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  • Dr Emma

The Bad Skin Clinic: Episode 7

Updated: Oct 18, 2019

Even though this season of The #badskinclinic is so close to it's end, the excitement of it has never ceased once throughout the whole process! It was such a pleasure to help the patients from episode 7, it's always exciting having a job where you always get to meet new people. To catch up on any episodes, watch them here:

Pilar Cysts - Jordan

Jordan was my first ever patient for The Bad Skin Clinic and one of the most straightforward. He had two Pilar cysts that were continuing to grow and become cosmetically annoying and he wanted them removed.

Pilar cysts: What are epidermoid and pilar cysts? By definition, a cyst is a closed sac that has two main features: it has a lining and it has contents that are liquid or semi-solid. The lining. Differences between the lining of epidermoid and pilar cysts can be seen under the microscope: The lining of an epidermoid cyst looks like the epidermis (the outermost layer of cells in the skin) The lining of a pilar cyst is made up of cells like those found in the roots of hairs. The contents. Both types of cyst contain a cheesy material, looking rather like white toothpaste. This is made of keratin - the material that makes up hair and the outer layer of the skin. ❌ In the past, pilar and epidermoid cysts were wrongly known as ‘sebaceous’ cysts but this term should be used only for a quite different and much less common type of cyst that is filled with a clear oily liquid made by sebaceous (grease) glands. Removal is straight forward and often the lining of Pilar cysts make them nice and easy to be able to pop out. 1. Mark with surgical pen 2. Closure orientated to protect the hair follicles (sometimes make this zig-zagged) 3. Incise with a 15 blade tip to the sac 4. Gently tease and dissect out around the cyst 5. Give it a POP

Spindle Cell Lipoma - David

I was so pleased to be able to help David get rid of his big heavy lump that had been weighing down on his upper mid back. In the UK our radiology guidelines require us to scan large lumps (especially those with a quick rate of change) before we remove them. David’s lump looked suspicious for liposarcoma on the MRI scan. In fact it looked like a little rabbit 🐇. He was referred to a sarcoma MDM and had needle biopsy’s; the results of which were reassuring as to not being malignant. So they said I could just proceed to removal.

Normal planning for removal: 1. Mark up of lump 2. Orientate incision along Relaxed skin tension lines 3. Infiltration with local anaesthesia 4. Incise to capsule 5. Slow and gentle dissection around the capsule 6. Out it pops. 7. Layered closure and eversion of the wound edges. It was hard and heavy and very fibrous. Very different to a regular lipoma. It looked and felt like the consistency of a preserved (in formaldehyde) heart. It was a spindle cell lipoma. These are rare and make up less than 1% of all lipomas. I have removed many hundreds of lipomas but never one like this. They are benign and it was removed in its entirety as confirmed by the pathologist.

Acne - Katerina

Treating Katerina for her acne has been fantastic she is such a good patient and has followed her “during treatment” instructions to the letter. She is having the usual and expected side effects of treatment. She is still taking Isotretinoin so we will be seeing each other regularly until her therapy is complete and then I can assess any scarring that she might have and start early treatment for that. Isotretinoin (brand name Roaccutane) belongs to a group of drugs called retinoids, which are closely related to vitamin A. It works in a variety of ways, targeting different factors that cause acne including the production of sebum (an oily substance produced by the skin) and the production of keratin (outer scales of skin) that block the pores of the hair follicle.

Isotretinoin is licensed to treat moderate and severe acne, often where there is risk of scarring. In the United Kingdom, isotretinoin may only be prescribed if you are under the care of a consultant dermatologist. ⚠️IMPORTANT: make sure to check that the person treating you is a dermatologist listed as a specialist on the GMC register.

Hair Removal - Aria

Treating the wonderful Aria @misstransgenderuk2019 has been an honour. She is the current Miss Transgender UK and is as beautiful on the inside as on the out. Her main concern was the hair growth in the beard area and on the chest. Hair removal can be an important concern for many transgender women. For most, hormone replacement therapy will decrease new hair growth, but doesn’t always dramatically reduce the presence of body and chest hair. Her treatment was initially with an intense pulsed light device as you see on the show, but the rest of the treatment is with the Cynosure 755nm laser. 6 treatments spaced 6 weekly and of course with hormone replacement therapy. Laser hair removal uses concentrated beams of light to target and destroy unwanted hair follicles. During a laser hair removal session, a practitioner will use a handheld device to deliver laser energy to the surface of your skin. The light will pass through the surface of your skin and be absorbed by the pigment of your hair follicles. Many patients choose laser hair removal because it offers long lasting (and in most cases, permanent) results. It’s important to know that multiple sessions will be needed to achieve desired results, and the result is hair reduction (the hairs become lighter and finer) not complete hair removal. Additionally, laser hair removal isn’t ideal for everyone. The best candidates have lighter skin and darker hair. • Discomfort or pain • Localized swelling • Skin redness • Hyper pigmentation (temporary skin darkening) • Scab formation As with electrolysis, it’s essential to seek out a qualified professional for laser hair removal to reduce your risk of undesirable side effects.

Aquagenic Wrinkling - Sofie

It was such a pleasure to treat Sofie who is from my home town in Northern Ireland. Sophie has a rare condition called Aquagenic wrinkling of the palms. Aquagenic wrinkling of the palms is a rare condition that often occurs in patients with cystic fibrosis. It may also occur in carriers of the cystic fibrosis gene. Aquagenic wrinkling of the palms resembles the exaggerated transient wrinkling of the palms that is caused by spending a prolonged period in a bath or pool. It is characterised by the appearance or worsening of a palmar eruption following brief exposure to water (about 3 minutes). It takes longer to appear in mutation carriers (about 7 minutes) than in patients with cystic fibrosis (2–3 minutes). Wrinkling typically disappears within 10–60 minutes after drying, however, the eruption can persist for longer periods. It is painful and was stopping Sofie from being able to reach her full potential at swimming.

We did perform the CF genetic test which was negative. I treated her with 20% aluminium chloride hexahydrate applied to the palms at night and swimming in sea water. Other treatments include: • Oral antihistamines to reduce itch • Botulinum toxin injections.

The Bad Skin Clinic

Use the link above to catch up on any episodes of The Bad Skin Clinic that you missed!

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