The Bad Skin Clinic: Episode 3

Thank you to all of the support on the show so far! It's been an immensely fun journey! The patients along the way have all been incredible! If you haven't watched The Bad Skin Clinic yet, you can catch up using this link:

https://www.questod.co.uk/show/the-bad-skin-clinic

Thanks to @quest_red for making this possible. Go check it out!

Acne - Abi

What a joy it has been to treat Abi @abis_acne she has struggled with acne since she was 16. Acne runs in Abi’s family and most of her family members have had to take the drug to reduce or prevent scars caused by cystic inflammatory acne. Abi has been exemplary in her use of topical treatments and applies them exactly as directed. Sadly, and partly, due to her PCOS this has not been enough to stop the scarring acne. You can see when she removes her make up quite how much inflammation there is. This is really a time to start using Isotretinoin (accutane or roaccutane). But each time she has tried this treatment she hasn’t been able to continue as she just cannot swallow tablets.

Consultation with Abi

Her main problem is due to physiological reasons, specifically her tongue, making it impossible for Abi to swallow tablets. We tried sourcing the smallest tablet; and with psychological techniques but after a month it was still impossible for her .... so 👩🏻‍⚕️I thought back to my days on paediatric oncology and remembered.... if you were very careful, followed instructions diligently and had the right kit at home you could get the contents out of the capsules. So her mum took on this role and .... it worked! 🙌

Click this link to read a PDF from the NHS with guidelines!

https://www.ouh.nhs.uk/patient-guide/leaflets/files/110214guidelines.pdf There are still at least 4 months to go on the treatment and then we will start some of lasers to treat the scarring but things are finally, actively working for her.

Lipoma - Gemma

⚠️ SENSITIVITY WARNING ⚠️ .

Consultation with Gemma

Gemma has one big lipoma!! It’s growing in the left supraclavicular area and has been causing her functional symptoms of pain and sensation change. She is also concerned because of the rapid change within the lump and it’s growth. Because of the size of this and the complex anatomy at this site I ordered an MRI.

Gemma's Lipoma

The MRI showed that this was a simple lipoma but it was going under the muscle and was sat right on top of the external jugular vein. This is not something for my outpatient setting.

https://video.wixstatic.com/video/b17b0b_34d650e5769d4c7bb555c937e3b22eff/480p/mp4/file.mp4

👩🏻‍⚕️ The surgery under GA by Mr Healy went beautifully and a joy to watch. Perfect removal.

The technique:- Orientation of the scar line determined to allow for optimal scar outcome. Even under GA the area is still injected with local anaesthesia. Incision made 1/2 length of lipoma. The Lipoma is gentle dissected out to avoid trauma to nearby structures of vessels and nerves; particularly the external jugular vein and the spinal accessory nerve. Layered closure of sutures and pressure dressing.

Gemma after surgery

Job done 👏👏👏

Gemma is now feeling much happier. Her scar is healing well and she has a more optimistic outlook on life. She is keen to get on and start her family now and I wish them all the very best.

Hailey-Hailey - Gavin

Gavin undergoing surgery

Gavin is just one of the greatest guys, he has been through so much with his condition. He has been hospitalised with sepsis on numerous occasions and despite excellent care by his local dermatologist team his condition is continuing to cause a real struggle in his life. 👩🏻‍⚕️ Gavin has Hailey-Hailey disease; a condition that runs in families and is of autosomal dominant inheritance. The condition is chronic and lifelong and is characterised by relapses and remissions. The key is to try and get as few relapses as possible and for the remissions to last as long as possible. Hailey-Hailey disease, results from a genetic defect in a calcium pump protein.

Gavin's Hailey-Hailey condition

The pump mutation is in ATP2C1, a gene localized on chromosome 3. This means that the skin cells (keratinocytes) aren’t held together as well and come apart more easily. This is made worse by heat, friction, and infection, resulting in separation of keratinocytes, especially in the folded areas of skin. 👩🏻‍⚕️When the skin is broken it is painful and very uncomfortable but if these areas become secondarily infected it can be very serious as has happened with Gavin.

Gavin has been through all of the conventional treatments but I was able to add in two things he hadn’t done before:

Bleach bath instructions

▫️Bleach baths

▫️Co2 laser ablation with the Lumenis Ultrapulse - to destroy and heat up the superficial dermis cause a superficial scar to the area (I will include pictures about these two treatments in Episode 3’s blog post)

Gavin’s year patch of the laser went really well and we have since treated his armpits. The groin area is next on the list. 🙀🙀But with the addition of the bleach baths and further topicals I have given him he is back to playing football and symptom free in the area at the moment. 🙌👍

Seborrhoeic Keratosis - Lily

Lily after surgery

Lily came to see me about her “ouchee”. She described to me in great detail how she has to keep licking her finger to try and stick down the protruding part ands how she is so worried it will I therefore with kissing when she is in the arms of a handsome man.

She came back to clinic just today to see me for follow-up and is delighted that her dates aren’t going to be hampered now that the “ouchee” is removed. 👩🏻‍⚕️ What she has in Derm speak is a seborrhoeic keratosis.

https://video.wixstatic.com/video/b17b0b_b0aa78ec64d84c1a9a2e60822d0a9026/720p/mp4/file.mp4

They are benign growths due to a build-up of skin cells. They are very common, harmless, often pigmented, growths on the skin. In the UK more than half the men and more than third of women would have at least one SK. By the age of 70 they are found in 75% of the population, perhaps not quite as obvious as Lily’s. They are also found in younger people. Some people will have only few seborrhoeic keratoses, while others will have large numbers. They are not infectious and do not become skin cancer.

Lily after surgery

👩🏻‍⚕️How did I treat it? ⁃ Injection with local anaesthetic ⁃ Curettage of the growth ⁃ Gentle hyfrecation ⁃ Keep covered for 1 day 🧼Daily care for 10 days ⁃ Wash the area with gentle soap ⁃ Pay dry with cotton gauze ⁃ Apply Vaseline ⁃ No make up ⁃ No sunexposure

🕺🏻Enjoy those men Lily😉

The Bad Skin Clinic

Watch the trailer for The Bad Skin Clinic here - be sure to check it out if you haven't already!

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

#isotretinointips #isotretinoinjourney #accutanejourney#cysticacne #lipoma #badskinclinic #dermatologysurgery . #bleachbaths #lumenis #ultrapulse #haileyhaileydisease #sebhorreickeratosis