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00:00It's not me anymore, I just can't accept it.
00:12I worry that people might think, she's gross, wonder what's wrong with her?
00:17I feel trapped in my skin, I just want a normal life.
00:24When our skin goes wrong, it can really ruin lives.
00:27It's extremely itchy. It's like, I feel like ants are crawling all over you constantly.
00:32You do not need to keep living like this.
00:34We've spent 13,000 so far trying to start this out.
00:38So when people who are desperate come to see us, Motty, Rosie and I can't wait to help.
00:43I think this will be fun to do.
00:46If they've been turned away elsewhere because their skin condition has been deemed cosmetic,
00:52well then that's even more of a privilege.
00:54Somebody has used the fact that this is a cosmetic treatment.
00:57More than once.
00:59Every skin condition is cosmetic because we can see it.
01:02But there's a medical issue underlying it that needs understanding and treatment.
01:07This is so heavy and that's why you can't breathe through your nose.
01:11And that's where we come in.
01:13Squeeze.
01:14Deflated.
01:16Thank you so much.
01:19Wow.
01:20It's gold.
01:21Oh, it's just gorgeous isn't it today?
01:32It is.
01:33How's the baby?
01:34Yeah, good.
01:35But with this light, I need to get some blackout blinds.
01:37I know.
01:38I mean, I think that's a lifesaver when you put the blackout blinds in.
01:40How's she sleeping anyway?
01:41Good.
01:42But it could be better.
01:43Should we get a coffee?
01:56Definitely.
01:57Morning Anouska.
01:58Do you know where you're going?
02:09Oh, it's just there.
02:10It's just there on the corner.
02:11Oh, we made it.
02:19Hello dermatology department.
02:20How can I help?
02:28I will only leave the house if I am wearing a cap.
02:32Because that's what I hide behind.
02:39Hi.
02:40I'm Fize.
02:41I'm here to see Dr. Emma.
02:42Great.
02:43Just take a seat and she'll be with you shortly.
02:45My life's on hold because my skin controls everything that I do.
02:50If it's a bad day, I'll be housebound.
02:54When I look in the mirror, I see somebody that doesn't really look like me.
03:12Someone who is in pain, struggling with her skin.
03:17I just don't see myself.
03:21My skin is extremely dry and shedding.
03:25Very itchy.
03:26It's like a feeling like ants are crawling all over you constantly.
03:30All of my twenties, I had clear skin.
03:33And then I used a cream and then it's just been downhill.
03:38Oh, can you see the cream there?
03:41They're still selling it.
03:42The cream was recommended by a friend of mine as it gives you quite glowy skin.
03:47Online, a lot of people were saying it was great.
03:49And on social media, lots of people were saying it was amazing.
03:55So I brought a pot.
03:57£45?
03:58Cheaper than what I paid for it.
04:02Gradually, her skin became very blotchy.
04:05It started irritating her face a lot.
04:07So her face became red, swollen, itchy, dry.
04:12And once I'd stopped the cream completely, my skin exploded.
04:17It would just burn and it would ooze.
04:20So I looked into it further online.
04:23And an article had come out where a mother had had it tested
04:27and it contained very potent steroids.
04:31Well, there's a question there as well.
04:33Is there any steroids in the cream?
04:35She said, oh, DM me.
04:37That was four years ago and my skin has never been the same since.
04:44I am a teacher and I love my job.
04:46I was working full time but because of my skin I've had to drop my hours.
04:52I only work two afternoons now.
04:54I just like to go back to being me.
04:57Me before the skin condition.
04:59Is it really itchy?
05:05Yeah, it's quite bad.
05:07I'll try not to.
05:14Hi, Faiza.
05:15Hi.
05:16Hi, nice to meet you.
05:17Hi, I'm Dr Emma.
05:18Come with me.
05:19Hi.
05:20Hi, are you okay?
05:21Have a seat.
05:22And this is Yubani.
05:23He's our nurse.
05:24Hi, nice to meet you.
05:25Hi.
05:26So tell me a little bit about what's brought you to clinic.
05:29I've got skin problems.
05:30Very dry, itchy and then really hyperpigmented as you can see.
05:35I've got really like thick skin.
05:37Okay.
05:38So tell me when did this all first start?
05:41I had severe eczema up until five and then I grew out of it.
05:46I had very clear skin up until 30 and then I used a herbal cream that I didn't know had
05:52hidden steroids in it.
05:53Why did you use the cream in the first place?
05:55Because it was a moisturiser.
05:56Oh, you thought it was a moisturiser?
05:57Moisturiser, yeah.
05:58And were you using the cream all over your body?
06:01Mainly on my face and my arms.
06:03Okay.
06:04Started off with blotches on my face initially once I stopped using it.
06:09If you look at my skin, it'd say, okay, that's 2012.
06:13Absolutely clear.
06:15Mm-hmm.
06:16What was the name of the cream?
06:17It was called the orange cream.
06:19It's not going to be that one, is it?
06:21It's not this one, is it?
06:23Yeah.
06:24Oh, it is?
06:25Yeah.
06:26It doesn't have a website.
