The Bad Skin Clinic: Episode 1

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I will be posting blog entries for each episode of #TheBadSkinClinic, where you can access the insight and information about each patient, per episode, in one place! Be sure to keep updated with the blog so you don't miss out on any posts! There will be uploads every Saturday.

If you haven't already, go check out my Instagram (@dremmacraythorne), where there are also frequent posts about the wonderful patients from the show! I am very grateful to able to be a part of such a great opportunity. My aim is to always help patients as much as I can, and now I am also able to help spread awareness of skin conditions alongside the patients. A great big thank you to @quest_red once again!

Back Acne - Scott

Watch me treat Scott tonight on The Bad Skin Clinic’s 1st episode tonight! It’s been great to work with @quest_red - go check it out!

I was so delighted to be part of Scott’s story. He had been really stuck in a rut with his back acne. Like many of my patients, he just needed to be given a bit of a head start with the cyst removals and the right treatments to apply. He has been the first patient to ever send me a #1minskin video and he has been diligent with his treatment. I can’t wait to see his skin in a year...

Dr Emma with Scott

Bacne or back acne can be a real pain and when they pop it can be very embarrassing. 

For many people, if this is mild it can be treated at home – and for other who may have had to have dermatologist prescribed treatment in the past, the following tips can be helpful and preventing it from coming back and reducing flares.

If you have deep painful cysts of acne you should see a Consultant Dermatologist – that is a doctor who’s name appears on the GMC Specialist Register - for their advice on how to manage it.  It doesn’t take much to do this EVERY day and try and not think of it as a chore – most people have to put some kind of cream on their skin every day – and we all have to wash, right? It just takes 1 minute a day.

#1MinSkin Regime 

Buy a back lotion applicator – these are available on amazon

Morning ✅

- Benzoyl Peroxide – Let this sit on your skin for a few minutes to help the medicine penetrate the thicker skin on the back. Then rinse off to prevent bleaching clothes and bedsheets. 

Benzoyl peroxide foaming washes in different strengths.

• 5.3% benzoyl peroxide is less likely to cause irritated skin, dryness, or peeling

• 10% benzoyl peroxide is the strongest you can get without a script. 

Night ✅

-Adapalene Gel – apply this before bed and no need to rinse off.

Lifestyle adjustments ✅

- Wear loose-fitting workout clothes made of cotton or sweat-wicking fabric.

- Wash workout clothes after each use.

- Shower and change clothes ASAP after working out (or doing anything that causes you to sweat).

- Cleanse your skin gently. 

You want to be gentle or this will make the acne worse. No loofahs, back brushes, and buff puffs. For best results, you’ll want to use gentle, fragrance-free skin care products.

It’s important to remember: this not a quick fix, but a longer lifestyle adjustment.

- Dr Emma 👩🏻‍⚕️ .

Keloids - Andrew

Andrew was a fantastic patient to treat for his keloids, as well as being such a cool and

funny guy he had realistic expectations, attended for all of his follow up appointments and was diligent with his #1MinSkin daily regime. His treatment is a combination of CO2 laser excision and postoperative steroid injections and then my special Box for his #1MinSkin routine. See below for all about keloids….

Man with keloids on scalp.

👩🏻‍⚕️ So, what are keloids?

Keloids are benign tumours of the skin – they are scars that just don't know when to stop scarring. They usually have a smooth top and are pink, purple or brown colour. Keloids are irregularly shaped and tend to enlarge progressively.

👩🏻‍⚕️Who gets them?

Although people with darker skin are more likely to develop them, keloids can occur in people of all skin types, those of you of African or Indian descent have 15 times increase risk of developing one. The tendency to form keloids seems to run in families particularly from the mother’s side. A mutation in a gene known as NEDD4 gene may indicate that a person has a predisposition to keloid formation.

Man with keloids.

👩🏻‍⚕️What are the treatment options?

Keloid scars should be treated by a specialist used to dealing with keloids to help you

understand all of the options. Very importantly address underlying factors such as folliculitis or acne and treat it.

The aim is to replace the keloid with a flat-scar that has stopped itching!! Most people will be initially trialled with Steroid injections, 5 fluorouracil injections, Steroid tape.

Gold Standard treatment is C02 laser surgery or blade excision surgery – this needs to be

followed up with either steroid injections or radiotherapy – or the keloid will come back.

Radiotherapy is the better of the two in preventing a recurrence however some patients

decide against radiotherapy and then they will need monthly injections of steroid into the

scar for around 6 months. Some people are bit concerned about the risk of malignancy

associated with radiotherapy but this is in fact very LOW (a diagnostic CT scan of the chest carries a higher risk).

