Abstract The skin is the largest organ in human body. Around 30%-70% of individuals worldwide have skin related health problems, for whom effective and efficient diagnosis is necessary. Recently, computer aided diagnosis (CAD) systems have been successfully applied to the recognition of skin cancers in dermatoscopic images. However, little work has concentrated on the commonly encountered skin diseases in clinical images captured by easily-accessed cameras or mobile phones. Meanwhile, for a CAD system, the representations of skin lesions are required to be understandable for dermatologists so that the predictions are convincing. To address this problem, we present effective representations inspired by the accepted dermatological criteria for diagnosing clinical skin lesions. We demonstrate that the dermatological criteria are highly correlated with measurable visual components. Accordingly, we design six medical representations considering different criteria for the recognition of skin lesions, and construct a diagnosis system for clinical skin disease images. Experimental results show that the proposed medical representations can not only capture the manifestations of skin lesions effectively, and consistently with the dermatological criteria, but also improve the prediction performance with respect to the state-of-the-art methods based on uninterpretable features