06:27Just say to WhatsApp.
06:28Yeah.
06:29Yeah.
06:30That's literally it.
06:32But do you think the reviews people are doing from these, are they doing it themselves
06:36or paying someone to do them?
06:37I have no idea.
06:38I used about a tub.
06:39How much did you pay for it?
06:40£50 for a little tub about that big.
06:42What?
06:43Yeah.
06:44And I've never had eczema on my face.
06:46Mm-hmm.
06:47And you've been using the orange cream on your face?
06:49Yes.
06:50So this is how it started.
06:52Can you see these patches?
06:55And then it just got progressively worse.
06:58Is it itchy?
06:59Yes, extremely itchy, especially at night.
07:02And then you've been tested for allergies now, is that right?
07:05I have.
07:06I've had patch testing that came up with nothing.
07:08Mm-hmm.
07:09I did try cyclosporine.
07:10Mm-hmm.
07:11Didn't work.
07:12Okay.
07:13How long did you try it for?
07:14Three months.
07:15This is having a big, big, big impact on you, isn't it?
07:17Massive.
07:18Massive.
07:19Can I put your face now, is that okay?
07:20Fabulous.
07:21Yes, please do.
07:25So let's have a wee look at you.
07:26Close your wee eyes for me.
07:29Okay, so almost looks like a wrinkling of the skin, really, doesn't it?
07:33It's something called lichenification, and lichenification is where the skin has thickened up.
07:40And then the same thing's happening coming round the mouth and especially round that top upper lip.
07:46Okay, and again, so the palms of the hands are pretty good, but then on the back of the hand here, you just see this really marked lichenification.
07:58Okay, so having looked at all of the skin and hearing all of the story, what I'm looking at is somebody who has a very chronic eczema.
08:08Most of the times, people who have this as a kid, they do grow out of it, and it never comes back to bother them again.
08:16Yeah.
08:17But in a small number of people, certain things can trigger it off, and then the eczema can return, and can return in quite a spectacular way.
08:27Because you've been using this orange cream, I think this has probably been the thing that's irritated your skin barrier.
08:32Yes.
08:33And it's then allowed your kind of underlying eczema to just go absolutely crazy.
08:39Yeah.
08:40When it comes to treating eczema, there's a couple of different things that we have to think about.
08:45Number one is trying to get a better skin barrier in place.
08:51Yeah.
08:52So that is the most important thing.
08:53And the way we do that is to use certain emollients or moisturisers.
08:57I'm going to give you two lots of these ones to try.
09:00The next thing is the thing that's a bit trickier, because we have to switch off the inflammation.
09:07So it's your immune system is driving this.
09:10But the medicine I'm going to give you is something called dupilumab.
09:13Yeah.
09:14The injection targets a more specific point of the immune system.
09:19Okay, perfect.
09:20Okay.
09:21Yeah.
09:22It's not going to be a quick fix.
09:23Like, in two weeks, it's going to be great.
09:25It's going to be about a year of, you know, gradually changing things along.
09:29Yeah.
09:30And getting better bit by bit by bit.
09:31But this is a fixable condition.
09:34Yeah.
09:35You do not need to keep living like this.
09:37Absolutely not.
09:38Yeah, that would be great.
09:39No, thank you so much.
09:41Okay.
09:42Yeah.
09:43I'm happy for that.
09:44Sounds like a plan.
09:48Can you believe the screens are completely unregulated?
09:51It is just crazy, isn't it?
09:54So sad.
09:55My consultation with Dr. Emma was amazing.
09:58It's really nice that I've now got like a diagnosis and I know what's triggered it.
10:03I mean, all of these things that you buy on a social media channel like that, most of them aren't made in the UK,
10:09so they don't have to go through the regulations that we have to keep something safe.
10:13I mean, it just makes me so mad.
10:16We've got a plan in place now with the treatment and that should be starting soon.
10:22I saw Dr. Emma a couple of years ago and it changed my life.
10:37Last time, Dr. Emma removed 15 lipomas from my arms and it was quite a difference.
10:43And I'm really, really grateful for the work that she's done.
10:47Hi there.
10:49My name's Adam.
10:50I'm here to see you, Dr. Emma again.
10:51Fantastic.
10:52I'll let her know you're here.
10:54The locations of my lipomas right now is on my lower side and most of them are on my legs.
11:04I would describe it as ugly, awful and uncomfortable.
11:10They just shouldn't be there.
11:15This time I'm back and hopefully she's going to remove as many as she can.
11:20It would change my life.
11:21It would just be a different world for me.
11:24Hi Adam.
11:25Hello there.
11:26How are you doing?
11:27Good.
11:28Nice to see you.
11:29I've got something for you.
11:30What have you got for me?
11:32No.
11:35That is so nice.
11:37Wow.
11:38Come with me.
11:40So that's like, what, two years ago now?
11:43Yeah, exactly.
11:44Do you remember if we were timing them if I could see if we could get them out?
11:47Well one came out in seven seconds so that's still the record.
11:50Oh my God.
11:51Come on in.
