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00:01It's not me anymore.
00:03I just can't accept it.
00:06I worry that people might think,
00:09she's gross, wonder what's wrong with her?
00:12I feel trapped in my skin.
00:15I just want a normal life.
00:18When our skin goes wrong, it can really ruin lives.
00:22It's extremely itchy.
00:23It's like a feeling like ants are crawling all over you constantly.
00:27You do not need to keep living like this.
00:29We've spent 13,000 so far trying to start this out.
00:33So when people who are desperate come to see us,
00:36Mottie, Rosie and I can't wait to help.
00:38I think this will be fun to do.
00:40It will be very fun.
00:42If they've been turned away elsewhere
00:44because their skin condition is being deemed cosmetic,
00:47well then that's even more of a privilege.
00:49Somebody has used the fact that this is a cosmetic problem more than once.
00:54Every skin condition is cosmetic because we can see it.
00:57But there's a medical issue underlying it that needs understanding and treatment.
01:02This is so heavy.
01:04That's why you can't breathe through your nose.
01:06And that's where we come in.
01:08Squeeze.
01:10Deflated.
01:12Thank you so much.
01:14Wow.
01:15It's gone.
01:27Hey.
01:28Good morning.
01:29Can we park here?
01:30Yeah.
01:31What a nice day.
01:32Isn't it?
01:32Did you ride in too?
01:34No, I didn't.
01:36I didn't wake up early enough.
01:40Do you like my helmet?
01:41I do.
01:41It's a pleasure.
01:42Yeah, that's what it's like.
01:43It was the same as the kids ones and I was like,
01:45have you got one of my size?
01:47Yeah.
01:54I think it's going this way, wasn't it?
01:57I don't know.
01:57That's number three.
02:05Hey.
02:06Would you like to see the baby scare?
02:08Oh, yes!
02:10Oh.
02:10Yeah.
02:11And we know the gender.
02:12What is it?
02:13Have a guess.
02:15Girl.
02:16Boy.
02:16It's a boy.
02:18Oh!
02:19Yeah.
02:20Oh!
02:21Exciting.
02:27So have you still got really itch ankles?
02:29It's starting to itch.
02:31These itches are deep.
02:33It's like somebody's inside you with a needle poking you like a voodoo doll.
02:39Hi, sir.
02:40I'm here to see Dr. Emma.
02:42It's Will.
02:42Fantastic.
02:43Just take a seat.
02:44She'll see you soon.
02:49I feel a bit sad because my skin wasn't always like this.
02:55The actual little patches are very sore.
02:58It's so dry and tight that I'm almost trying to poke my finger through my hand
03:03because it really does itch that much.
03:07Lately, it's come back in such a force that it can't just be eczema or psoriasis, which is what the
03:15doctors always thought it was.
03:17Try and leave it.
03:19Try and leave it.
03:20Try and leave it.
03:20Try and go out to sleep.
03:21Oh, yeah.
03:21Would we?
03:22You might be awake two or three times in the night, sticking to the sheets, itching, scratching.
03:29You all right?
03:31Yeah.
03:31I can't.
03:32I'm just itching.
03:33Like, oh, my back.
03:36There's blood.
03:37There's pus.
03:38I don't want my wife to have to sleep in a bed that's covered in blood.
03:43All right, boy.
03:43It's time to go.
03:44Let's make a hustle.
03:45Come on.
03:45Let's get a bolt in the sink.
03:47Shoes on.
03:48Coats on.
03:49So being a stay-at-home dad, it's been a struggle due to the sort of lack of sleep.
03:57Come on.
03:58Come on.
03:58Come on.
03:59All right.
04:00Let's go.
04:01Let's go.
04:03He's so sort of stoic and just gets on with everything.
04:06It makes me very sad to watch him struggle with it and suffer in silence.
04:13It's having a huge impact on you.
04:16It really is.
04:17Yeah.
04:18Like you say, you're living it day to day, you just don't see it.
04:20You just don't realise.
04:22I don't think you'll know how much of an impact it's having until you don't have it anymore.
04:28It would be life-changing for him to actually get some kind of treatment and a diagnosis.
04:34Well, you can't keep on going like this?
04:35No.
04:36I can't keep on going like this.
04:37It's just...
04:39Hi, Will.
04:40Oh, yes, I am.
04:41Hi, nice to see you.
