The Bad Skin Clinic: Episode 2

Updated: Aug 31, 2019

Purchase a bracelet by @hidradenitis.selina to help support those with HS!

Here is a blog post for the patients from Episode 2 of The #BadSkinClinic! A description about each patient's condition is here all in one place! There will be uploads every Saturday. I've also posted about each patient on my Instagram (@dremmacraythorne), so go check it out if you haven't already! As always, thanks to @quest_red for letting me be a part of such an exciting opportunity! Make sure to watch The Bad Skin Clinic - the trailer is down below if you haven't started watching! Before the patient's descriptions begin, I'd like to talk about raising awareness for the condition: Hidradenitis suppurativa. The wonderful, @hidradenitis.selina makes these great bracelets to help support those with the condition. You can buy a bracelet on her Etsy page (click the picture), and the proceeds go to a charity fund!

Keloid - Onique

What a wonderful woman Onique is and so inspiring. She has 2 jobs and looks after 2 children and seems to put everyone’s needs before her own. I was so happy to be able to help her.

👩🏻‍⚕️She has a keloid scar on her ear as a consequence of an ear piercing. The keloid scar actually went all the way through the cartilage piercing hole. A keloid is a form of abnormal scarring in which the body “forgets” to stop scarring and the lump gets bigger and bigger.

👩🏻‍⚕️ My preferred option on the ear is to do a “fillet-flap” procedure. In this case I dissect the skin overlying the keloid off, leaving a flap of skin. I then remove ALL of the keloid lump that is there and suture the flap of skin back down to recreate the shape of the ear. ALL of the keloid must be removed or it will come back. Onique will need to be seen every 6 weeks and monitored for recurrence if there is any evidence of this she will need steroid injections. My recurrence rate with this technique on the ear is less than 10%. Pretty good for a keloid 👏

Hidradenitis Suppurativa - Elise

Meeting Elise for The “bad skin” clinic, has been such a privilege. She is a remarkable woman who really wants to raise awareness of her condition and enable those suffering with it to get the support and treatment that is best for them. Remember this condition affects 1% of the population, that is a LOT of people,

I am only part of her story. She has a wonderful Consultant Dermatologist who is managing her condition long term, and Dr Adam Friedman who prescribed and managed her introduction to her biological agent.

👩🏻‍⚕️ Hidradenitis suppurativa (HS) is a painful, long-term skin condition that causes abscesses and scarring on the skin. The exact cause of hidradenitis suppurativa is unknown, but it occurs near hair follicles where there are sweat glands, usually around the groin, buttocks, breasts and armpits. It causes a mixture of red boil like lumps, blackheads, cysts, scarring and channels in the skin that leak pus.

👩🏻‍⚕️Hidradenitis suppurativa is very painful. The lumps develop on the skin in the following areas:

• around the groin and genitals • in the armpits

• on the buttocks and around the anus (back passage)

• below the breasts Many people with hidradenitis suppurativa also develop a pilonidal sinus, which is a small hole or "tunnel" in the skin. If you check Elise’s yesterday, @hsmylifemystory you can see one in action!

👩🏻‍⚕️Lifestyle advice If you have hidradenitis suppurativa you should:

• lose any excess weight - this is hard when it is difficult to exercise.

• stop smoking, if you smoke

• use an antiseptic skin wash or antiseptic soap – this may be prescribed alongside other treatment (see above)

• hold a warm flannel on the lumps to encourage the pus to drain

• wear loose-fitting clothes • avoid shaving affected skin and avoid wearing perfume or perfumed deodorants in the affected areas.

👩🏻‍⚕️Treatment See a Consultant Dermatologist / Board-certified to discuss the treatment plan for you. Don’t sit at home and feel embarrassed about this, come and see your dermatologist so we can help.

Lipoma - Gary

It was such a pleasure to meet Gary and his wife and be able to alleviate his fears about this growing lump on the back of his scalp. It was a shame to give him such a crazy haircut before his 4 year olds birthday though! 👩🏻‍⚕️ I was so pleased to be able to tell them it was a simple lipoma, going under the muscle slightly, but a very straightforward,very big, lipoma. He had been told it couldn’t be operated on as it was touching the spine. This, of course, was not true and anatomically is very far away from the spine.

Gary had an MRI performed; this is important for a lesion of this size to exclude any rare but potential liposarcoma change (cancer). I love removing lipomas especially large ones. Due to the position, size and muscular component I knew he would be more comfortable with a general anaesthetic. I set up an appointment with one of my colleagues; Mr Richard Young is a Consultant Plastic Surgeon and he performed the procedure for Gary under GA.

👩🏻‍⚕️ Notes : It is important to get an MRI scan of those big lipomas to know what you are dealing with in case of cancer change (rare). Consider GA if the lipoma has a large intramuscular component.

Lipoma - Callum

Well that was certainly fun treating Callum and what a great guy he is, so clever and witty. I certainly wasn’t expecting to hear my own voice repeated so many times back to me at the removal of the “shamrock- shaped“ lipoma! 🙈

Callum has a condition that is not worrying- because it won’t harm him- but is annoying for him as he makes hundreds of lipomas. These are all simple lipomas that are, for the most part, not painful. This condition can often run in families. Those that are cosmetically a problem, or causing pain or a limitation of function can be removed.

👩🏻‍⚕️ Top Tips : Lipomas like this do better if surgically removed rather than by liposuction or fat dissolving injections. The smallest incision line is the best in order to keep the scar as small as possible. That is why I like to use a technique called Punch extrusion.

👩🏻‍⚕️ Punch extrusion technique 1. Palpate the lipoma and dot around it with a surgical marker 2. Administration of a small amount of 2% xylocaine to the skin and then deep at the marked area 3. Punch tool - 5-8 mm 4. Gentle dissect with curved scissor the capsule 5. Pop it out (the best bit) if you are really lucky like Calum and I, you get a ☘️