11:52Adam has familial multiple lipomatosis and that's where lots of lipomas appear all over the body.
12:01Now these are benign and they don't necessarily need to be cut out.
12:05However, when they're at sites that everybody keeps looking at or if they're painful and uncomfortable,
12:11then the best thing to do is to surgically remove them.
12:14All right.
12:15Let's have a look at the legs then.
12:17Okay.
12:18Yeah.
12:19There's loads in there, isn't there?
12:22It's quite a few.
12:23Okay.
12:24That's a fabulous one.
12:25Yeah.
12:26Tell me about it.
12:27You said you have some on the side as well?
12:29Yeah.
12:30There you go.
12:31I have these.
12:32Oh yeah.
12:33I think that's probably the biggest one of all.
12:35Yeah, and I bumped it.
12:36Yeah, you've got a bruise over this one.
12:38Yeah.
12:39Okay.
12:40So there's only a certain amount we can do because we're only allowed to put a certain amount of anaesthetic into you.
12:45Yeah.
12:46But I'm happy to do whichever area seems most problematic to you.
12:50Yeah.
12:51I think this would be better because it would let me sleep properly without, you know, having pain sometimes.
12:58Yeah.
12:59Should we do that then?
13:00I think so, yeah.
13:01Yeah?
13:02Perfect.
13:03Good.
13:04And then you can always come back for more.
13:05I seem to like it.
13:06Okay, if you lie yourself here, Adam, so I'm just going to pop the anaesthetic in.
13:18We tiny scratch.
13:21And then after that it goes all nice and numb.
13:24Yeah, I'm a bit nervous about this because, you know, well, you know, I'm being worked on.
13:31I think the biggest problem is that I've been here before and I know what's going to happen.
13:35Yeah.
13:36Yeah.
13:37Ready?
13:38We'll start on the top one, small to big.
13:53Now, I'm just going to touch the area and you just tell me if you feel anything sharp or sore or uncomfortable.
13:59Yeah.
14:00Yeah.
14:01That feel okay?
14:02Yeah.
14:03Good.
14:04Good thing about you is you have hardly any fat anywhere, so when you hit a bit of fat on you, it's a lipoma.
14:09I'm going to give you a wee squeeze and here we go.
14:14Out you pop.
14:16What was on the inside is now on the outside.
14:21The last little bit.
14:23You want to see him?
14:24It's a little bit like a shamrock, isn't it?
14:27Yeah.
14:28I like your one.
14:29That's good luck for the rest of them.
14:30There we go.
14:33That's okay?
14:34Yeah.
14:35Good.
14:37I'm just listening out around the area.
14:41Yeah.
14:42Okay, should we give this one a squeeze now, Rosie?
14:46Yeah.
14:47Hey.
14:48Out you pop.
14:51We've had the baby, now we've got the mummy, and then we'll have the daddy.
14:56There's another little lipoma over here, so we're going to avert the skin so we can find it, which is here.
15:04And if this one will pop out, there it goes.
15:08Beautiful.
15:09Beautiful.
15:11Right.
15:12Now we'll have the daddy.
15:13Anything at all, you just let me know.
15:16Does that all feel okay?
15:17Yeah, it's all good.
15:18Always good when the anesthetic works.
15:24I think we're going to go digging.
15:26I don't think we're going to have to go digging.
15:28I think it's going to come jumping.
15:32Quite happy to be leaving you.
15:35You've got really strong hands.
15:37It actually looks like it's a hand coming out of you.
15:40Oh, my God.
15:41That's the biggest one so far, isn't it?
15:46You're very relaxed, Adam.
15:47It's like you're lying on a beach.
15:49How does that hurt?
15:51How does that hurt?
15:52Yeah, it's coming to this little bit where the bruise is just tethered, yeah.
15:58Shall we put a little bit of this anesthetic on the tray?
16:00Yeah, you can feel that it's tugging, can't you?
16:03Yeah, yeah, yeah.
16:04Yeah.
16:05That's where the bruise is.
16:06Oh, right, okay.
16:07And it's all out everywhere, apart from where you bruised it.
16:11Okay.
16:12That's what this is all about.
16:14Ah, it's the bruise that hurts.
16:16Yeah.
16:17Yeah, yeah, yeah, probably.
16:19It's very nearly out.
16:25Look at that.
16:26Oh, hi there.
16:27Hi.
16:28There we go.
16:31There's another little lipoma over here.
16:34Again, we're removing one from the inside.
16:38The reverse.
16:39The reverse.
16:40And there's a wee secret bonus.
16:42So we've removed five lipomas.
16:45Oh, my God.
16:47Oh, this is going to be so nice.
16:49It's already nice.
16:50It already is, yeah.
16:52Okay, right.
16:54And then here are your little friends.
16:58All right.
17:00Well, there's your little friends.
17:02All right, picture time.
17:03That was from the top one.
17:05And that was from the middle.
17:07Quite a lot, eh?
17:09No, she's a magician.
17:10It's amazing.
17:11Oh, my God.
17:13Wow.
17:17It's really, really, really fabulous.