04:42I'm Dr. Emma.
04:43Come with me.
04:45Did you have to come from far away?
04:46No.
04:47We're only south London, like Sidcup.
04:49Oh, so easy.
04:50Yeah, not too bad.
04:52And this is your Barney.
04:53He's our nurse.
04:53Hi.
04:54Hi.
04:54How's it doing?
04:55Very good.
04:55Very good.
04:57So, tell me what's brought you to clinic today.
05:00So, I've been suffering with some type of skin condition for going on, what, ten years.
05:06It first came about in 2015.
05:09Yeah.
05:10And I was covered from wrist all the way up my arm, most of my body, my legs.
05:18And did you speak to any doctors about your skin?
05:22Yeah, I mean, I did go and see a local GP.
05:26It was always just called eczema or psoriasis, really.
05:29It was courses of steroid cream, make sure you moisturise so many times a day.
05:36In the process, though, I scratched myself so hard, I gave myself MRSA.
05:40So, then I was putting on antibiotics to cure that.
05:43And then, what, a year ago, it erupted again and I got infected again.
05:49Obviously, I went to the GPs and stuff.
05:51Antibiotics kicked in.
05:52And it has sealed up, but it is still itchy.
05:55And, obviously, I've been on a quest to try and find out what it is.
05:59Mm-hm.
05:59Can I do something to prevent it?
06:01So, when you were younger, did you have any problems with your skin at all?
06:06Do you remember...?
06:07I did have eczema.
06:08Yes.
06:08But really...
06:09Mild.
06:10It might come for a day or two, then go away.
06:13But that was it.
06:14Nothing like what this has been.
06:16Have you noticed the change in him with his skin getting worse?
06:19He doesn't really say how bad it is, but he doesn't really sleep very well at all.
06:25And because of that, he's sore, he's itchy, he's tired constantly.
06:31There are nights where you start scratching one place and then you're moving on to the next.
06:37And then, well, before you know it, two hours have gone by.
06:40Yeah.
06:40And you'll suddenly look at your watch going, I'll copy up at six.
06:42Ha-ha-ha-ha-ha-no!
06:43I've got to get some sleep.
06:45It's kind of all of his resilience is taken up just by dealing with this issue.
06:52And there's nothing left.
06:53It sounds like this is having a pretty big impact.
06:58OK, well, I'm going to look at the skin all over, if that's OK.
07:00OK, no problem.
07:00Can we get it going?
07:02Yes.
07:02Yeah, see you in a moment.
07:03Super.
07:10We can see it's arranged in these plaques, so they're raised and they're thickened.
07:16And around the edge of the plaques, it's where these little blisters have been.
07:20Mm-hm.
07:21And then they get scratched.
07:23That's, yeah.
07:23I mean, that is me.
07:25Scratching it.
07:26Yeah, basically.
07:29So the back is interesting because we've got these patches again.
07:35Do you scratch with a back scratcher or do you scratch with an instrument?
07:39A spatula.
07:39A spatula, yeah.
07:41Because you can get a bit further down here, actually, than most people can.
07:45Okey-dokey.
07:47Fine.
07:48All of these patches here.
07:51And then you can see where you're just getting in and just scratching the top of these off
07:56because they're so itchy.
08:00OK.
08:01Fine.
08:03Now, to me, this looks like an underlying chronic eczema.
08:09You're somebody who has this tendency to eczema.
08:12It's something that you've had all your life.
08:14OK.
08:14Now, that has gone away, but for some reason has been reactivated again.
08:20Yes.
08:21Sometimes it's things like some stressful events can trigger it off.
08:24Sometimes medicines can trigger it off.
08:26But then, because of the actual constant rubbing or the scratching, that then thickens up the areas of the skin
08:34and forming these hard plaques that you're seeing scattered all over.
08:39Right, OK.
08:39I mean, this is the furthest I've ever come, knowing it is actually eczema.
08:43Yeah.
08:43Getting a definite answer for that.
08:45When it comes to the actual treatment of it, first of all, I need to give you a barrier
08:52and moisturising cream to use as an invisible barrier protecting your skin.
08:56OK.
08:56And some steroids to put on these individual lesions.
09:00Mm-hm.
09:00And I'm also going to give you a special dressing that you stick on top of them.
09:06OK.
09:06To hold the steroid in place means you won't be able to get at it to scratch it.
