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  • Dr Emma

The Bad Skin Clinic: Episode 6

Updated: Oct 18, 2019

Episode 6 of the #badskinclinic was full of such lovely patients! From patterned shirts, to super sci-fi, the personalities of the patients were all wonderful! There are only two episodes left of the season. I can't believe how quickly the episodes have run by! If you want to catch up on any of the episodes: click the link below!

Lipomas - Stephen

The amazing Stephen has as many beautiful fantastic shirts as I have patterned frocks. I loved them! He had hundreds of painful lipomas symmetrically distributed across his body. They had been becoming more painful over the years and more had been appearing. He was otherwise very well and managed the pain well as he was remaining very active. He was most troubled by the cosmetic appearance. Because he has so many lipomas and they were all grouped together I set about trying to remove as many as possible through as few incisions as possible. Procedure is under a local anaesthetic with 1% incision made along the relaxed skin tension lines. Try and get as many out as possible with nice blunt dissection. Deep sutures placed to close the dead space, then some top stitches then pressure dressing.

In a situation where there are so many lipomas that are so very painful - this is called Dercum's disease. Dercum's disease is a consideration here given how painful they are but as he is very fit he doesn’t have the significant weight gain that many people with Dercum's have.

Dercum's disease is an extremely rare disorder characterised by multiple, painful growths consisting of fatty tissue (lipomas). Pain associated with Dercum's disease can often be severe. Pain may be caused by these growths pressing on nearby nerves. Dercum's disease mainly occurs in adults and more women are affected than men. In some cases, affected individuals may also experience weight gain, depression, lethargy, and/or confusion. The exact cause of Dercum's disease is unknown.

Generalised Hyperhidrosis - Abi

It was so lovely to meet Abi and really understand the impact that her condition was having on her quality of life. I was also completely in awe of her make-up skills. She could create the most wonderful eyes I had ever seen. Abi has generalised hyperhidrosis and although the hands and feet are most problematic; this is really a problem for the whole body. Abi has had very good treatments try and fail for her and so it was difficult to come up with the next step in her treatment.

I really wanted to revisit the iontophoresis and thought if she had her own machine then this might make things easier. We also coupled this with a drug called glycopyrrolate in the hope to improve outcome. There has been some improvement with medicine and this would need to be continued unless side effects, like dry eyes and mouth, start to appear. One of the most helpful things for Abi has been CBT and this is incredibly helpful for all patients with chronic disease where modern medicine hasn’t been able to develop a cure for yet. I am delighted that this has been so helpful for her. Click through for the article that I use to get my most up-to-date evidence based treatment guide in treating hyperhidrosis. Click through for the guide to CBT that is available for free online for many NHS patients.

Acne Rosacia - Lynne

It has been so wonderful to meet Lynne and be able to help her with her skin. Lynne is a very successful TV presenter but sadly she hasn’t been able to work for the last 5 years because of her skin. Lynne has an acne rosacea and the lumps and bumps on her face were becoming so difficult to cover with make up that she wasn’t employed. I treated Lynne with a combination of:- intense pulsed light Oral antibiotics for 6 weeks Topical ivermectin cream Topical dapsone La Roche Posay Rosaliac AR intense serum. She has had a great response and is back working on some amazing project. Again this is something that is not a cure but is entirely about managing the problem for the long term. Some day will be great some days will be tough. But continued management with the correct treatment and skin mindfulness for 1 minute a day will really help. ✅

Hypertrophic Scars - Mitchell

I LOVED treating Mitchell. He has hypertrophic scars on his back and shoulders as a consequence of acne scarring. These are painful, itchy and continuing to grow. Scars take time to treat and you will never be able to get back the normal skin in that area. However we can ameliorate the scar with energy based devices.

Mitchell loves all things sci-fi and he was so interested in the lasers we were using. I barely used any local anaesthesia at all. Tough guy! We did:

0. Pulsed Dye Laser or Intense Pulsed Light 0. Ultrapulse CO2 fractionated laser 0. Laser assisted delivery of triamcinolone (a steroid)

0. Injections into some of the very thickened scars with steroids

Mitchell got the full treatment and he is doing great!

The Bad Skin Clinic

With only 2 episodes left of the season, go watch The Bad Skin Clinic!

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Dec 31, 2019

I was most interested in your treatment of Mitchell’s scars, as I have a large number of keloid scars (hereditary). What is the cream you used before the laser? I had steroid injections 50 years ago no help - are steroid injections better now? Also had radiation after/before surgery, also excisions - some good some not. Unfortunately I can’t afford to see you in London, do you know who could help me in Sydney? Thank you Judith Peterson

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