17:19The good thing whenever you've removed a whole lot of lipomas from one side
17:23and they're not on the other
17:25is that you immediately get this sense of symmetry back.
17:30The procedure was just straightforward.
17:32Nearly painless.
17:34Removing Adam's lipomas are incredibly satisfying,
17:38and particularly that last big one.
17:41I'm really massively grateful to all the team,
17:45and Dr. Emma is going to help me just live life a lot better now.
17:52As I told her, she's a magician,
17:55because she just makes people's lives way better.
17:58I have noticed a massive difference,
18:10and I can see a lot more clear skin coming through.
18:14This is a facial wash that has been recommended by Dr. Emma,
18:19as it cleans the skin without leaving it dry.
18:24It heals the skin barrier.
18:26Now I'm good to go.
18:29So the injection I take every two weeks,
18:32and I'm really, really strict with it.
18:35It has taken a while to kick in.
18:37However, I have seen a turning point after my last injection.
18:41So I heard the first click, count to ten.
18:45One, two, three.
18:47It is less inflamed and more receptive to moisturisers.
18:52I'm able to sleep better,
18:53which means that I've got more energy,
18:55and I can spend time with the children,
18:58and I'm just a lot happier.
18:59I really can't decide what colour to paint my hallway.
19:13Well, this is my specialist subject.
19:16What's yours?
19:17Mine is this one, this green, and this white together.
19:20Yeah, that looks really nice.
19:21But I actually think that your hallway would be beautiful
19:23in this slightly pinky colour.
19:25Yeah.
19:26I love all these greens.
19:27Any of these look gorgeous.
19:28Yeah.
19:29It's so hard.
19:30Which one?
19:34Are they all right?
19:35It's all right.
19:36Are you all right?
19:37Just got to get it protected.
19:38I don't know.
19:40I would prefer to be completely stark naked
19:43than someone being stood right behind me looking at it.
19:45That's how strongly I feel about it.
19:51It's painful.
19:53It's embarrassing.
19:55And it rules my life.
19:59Doors opening.
20:03Hi, I'm Jim.
20:04To come see Dr Emma.
20:05Fantastic.
20:06If you'd just take a seat, I'll be with you shortly.
20:07Super.
20:10He's a lovely, big, confident, happy chap, and he has lost so much confidence because of this.
20:19I never really had an answer to what it is.
20:21I look at the illnesses that you can get and skin conditions that you can get and people seem to get answers.
20:26They know what it is.
20:27And then you've got this on the back of my head and I just can't get rid of it.
20:30Dr Emma is, without a shadow of a doubt, my last hope.
20:34If nothing can happen with it, then, yeah, I'll just accept it. It's on there forever.
20:39Hi, Jim.
20:41Hiya.
20:42Hi, nice to see you.
20:43I'm Dr Emma.
20:44Nice to meet you.
20:45Hiya, nice to meet you.
20:46Come with me.
20:47Thank you very much.
20:49Just down this way.
20:52Come on in and have a seat.
20:53Thank you very much.
20:54This is Mottie, who's our nurse.
20:55Hi, Mottie.
20:56Nice to meet you.
20:57Nice to meet you.
20:58So, tell me a little bit about what's brought you to clinic today.
21:01So, basically, I've got on the back of my head, I've had it for, it's got to be around about 20 years, I would say.
21:07I call it a rash, but it's more of a lumpy, horrible marks across the back of my head.
21:12So, yeah.
21:13Okay.
21:14Is it painful?
21:15Extremely painful, yeah.
21:16It can go from one, it can be crazily itchy, all the way up to not even being able to touch it.
21:21That painful.
21:22One extreme to the other.
21:23Yeah.
21:24And do you find that you're, when it's itchy, you're scratching it?
21:26Oh, I do, yeah, yeah.
21:27Do you ever wake up with blood and stuff on the pillow?
21:28Yes, yeah, yeah, yeah, there's blood on the pillow.
21:29My partner, Caroline, she's always telling me off because I'm scratching it.
21:32And I see you're wearing your collar up.
21:34Yeah.
21:35Is that because you're trying to hide it?
21:36Yeah, that's standard, yeah, that's what I do.
21:37Yeah, either that or hoodie, or kind of walk with my head slightly back like that,
21:42because it creates like a bit of a crease in my head, so you can't see it as bad if I do that.
21:45So, quite often, whenever somebody's hiding things like that, actually, it ends up rubbing as well,
21:50because a hoodie's going to rub, a scarf's going to rub, a hat's going to rub.
21:54Yeah, yeah, yeah.
21:55Have you seen a doctor about it?
21:56I have seen, I've seen a couple of doctors about it.
21:58I've had antibiotics that didn't really, didn't do anything.
22:02I've had some creams that I've tried and things like that.
22:04Just nothing seems to touch it.
22:05It's just impossible to get rid of us.
22:07I get very, sort of, anxious about it.
22:09I can feel my body, it's very tense.
22:10Yeah, so the anxiety of it is quite extreme, really.
22:14I try and convince myself that it's not as bad as what it is.
22:18I think, deep down, I know people can see it.
22:20And I'm even getting nervous about you looking at it.