09:11Yeah.
09:11That's only a temporary thing we're doing.
09:13Mm-hm.
09:14That'll give you a chance to let the skin heal.
09:17Yeah.
09:17Because I think we have to give you a tablet to switch off this itchiness that you're experiencing all over
09:24the body.
09:24Right.
09:25But it is a multi-step treatment, you know.
09:28OK.
09:28It's all of it together.
09:29Yeah.
09:29And I would like to think that once the skin is healed, the skin's not going to go back into
09:33this kind of state again.
09:35Mm.
09:35Yeah, hopefully not.
09:36No, it would be nice.
09:37It really would be nice.
09:39OK.
09:39How does that all sound?
09:41Sounds marvellous.
09:42I love it.
09:43I'm loving it.
09:43I'm really excited.
09:45OK.
09:45Perfect.
09:51So, how'd you get on?
09:53Oh, yeah.
09:54Really good.
09:54Well, so it's definitely eczema.
09:56Right.
09:57But it's like a real chronic form of eczema.
10:00It's been such a relief to actually get a proper diagnosis.
10:04Oh.
10:05Oh, yeah.
10:06Brilliant.
10:07No, it's really good.
10:08Yeah.
10:08It's really good.
10:09Come on then.
10:10Come on then.
10:11Let's get home.
10:12Put our feet up.
10:14Will's a complex case.
10:16It's really hard to get on top of eczema whenever it is this out of control.
10:20And Will has a few things that he's going to have to do himself at home.
10:24He has to do his dressings.
10:25He has to do his creams.
10:27And he has to remember to take his tablet every single day.
10:29But if he sticks to this, I would say we'd start to see a difference in a few months.
10:35Dr. Emma has given me a lot of hope in that we can clear up this condition.
10:39I'm well on board.
10:49Rosie, do you need any help?
10:51Oh, yeah.
10:51Do you mind moving that?
10:52I'm just prepping for the next patient.
10:54Okay.
11:07Excited to see Dr. Emma today.
11:08I am, yeah.
11:09Hopefully get some answers for the unknown.
11:13I've been in tears before with the pain.
11:15It makes you feel sick.
11:17It's just excruciating.
11:20Sticking out a lot today.
11:21Really noticeable.
11:23The cyst on my neck has definitely made me feel more self-conscious.
11:27I'm not somebody that likes to be looked at anyway.
11:29We must do this.
11:31We've got it.
11:33It does upset me.
11:34It breaks my heart for him.
11:36I don't think he'd admit to me that it's making him as low as it is,
11:38but I know it is.
11:41To get a diagnosis is everything.
11:44Whether it's treatable, curable, just an answer is all I want.
12:01Good morning, Dr. Creighton's office.
12:04The kids have massaged.
12:05Wishing you good luck for today.
12:07Bless them.
12:09Hello, Brian.
12:10Hi, are you okay?
12:11Nice to see you.
12:13And you.
12:13Come with me.
12:14Hello.
12:15Nice to meet you.
12:16And you as well.
12:17Was it an early start for you this morning?
12:19Yeah, definitely.
12:20Could have done with an extra hour at bed.
12:23Aw, come on in.
12:25This is Rosie.
12:26He's our nurse.
12:27Hi, are you okay?
12:28Come and have a seat.
12:30So what's brought you to clinic, Ryan?
12:32Er, well.
12:33I can see.
12:34Yeah.
12:35Bit of a lump on the old neck.
12:36Been there for a few years now.
12:37Bit fed up of people looking at it and talking about it.
12:41I also get growths in my sort of groin onto my scrotal sac
12:45and they are just beyond painful.
12:48Okay.
12:49Let's think about the one on the neck, first of all.
12:51Have you been to see the doctor about it?
12:53They always say it and they're just, oh, what is it?
12:55I'm like, I don't know.
12:56How long have you had it?
12:57Five years.
12:57Oh, it's all right.
12:58Oh, that's it.
12:59But basically...
13:00Yeah.
13:01All right then.
13:02Yeah, because I've had it for so long.
13:04And tell me a little bit then about what's happening in the groin.
13:08Er, so it just starts a little bit of itching or whatever.
13:11And then a small sort of pea-sized lump can be 24 hours, 48 hours.
13:16It can go to, like, three inches long, two inches wide.
13:19And it's just stupid pain.
13:21Like, early 20s is when they really started down there.
