLM is trained to produce desired answers. However, LLMs trained with SFT sometimes make simple mistakes and result in hallucinations on reasoning tasks such as question-answering. Without external feedback, it is difficult for SFT to learn a good mapping between the question and the desired answer, especially with a small dataset. This paper introduces an alternative to SFT called Natural Language Feedback for Finetuning LLMs (LaFFi). LaFFi has LLMs directly predict the feedback they will receive from an annotator. We find that requiring such reflection can significantly improve the accuracy in in-domain question-answering tasks, providing a promising direction for the application of natural language feedback in the realm of SFT LLMs. Additional ablation studies show that the portion of human-annotated data in the annotated datasets affects the fine-tuning performance.