22:22I know you have to look at it, but...
22:23Yeah, I can see it.
22:24Your head is starting to sweat because you're worried that Emma's going to look at it.
22:27Yeah, yeah, yeah.
22:28So it's just the whole, yeah, having someone look closely, that's it.
22:31Yeah.
22:34Um, yeah.
22:35I apologise for it now when you say it, so...
22:37You don't need to apologise for it at all.
22:39Yeah, it's not nice.
22:41So...
22:42So can I have a look at it, is that okay?
22:44You can have a look at it, yeah.
22:45Let's go for it.
22:46You don't want me to really, do you?
22:47No, I don't, no.
22:48Yeah.
22:57OK.
22:58Now, it looks like you've had hair removed...
22:59Yeah, yeah.
23:00..from a bit off it, that's right, is it?
23:01Yeah, that's correct, yeah.
23:02Yeah.
23:03And actually, in the area where the hair is removed, there's not as many of these forming.
23:14OK.
23:15But where the hair still remains is actually where you then have a lot more of the inflammation.
23:21Yeah.
23:22Within the lumps, you can see little bits of pus, because that's inflamed.
23:26And then that gets itchy, and then you scratch it, and then that breaks the surface of the skin.
23:34OK.
23:35OK.
23:36Well.
23:38How did you feel whenever I was round there again?
23:40It was terrible.
23:41My body was extreme, that was extreme there.
23:44How do you feel now?
23:45I feel...
23:46I'm relaxing again now.
23:47I feel very hot and clammy.
23:49OK.
23:50So this condition is called acne keloidalis nookie.
23:53Yeah.
23:54And it typically starts with a bit of inflammation around a follicle.
23:57Yeah.
23:58Sometimes it's just the type of skin that you have.
24:00Yeah.
24:01That's all that it is.
24:02Sometimes it's because of rubbing, so the hair follicle gets inflamed.
24:05Yeah.
24:06And what happens then after the inflammation is that the hair struggles to get through.
24:11Right.
24:12They start to group together.
24:13Yeah.
24:14We have to switch off the inflammation that's already there.
24:17Yeah.
24:18The best way to do that is with a combination of antibiotics.
24:20Yeah.
24:21The next thing that we need to do is think about the actual bumps that are there.
24:25We can start to flatten some of those bumps down.
24:27Yeah.
24:28I can do that with a combination of a laser treatment and steroids.
24:33The next thing is that we want to think about the hair removal looks like it's done a good job.
24:38Yeah.
24:39The bit where the hair has been removed.
24:41Yeah.
24:42There's not very many lesions.
24:43And I really think that extending the area that's had the hair removed is something that we should do.
24:48Yeah, that's fine with me.
24:49Yeah.
24:50So how do you feel now?
24:51I feel really happy.
24:52I'm over the moon.
24:53I really am.
24:54I'm buzzing.
24:55Good.
24:56Yeah.
24:57We're really good.
24:58Yeah.
24:59This is a condition that needs lots of different kinds of treatments.
25:02So I think we'll start with some lasering today.
25:04Is that okay?
25:05Sounds great.
25:06Okay.
25:07Well, I think we'll get some cream put on the back of your neck then because that makes everything go all numb.
25:11Brilliant.
25:12Yeah.
25:13Yeah.
25:14Perfect.
25:15Yeah.
25:19Jim has had acne, Keloidalis, Nuki for over 20 years.
25:23And this is causing infections that's resulting in scarring.
25:27And so my treatment for him is going to involve injections with some steroids, some antibiotics.
25:33And then I'm going to use two lasers.
25:35One of them a carbon dioxide laser to control the bumps that he has.
25:39And the other laser over the next few months is going to remove the hair in the area
25:44that's contributing to the problem.
25:47Right, Emma.
25:48So I've got the cream on, Jim.
25:50Good.
25:51I thought he was going to have a panic attack whenever I was going to have a look at it.
25:54He really is so petrified of anyone looking at the back of his neck.
25:58Oh, yeah.
25:59He was so anxious.
26:00That sweat.
26:01You could see the sweat beads just glistening away as soon as you were like,
26:03can I have a look at it?
26:04I know.
26:05And he was just like...
26:06Poor guy.
26:07Yeah, it's always the big burly men though, is it?
26:09Always the big burly men.
26:18It's obviously important to know that this is a permanent form of hair removal.
26:21Yeah.
26:22OK, so I'm just going to do a little test first.
26:24How, what did that feel like?
26:29Yeah, it's absolutely fine.
26:30Yeah, nothing.
26:31Just call me the hairdresser.
26:32Right, OK.
26:33So the way the laser works is that it converts light energy into heat.
26:39And it's the heat that really kills the bulb at the bottom of the hair follicles.
26:44You have to repeat it in about six weeks' time.
26:46Very good.
26:47How did that feel?
26:48I didn't feel it.
26:49It was, it was just, I just felt the air and maybe a little tap, but there was no pain
26:53or anything.
26:54It was painless, I would say.
26:55Wow.
26:56Yeah.
26:57That is great.
26:58Great.