13:24It's steadily got more and more frequent.
13:26And the worry is it's just going to become a constant and I won't be able to move.
13:31Yeah.
13:32Essentially.
13:33And then what?
13:33So just so I've got this right, you've had this problem in the groin really for most of your adult
13:40life.
13:41Yeah.
13:41But you haven't had a diagnosis or any long-term treatment plan for these?
13:45No.
13:46I've had a few surgeries done on them, get left with an open hole.
13:50That's one of the sort of things I end up with.
13:53Yeah.
13:54Oh, yeah, that looks angry.
13:55It's a real boil, like, yeah.
13:57So, and it's just discharging this kind of hussy material?
14:01And then it gets very red and inflamed all the way around it?
14:05Yeah.
14:06OK.
14:07Now, you have to clean it.
14:08You have to look after me and the kids and the house and everything in between,
14:12cos I just can't do anything.
14:15I can see that this is something that's having a big impact, not just on you,
14:19but probably both of your, all of your family.
14:21Yeah.
14:22It's just horrible, you know, having to shoot the kids,
14:24oh, Dad, can we do this?
14:25Can't, cos I can't even walk, never mind, come and do whatever you want to do,
14:28you know.
14:29It's hard.
14:31OK.
14:31Do you smoke?
14:32Yeah.
14:33And how much do you smoke?
14:35Probably about 15 to 20 a day, but I am trying to, trying to quit.
14:39Yeah.
14:40OK.
14:41OK.
14:41Well, I really do need to have a look, if that's OK?
14:45Yeah, that's OK.
14:45Yeah?
14:46OK.
14:46Good.
14:51Okey-dokey.
14:52Well, let's start with the groin area, is that OK?
14:55Yeah, that's fine.
14:55Because I think this is the area that, from the story, is bothering you the most, really.
14:59When I'm in a flare-up, it's beyond ridiculous.
15:02OK.
15:03Let's have a little look.
15:07OK, so no flare-up right now.
15:12That's happy at the minute.
15:14I can see you've had some here.
15:16Yeah.
15:17But you've also got some of these areas that we call bridged comedones.
15:22They're like little blackheads, but there's a little tunnel going between the follicles.
15:28And then let's have a look at this side.
15:30You can see where the redness and purple has been.
15:32But then I can see some of the scarring as well.
15:36Actually, I'll take this opportunity to look at your chest.
15:38Yeah.
15:39So you get some of the little spots appearing on the chest area.
15:43All part of the same kind of problem.
15:46I can tell that you had quite a bit of acne whenever you were younger.
15:50Yeah.
15:50Because you've got all of the little tiny white scar marks where it was.
15:55Then I'll let you lie back, and I'm going to come around and have a look at this one on
15:58your neck.
15:59Yeah, no worries.
16:01Okey-doke.
16:02So on your neck as well, I can see where you've got some of these areas of dipped acne scars.
16:07Yeah.
16:08And then what we have here is a cyst.
16:13Okay.
16:16I think all of these things are all related together.
16:21It's all part of something that we call a follicular occlusion.
16:26In other words, the follicles on our skin become blocked.
16:31They either make a spot like you have with your acne.
16:34They make a cyst like you have on your neck.
16:38Or they make these boils that you have in the groin area.
16:43Okay.
16:43We call this a condition called hydradonitis superativa.
16:48It's a condition that's a little bit like acne and the two are related together.
16:52Okay.
16:53But the main thing that happens is, is the follicles become blocked.
16:58Right.
16:58Okay.
16:59So now we know what it is, we're able to then start the right kind of treatment to get it
17:05under control for you.
17:06Amazing.
17:07It's what I've been waiting for for so long now.
17:10So it's just perfect.
17:12So you know what it is.
17:14Yeah.
17:14That's the thing is sometimes not knowing why you get these.
17:17Always being in the unknown, isn't it?
17:18Once you've got a cyst like the one you have on your neck, there's no amount of tablets or anything
17:24else that's going to get rid of it other than surgery.
17:26Okay.
17:27How we deal with the rest of the skin elsewhere is usually by tablets and it's usually by a tablet
17:34that you end up taking for sometimes even a couple of years to try and get things under control.
17:39Yeah.
17:40But there is one really, really important thing that you have to do.
17:45And there is no point me doing any of this treatment unless you do it.