Eczema - Louise

Treating Louise has been a real privilege and we have formed a great professional relationship with lots of debate and a clear treatment plan.

👩🏻‍⚕️ Topical steroids for the skin have been one of the greatest achievements for controlling atopic dermatitis and other inflammatory skin conditions and have been showing to reduce morbidity and improve quality of life when they are used appropriately. They are integral to the care of patients with eczema.

Dr Emma with Louise

👩🏻‍⚕️ When there is overuse (not usually the fault of the patient) in both strength of steroid and frequency of use for a sustained period of time this can result in side-effects on the skin.

Local side effects: skin thinning, stretch marks, rosacea, perioral dermatitis, acne and bruising and fixed vasodilation (expansion of the blood vessels) – causing redness. This is all more common in areas where the skin is thin – face, neck, chest, genital and eyelids.

But what is chronic worsening original disease and what is as a consequence of steroid overuse? Determining the signs and symptoms is necessary to avoid the unnecessary with-holding of much needed anti-inflammatory medications. Scientific literature review has to look at large numbers and starts with a null hypothesis so all options are considered and a conclusion drawn after complete review.

👩🏻‍⚕️ A study published in the Journal of the American Association of Dermatologists https://www.jaad.org/article/S0190-9622(14)02209-9/abstract performed a systematic review looking at symptoms and signs of patients withdrawing from topical steroids. A systematic review looks at all published papers, because most of what is found is case reports or case series this is classed as low-level evidence. But it is a starting point…What they found was that in the rare cases of side effects from topical steroids symptoms most commonly started at day 14 following cessation and consisted of burning, pruritis, pain and worsened by heat and had signs of erythema (redness) swelling, dryness and cracked skin with small bumps on the skin. These are divided into two types – an acneiform response and an eczema-like response. Any skin biopsies that were taken showed eczematous changes or steroid induced rosacea-like changes. On cessation of topical steroids 77% of people had clearance at 3 months and 90% at 6 months.

Pointers towards topical steroid withdrawal is the history of high dose, frequent, long term topical corticosteroids and:

1. Burning as the prominent features.

2. Confluent erythema within weeks of stopping long-term topical corticosteroids.

3. Resolution at 3 months in most cases.

👩🏻‍⚕️ How should the skin be treated if you aren’t using topical steroids but you still have a compromised skin barrier? Well this needs to be under the control of a Consultant Dermatologist – that is a dermatologist who has completed training and who’s name you will find on the GMC Specialist Register.

Treatment Recommendations (assuming no contact allergy)

For the rosacea-like eruption then the use of oral tetracyclines will be most helpful.

For soothing of the skin in the scaling variant then it is being gentle and supportive of the skin barrier – the aim is to reduce the risk of infection, reduce waterloss from the skin and reduce irritants interacting with the skin. Most likely some form of immunosuppressant will be required if skin has not improved at 3 months and almost definitely if not at 6 months.

These recommendations are assuming no contact allergy.

#1MinSkin

✅ Wash with Dermol 500 - twice a day

✅ Cerave moisturising cream -twice a day

✅ Skinceuticals – Epidermal Repair for the face and neck at night

✅ Zipsoc – zinc impregnated bandages that are calming for the skin on the face and “red-sleeve” arms

Lipoma - Tracey

I loved delivering Lumpy to the world from the delightful Tracey. Lumpy was a simple lipoma.

👩🏻‍⚕️ A lipoma is a non cancerous (benign) lump that forms due to an overgrowth of fat cells. You can get a lipoma anywhere on the body where you have fat cells. Lipomas are not cancer.

Dr Emma with Tracey

It is very rare for lipomas to turn into a cancerous sarcoma. It is still important to tell your doctor if your lipoma changes in any way or if you get any new lumps.

👩🏻‍⚕️ How did I remove Lumpy?

Orientation of scar line determined to allow for optimal scar outcome.

Area is made sterile and anaesthetised. Incision made 1/3 length of lipoma. Lipoma is gentle dissected our to avoid trauma to nearby structure.

Layered closure of sutures and pressure dressing. Job done 👏👏

The Bad Skin Clinic

If you haven't seen the show yet, be sure to give it a watch!

https://video.wixstatic.com/video/b17b0b_c394bd6857714cb19c46b48910003be0/1080p/mp4/file.mp4

#dremma #thebadskinclinic #bacne #backacne #keloids #eczema #lipoma #lumpy #dermatology