26:59OK, well let's get you upstairs to do the CO2 treatment.
27:05Probably will get you to lie on your side if that's OK.
27:08Yep.
27:12OK, so a bit of beeping from my lovely laser.
27:16Here we go.
27:18How did that feel?
27:19Yeah, that was a little bit more painful, but it's not, it's actually fine.
27:21OK.
27:28So this is just flattening some of these little bumps that have already started to form.
27:35So this laser is essentially vaporising the skin.
27:39And so we're using it to debulk the skin and start to flatten it down.
27:44And it's going to facilitate getting the steroid in as well.
27:48So we can drill tiny little holes into the skin with the laser that are pretty painless.
27:54And then push the fluid in so you don't need an injection.
27:58There we go.
28:01And stand by.
28:02And now we're going to put the steroid in.
28:07So the steroid works as an anti-inflammatory agent.
28:11These go very, very deep within the skin, these small little laser beams.
28:15And so we push the steroid down then.
28:19Sorry for the pushing.
28:20That's all right.
28:21Like a nice little massage, Emma.
28:23Yeah.
28:25There we go.
28:29I went really well with Dr. Emma.
28:31I'm just over the moon that someone's actually going to have to finally tell me that,
28:35what it's called.
28:37Oh, yeah. How did it go?
28:39Yeah, all done.
28:40But yeah, I'm ready to rock and roll.
28:41Yeah, you want to go home?
28:42Yes.
28:44Done good.
28:45OK.
28:46Now I've started my treatment and I'm on the road to recovery.
28:50Just feeling great.
29:00Rosie, who have I got?
29:02You've got Gabrielle in room three.
29:04OK, great, thanks.
29:07Ready?
29:08Yeah.
29:10Hi, it's Gabrielle. See Dr. Emma.
29:11Tass, take a seat. We'll see you shortly.
29:17I don't actually know what my condition is.
29:20It's a large lump on my cheek, just under my eye.
29:25It feels quite soft to touch.
29:28Well, me and Gabrielle have been together for seven years
29:31and a year ago we got engaged.
29:34All right.
29:35Good.
29:37It makes me feel sad that she's thinking about it all the time.
29:40That's just worrying.
29:41You'll be all right.
29:43When we first got engaged and we was getting married,
29:44I was really excited, but then in the back of my mind
29:46it was always a sort of, I've got this lump on my face.
29:50Look.
29:52You can barely see it there.
29:54Yeah, there's basically nothing there.
29:56Hopefully she'll be able to tell us what it is.
29:58Yeah, hopefully.
29:59Hi Gabrielle.
30:00Hi.
30:01Hi, nice to see you.
30:02I'm Dr. Emma.
30:03Come with me.
30:04Hello.
30:05Hi.
30:06Come on through.
30:08Oh, nice to see you both.
30:09Come on in.
30:10This is Motti, who's our nurse.
30:11Hi.
30:12So I think I can guess why you've come to see us in clinic today.
30:13Yes.
30:14How long have you had this for?
30:15The second one I've had for about seven years.
30:16The second one?
30:17Yeah.
30:18I had the previous one removed.
30:19You can just see the scar there underneath.
30:20Okay.
30:21And did they get it all out the first time?
30:23Do you think?
30:24I don't know.
30:25They never told me what it was.
30:26They removed.
30:27They just removed it.
30:28It's frustrating because I'm in my late 20s.
30:31What 20-year-old would want this on the face all the time?
30:34Not many people, would they?
30:35No.
30:36We're getting married next week.
30:37So I think I can guess why you've come to see us in clinic today.
30:39How long have you had this for?
30:40The second one I've had for about seven years.
30:42The second one?
30:43Yeah.
30:44I had the previous one removed.
30:45You can just see the scar there underneath.
30:46Okay.
30:47And did they get it all out the first time?
30:48Do you think?
30:49We're getting married next year.
30:51And I haven't even booked a photographer yet
30:53because I don't want to think of having wedding photos
30:55with this being on my face.
30:57I think it's ugly.
30:58I think people think I'm dirty and...
31:01It's just embarrassing because I don't know what it is
31:04and I don't know how to stop it.
31:06Can I have a look at it up close?
31:08Yeah.
31:09Is that all right?
31:10Thanks.
31:11Okay, let's have a wee look.
31:14Okay, so this feels like a very firm but slightly bit of a squidge in it
31:23whenever I press my fingers against it.
31:25You can always feel it like a little trampoline.
31:27And it's actually whenever I'm pressing against it,
31:30it's ever so slightly tethered to that little scar.
31:34Okay.
31:35And, well, this is something called an epidermoid cyst.
31:40It comes from a gland that's in our skin that makes sebaceous materials,
31:45which is all the grease that comes up onto the surface of our skin.
31:48And sometimes those little glands can be blocked at the top.
31:53Under the skin, it looks like a little balloon,
31:56but instead of air being inside the balloon,
31:59it's dead skin cells.
32:01Right.
32:02Undoubtedly, this is from the one that you had before.
32:06Right.
32:07I suspect that they got the entire contents out.
32:11Okay.
