The Bad Skin Clinic: Episode 8

Ah, the final episode. I can't believe it's finally here! I've had such a fun journey filming this show and am so happy that so many people have enjoyed watching it! The connections I have made with people over social media due to the show have been so wonderful!

To catch up on any episodes, watch them here:

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

Basal Cell Carcinoma - Tracyleanne

It was fantastic meeting the beautiful and incredibly vocally talented Tracyleanne @tracyleanneofficial in clinic with her mum. 👩🏻‍⚕️ Tracyleanne had a basal cell carcinoma on her nose and she had had a biopsy before she came to see me in clinic. She wanted to find out how she could have this removed with the highest cute rate and the minimal amount of scarring. And the answer to that is Mohs micrographic surgery.

👩🏻‍⚕️ Tracyleanne required only one stage of surgery and avoided the forehead flap that was otherwise planned for her before she came to see me for Mohs surgery.

Brooke-Spiegler Syndrome - Victor

The fantastic and lovely Victor had several growths that were always going to be a challenge. He has had his condition for his entire life and has been treated by many of my seniors over the years. He was hoping to have something new to help him with his condition- so I had to get my thinking cap on 🧢.

👩🏻‍⚕️ Victor has a condition called Brooke-Spiegler. Brooke-Spiegler syndrome is a growth involving multiple skin tumors that develop from structures associated with the skin (skin appendages), such as sweat glands and hair follicles. People with Brooke-Spiegler syndrome may develop several types of tumors, including growths called spiradenomas, trichoepitheliomas, and cylindromas. Spiradenomas develop in sweat glands. Trichoepitheliomas arise from hair follicles. The origin of cylindromas has been unclear; while previously thought to derive from sweat glands, they are now generally believed to begin in hair follicles. The tumors associated with Brooke-Spiegler syndrome are generally noncancerous (benign), but occasionally they may become cancerous (malignant). Affected individuals are also at increased risk of developing tumors in tissues other than skin appendages, particularly benign or malignant tumors of the salivary glands. People with Brooke-Spiegler syndrome typically begin developing tumors in early adulthood. The tumors are most often found on the head and neck. They grow larger and increase in number over time. In severe cases, the tumors may get in the way of the eyes, ears, nose, or mouth and affect vision, hearing, or other functions. 👩🏻‍⚕️ As he has already had excisions and CO2 laser treatments on the past here wasn’t much skin left and any secondary intent wound would have taken many weeks to heal over. So we used the “Victor Technique.” - Anaesthetise the area. - Incise over the cylindroma. - Gently raise the flap over the cylindroma. - Scoop out the cylindroma. - Suture the flaps down in place. It worked 🙌🙌 and I have a few colleagues keen to learn the technique and help Victor get rid of a few more cylindromas.

Rosacea - Sarah

Being able to treat Sarah has been fantastic and what a turnaround in a fairly short space of time. Sarah has rosacea that is predominantly a papular/ pustular subtype but is also has a very prominent erythematous (red) background to it. 👩🏻‍⚕️ What did I do? 👩🏻‍⚕️ Course of oral tetracycline antibiotics - 1% ivermectin cream - 0.05% tretinoin - Combination Intense Pulsed Light & Pulsed Dye Laser - La Roche Posay antihelios SPF50 comfort - La Roche Posay Rosaliac AR Intense Serum 👩🏻‍⚕️ The key with rosacea is gentle treatment with the correct products every day- it only takes a minute.

Eczema - Stephen

It was great to see Stephen in the clinic, he really is such a Fun-Guy (he is a microbiology student!). Stephen has had eczema for all of his life and it can flare. The most painful thing is the small blisters and cracks on some of his fingertips. He has had a few mixed messages over the years and has been at a bit of a loss as to what creams to apply.

👩🏻‍⚕️ Detective skills had to come into play to try and determine what was going on. On questioning what he does day to day we were able to work out that handing our supermarket receipts from his part time job is likely to be the problem. Either as a handling response or contact allergic dermatitis – to a chemical in the receipt ink. ✅ Management – - Avoidance / protection from this activity - Patch testing to confirm (remember to stop antihistamines!) - Use topical steroids and emollients without any known allergans from patch testing.