The Bad Skin Clinic: Episode 4

Updated: Sep 17, 2019

I can't believe we're halfway through The #badskinclinic! I'm happy to have been able to help all the patients from the show and can't wait for you to watch the other episodes to come!

If you've missed out on any episodes: click the link below to catch up!

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

Rhinophyma - John

Oh my goodness. Treating John has been a real highlight. What a wonderful man with such a gentle soul. He is such a fantastic actor but sadly the rhinophyma on his nose has been holding him back and he has been unable to get the roles he deserves. He has had rhinophyma for more than 20 years and this was initially treated with dermabrasion 15 years previously but had recurred. If you notice the dorsum of the nose has a white honeycomb like appearance to it, that is the scarring from the old surgery. It had made a little ballerina frill around the bottoms of the nose and the phymatous change extends up the nose and onto the cheeks. Due to the previous surgery and increased risk of scarring he was a bit more of an interesting challenge. 👩🏻‍⚕️I used the Lumenis Ultrapulse Carbon Dioxide laser to both cut and ablate the “lumpy” parts of the nose. The advantage of this is that it vapourises the tissue so there isn’t much in the way of bleeding. I treated one side first to assess response and recovery. I then treated the entire nose on a second visit. A third visit which you all haven’t seen yet treated the changes going into the cheeks. He has said he will allow me to show you his photos when I see him back in a couple of months. 🤞🏻🙌 👩🏻‍⚕️Rhinophyma is a progressive skin condition that affects the nose. The condition is mainly seen in those who have rosacea, a rash that can affect the cheeks, forehead and nose (see rosacea leaflet for further information). If rosacea progresses, the nose becomes redder, swollen at the end and gains a bumpy surface which changes in its shape. This swelling is because there is formation of scar-like tissue and the sebaceous glands (which produce oil on the skin) get bigger. Much more rarely, swelling can arise on other parts of their face such as the ears and chin.

Neurofibromatosis - Rachael

The very amazing Rachael came to see me at the clinic to see if we could do anything further to help with her skin. Rachael has a condition called neurofibromatosis she was born with this although her symptoms only started to develop on her twenties.

The severity of the condition can vary considerably from person to person.

In most cases, the skin is affected, causing symptoms such as:

• pale, coffee-coloured patches (café au lait spots)

• soft, non-cancerous tumours on or under the skin (neurofibromas)

• clusters of freckles in unusual places – such as the armpits, groin and under the breast.

Important point - Women under 50 with NF1 have an increased risk of breast cancer and should start having breast screening appointments when they're 40 years old.

A fantastic resource for people who have neurofibromatosis and may benefit from support can be found here @nervetumoursuk

Rachael has a fantastic group of doctors looking after her in her local city but they didn’t have a carbon dioxide laser. I have been able to add this into her routine and be able to do this under local anaesthesia. Meaning she is able to have more procedures, more regularly and quicker recovery. We will plod away over the next few years to treat those larger more prominent ones and share the care with her local team.

Ganglion - Janette

WARNING - VIDEO HAS SENSITIVE CONTENT

👩🏼Janette lit up the room when she walked in with her bubbly personality and it’s been great to be able to help her with her skin problem. She has had a particularly large troublesome ganglion on her wrist that has been causing her pain on movement and sensation change. She also hates the cosmetic appearance of it and was so keen to have this removed. 👩🏻‍⚕️Ganglion cysts look and feel like a smooth lump under the skin. They're made up of a thick, jelly-like fluid called synovial fluid, which surrounds joints and tendons to lubricate and cushion them during movement. Ganglions can occur alongside any joint in the body, but are most common on the wrists. They are harmless, but can sometimes be painful. If they do not cause any pain or discomfort, they can be left well alone and may disappear without treatment, although this can take a number of years. It's not clear why ganglions form. They seem to happen when the synovial fluid that surrounds a joint or tendon leaks out and collects in a sac.

🔪Options for treatment include ⁃ incising and draining them however this is associated with a high recurrence rate ⁃ Surgery has a higher cure rate particularly if the entire cyst can be removed. Given the size of Janette’s ganglion I ordered a scan and ask this was wrapped around the artery as well I had my colleague. Consultant plastic surgeon Ms Barbara Jemec remove this for her under a general anaesthetic. This was done beautifully as you can see in the clip. No signs of recurrence to date 🙌

Lipoma - Paul

WARNING - VIDEO HAS SENSITIVE CONTENT

Paul has the most perfect skin on his back, it didn’t have a single blemish or discolouration and was so smooth. But he did have a really big “bow-tie” shaped lipoma in there. It bulged right out. It almost looked like an additional muscle. The lipoma has to go and so I had the challenge of trying to get it out and keep the scar as small as possible for him to protect that perfect skin. 👩🏻‍⚕️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. 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 The Bow-Tie Lipoma ? 👩🏻‍⚕️ Orientation of scar line determined to allow for optimal scar outcome. Area is made sterile and anaesthetised. Incisiopn made 1/3 length of lipoma.

- Lipoma is gently dissected out to avoid trauma to nearby structure. - Layered closure of sutures and pressure dressing. - The pressure dressing will stay in place for 48 hours - Suture out at two weeks! Job done 👏