32:12But I think they've left the balloon wall behind.
32:15Right.
32:16The balloon wall has just started to refill back up again.
32:19Okay.
32:20So in order to get rid of it for you,
32:23it is another little operation.
32:26Yeah.
32:27So you're replacing this sticky-out cyst...
32:29Yeah.
32:30..with a little scar.
32:32I can cope with the scar.
32:33Yeah?
32:34Yeah.
32:35Now you know what it is, do you want to keep it
32:37and you can tell people what it is or you want to get rid of it?
32:39No, let's just get rid of it completely.
32:41Let's...
32:42Be gone.
32:43Be gone.
32:44Yeah, I don't want to ever, ever see it again.
32:45Would you like to do that today?
32:47Yes.
32:48Shall we just get it done?
32:49Yes.
32:50Come with me.
32:56I finally got a diagnosis of an epidermoid cyst.
33:00I don't think it's fully sunken yet that it's actually going to be removed.
33:05I think this is going to make such a difference to Gabrielle, isn't it?
33:08Yeah.
33:09I mean, she's such a pretty girl.
33:10I know.
33:11Imagine having that for all of your twenties.
33:13You know, that's a time even when you get, like, little spots, you feel embarrassed.
33:16Yeah.
33:17And it's, you know, it's right there.
33:18Well, we're going to get it better for a wedding, aren't we?
33:19I can't wait to do this one.
33:20I know.
33:21OK, I'm just going to mark this up now, OK?
33:30OK.
33:31What are the chances of this going back?
33:35If we get the whole thing out and the cyst wall, I can pretty much tell you it will not come back.
33:42Gosh.
33:48All I do at this part is just put the anaesthetic in to make it go numb.
33:52So, if you want to wriggle your toes, wriggle your toes as fast as you can for me.
33:56Wriggle, wriggle, wriggle those toes.
33:57Well done.
33:58Very good.
33:59Well done.
34:00I'm just going to check the area before we do anything, OK?
34:05Yeah.
34:06So, your only job is to tell me, do you feel anything at all that is uncomfortable?
34:11No.
34:13Brilliant.
34:19It's desperate to come out.
34:22It's a nice white colour.
34:25I'll try and get this bit away and then we'll do a big squeeze.
34:28OK.
34:29One, two, three.
34:43You can see here, this is the cyst.
34:45And I described it as a little bit of a balloon.
34:48And then inside here is where all the dead skin cells are.
34:52It is ready and waiting.
34:54One, two, three.
34:55One, two, three.
35:04There we go.
35:05Deflated.
35:09Could you feel the release?
35:10Yeah.
35:12Then what you can see now here, this is the cyst wall itself.
35:16We don't want any of this left behind.
35:21And you can actually see where it's tugging a little bit here.
35:25That's where the surgery was before.
35:27So, I am sure that this is just left over from the last surgery.
35:31There we go.
35:32All right.
35:33Cyst wall completely removed.
35:34I can't see it out of the corner of my eye any more.
35:35It's weird.
35:36Shall I put it back?
35:37No.
35:38No.
35:39No.
35:40So, we're just going to pop the stitches in.
35:41We're just getting this just so perfect for you.
35:43OK.
35:44What made you, like, start doing all this?
35:45Well, I kind of like taking things and making them pretty again.
35:46I suppose, in truth.
35:47Emma was always really good at stitching.
35:49She made her own dresses.
35:50Yeah.
35:51So, we didn't see it out of the corner of my eye any more.
35:52I didn't see it out of the corner of my eye any more.
35:54It's weird.
35:55Shall I put it back?
35:56No.
35:57No.
35:58So, we're just going to pop the stitches in.
35:59We're just getting this just so perfect for you.
36:00OK.
36:01What made you, like, start doing all this?
36:02Well, I kind of like taking things and making them pretty again.
36:07I suppose, in truth.
36:10Emma was always really good at stitching.
36:13She's made her own dresses.
36:17Best stitch of all.
36:20Good.
36:21OK, you want to sit yourself up?
36:24No, I'm going to let you have a little look, OK?
36:26OK.
36:27OK.
36:28And then you've got a little sterile strip on that's twice the length of what the scar is.
36:31OK.
36:32Ready?
36:33Yeah?
36:34Ready?
36:35Oh, look.
36:37It's gone.
36:38It's gone.
36:39It's gone.
36:40It's gone.
36:41It's gone.
36:42It's gone.
36:43It's gone.
36:44It's gone.
36:45Back to you.
36:47Thank you so much.
36:48Oh, my pleasure.
36:49My pleasure.
36:52It's so frustrating whenever procedures aren't done completely the first time because she's
36:58had her cyst drained.
37:00She hasn't had the sac removed.
37:02So, unfortunately, hers kept growing for another seven years.
37:06And now we've done it in ten minutes, removed the sac, and it's not coming back.
37:11It's better than I ever thought it would look.
37:15Wow.
37:16Yeah?
37:17I look normal again.
37:18Everything OK?
37:19Yeah.
37:22Right, let's go see the kids.
37:23Yeah, get them back.
37:25It means everything to me because I can now enjoy planning the rest of my wedding.
37:31I'm so glad I've seen Dr Emma.
37:32She's well and truly changed my life.
37:37Emma?
37:38Yeah?
37:39For lunch for us.
37:40Oh, amazing.
37:41What did you get?
37:42Sushi.
37:43Yes.
37:49It has been six months since I've seen Dr Emma.
37:52My skin has improved.
37:54I can sleep at night.
37:55I'm not itching as much.
37:57I can just get on with day-to-day life that I was struggling with before I came here.
38:01But unfortunately, I've had to stop the injections for the time being.
38:06The good news is, is that Pfizer and her husband are expecting another baby.
38:11Hi, we're here to see Dr Emma.
38:13Yeah, go around and take a seat.
38:16So number three is on the way.
38:18And so we've brought her off the dupilumab and I'm going to manage her skin topically until the end of the pregnancy.
38:24Hiya, Pfizer.
38:25Hi.
38:26Come with me.
38:27Hi.
38:28Hi.
38:29Are you okay?
38:30Come on through.
38:31Okay, so come on in and have a seat.
38:32And this is Motti, our nurse, who you haven't met before.
38:33Hi, Motti.
38:34Hiya.
38:35Oh, well nice to see you back.
38:36And congratulations on the amazing, lovely news.
38:38Thank you very much.
38:39The new arrival that will be coming.
38:40Yeah.
38:41But it kind of has had a little bit of interference.
38:42It has.
38:43On the journey.
38:44But that's fine.
38:45You just adapt the journey because these things happen.
38:46Tell me, how was your skin on that dupilumab part of the journey?
38:51I was using it and my skin was clear.
38:52The skin on the face was looking pretty clear.
38:53Yeah, yeah, yeah.
38:54The itch had reduced massively, so my hands are doing so much better.
39:16I'm sleeping, yeah, just doing a lot better really.
39:19a lot better really good how do you feel that she is feel that she's camera in her skin yeah
39:24i think uh at night she's she's snoring now she's normally itching a lot on her hands and her arms
39:36but she's not itching at all so which is quite good and i think with all the routines that you've
39:41told her to do she's keeping on top of them as well and that's helped massively good yeah but
39:46with the pregnancy we decided okay let's try and manage the skin with the topical treatments we
39:52combined this topical um immunosuppressant and we're combining that with some of the
39:58topical steroids but in a controlled way not like the crazy way yeah that you were kind of tricked
40:04into with the orange cream so tell me how that journey was going in general i feel like it's
40:10doing really well and you did say that it would take up to about 12 months it will take up to 12
40:15months and obviously we have to adjust things now it might even be longer can i have a close look
40:21is that okay right let's have a look at the skin of your face oh it's a lot calmer yeah isn't it
40:27yeah yeah compared to what it was yeah
40:32before where there was kind of a lot of scratching happening and broken skin it's not as much
40:39there's not a lot of inflammation there actually no it's still much better than whenever we first
40:47met yeah yes though all of the inflammation is settled here
40:55well i'm really pleased where we are for many reasons but the main thing we're really trying to do
41:02is just get to the end of the pregnancy yeah by being able to manage things topically yeah so
41:09number one is the moisturizers going on every single day but then every single day we have to put on
41:17the topical anti-inflammatory yes and i think it's actually quite a good idea putting the steroid
41:23treatment on yes just to get it under control just for a short period of time yeah and this kind of
41:29delicate balance we just have to get until we get to the end of the pregnancy sounds great okay yeah
41:35good yeah good okay come with me and we'll get the creams thank you i am really confident i can get
41:43back on track i'm looking forward to it i know i have a plan going forward very positive vibes and all
41:52in all in all i'm really happy oh i was gonna hit the door just then what an idiot
42:08i can't believe looking back now how long i live with that anxiety for it's just just crazy i've been
42:13suffering it for 20 years now when it was at its worst it was a very lumpy oozy bloody mess on the back of
42:21my head and now it's gone getting it finally healed after all these years makes me realize how kind of
42:31depressed i was before with it i have noticed a massive difference in gym from the beginning of
42:37the treatment to now um it's been really quite a joy to watch so much better now i don't have to wear
42:43collars and hoodies and what have you caroline ready before the condition was treated anything that we
42:53did socially was quite an anxious moment for jim how are you feeling yeah all good not nervous
42:59looking forward to it bring him generally now he just seems much more relaxed sounds like it's busy in
43:05that's all good all good let's do it you can order yeah absolutely one of the best things now is being
43:16able to go to the bar and be able to order drinks without worrying that people are going to be stood
43:20behind me yeah a glass of white wine and a pint of beer please when it was at its peak i prefer to be
43:25naked rather than having someone stood behind me looking at the condition it was that's how bad it was
43:30thank you okay cheers cheers yeah incredible six months to clear and 20 years of stress really
43:41it's fantastic to see definitely that's for sure it is life-changing it does sound cheesy but it is
43:46life-changing i have got the big happy confident gym back dr emma has done an amazing job
44:00the
44:11Transcription by CastingWords
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