17:50You're going to say stop smoking, aren't you?
17:52Yeah.
17:53Because your smoking is part of the reason why you have this.
17:58All right.
17:59Okay.
17:59So when people smoke, one of the things it does to the skin is cause the follicles to become more
18:05blocked more easily.
18:07So, yeah, pack it in.
18:10Right.
18:10Okay.
18:11Have we a deal?
18:13Deal.
18:14Done and dusted.
18:15Okay.
18:15Since you're going to pack it in, I'm really happy to remove this for you today if you like.
18:21Yeah.
18:21Yeah?
18:22Yeah.
18:23Magic.
18:24Okay.
18:25Ready to do it right now?
18:26Yeah.
18:27Okay, let's do it then.
18:28Come on.
18:35So I'm just going to pop the anaesthetic in.
18:39Let me scratch.
18:42That's all the injection done.
18:45I can't wait to be honest with you.
18:46It's just one of them.
18:47I've lived with it for years now.
18:53I'm just going to check the area before we do anything, okay?
18:56And your only job is to tell me if you feel anything sharp, anything sore or anything uncomfortable.
19:03How's that?
19:04That's fine.
19:05Good.
19:05Beautiful.
19:06Good.
19:12And there you can see the lovely little cyst.
19:16So this will be an epidermoid cyst.
19:19And these epidermoid cysts have a much kind of softer sack wall.
19:26So the little balloon lining is much softer.
19:32Here we go.
19:34You ready for a wee squeeze?
19:36Yeah, go for it.
19:40I'll be gutted not to do that.
19:42Is that what she was hoping to do?
19:45Dying to do it.
19:46This is the most beautiful, shiny, pearly white.
19:50You've created a beautiful cyst in here.
19:53You know that?
19:54Lovely.
19:55You can keep it.
19:56I'd quite like to, actually.
19:59When the whole sack comes out, it means it's not coming back.
20:02There we go.
20:08There we go.
20:09So that's it all removed.
20:12And we'll pop a couple of little stitches in.
20:14And then you can go and have your lunch.
20:16It's as easy as that.
20:20Perfect.
20:22OK, let me show you what it now looks like.
20:27There you go.
20:28You can take the mirror.
20:29Oh, wow.
20:30It's gone.
20:32It's mad how much of a difference it makes, isn't it?
20:34Isn't it?
20:35Yeah.
20:36Lovely.
20:36Thank you very much.
20:37That feel good?
20:38Yeah, it's amazing.
20:39Shall we get Ellie to come in so you can see as well?
20:41Oh, yeah.
20:41It should be just.
20:43Oh, hello.
20:44Hey.
20:44There we go.
20:45Oh, wow.
20:45Look at that.
20:47It's gone.
20:47You don't care about that.
20:48You want to see what's in it, don't you?
20:50You know me too well, but it's gone.
20:53Right.
20:53Do you want to see what's in it?
20:54We did save it for you.
20:56I told you.
20:57There it is.
20:58It's a good one, isn't it?
21:01You can give it a poke if you want.
21:03Gloves are important.
21:05That's right.
21:07That's what's inside.
21:08Oh, it's a good one.
21:12It was great to be able to remove Ryan's cyst today,
21:15but it's the problem that he's having in the groin
21:17is going to take a little bit longer.
21:20That's your side.
21:21Thank you very much.
21:22But now that we know he has hydradinitis suppurativa,
21:26I can start him on the right medication for this condition
21:29and get his skin under much better control.
21:32The best thing of it is I know now
21:34that I'm not going to be waiting for pain or in pain.
21:38You're not going to have things holding you back now, are you?
21:40No.
21:40You can move forward rather than being stuck.
21:44Finally getting an answer, knowing what it is
21:47and that there's a way to move forward with treatment,
21:49and that's amazing.
22:00How many minutes to the next patient?
22:02I think you've got 20 minutes.
22:0420 minutes?
22:04Enough time for a break?
22:05Yeah.
22:05Oh, do you mind filling up my word bottle?
22:08Yeah.
22:08Can I grab mine as well?
22:09Yeah.
22:09Thanks.
22:17Well, it's started to rain.
22:19Oh, it's only spots, isn't it?
22:20Yeah, just a few spots.
22:21Not many.
22:23It's itching, grotesque and very debilitating.
22:27So looking forward to seeing Dr. Hermann.
22:31It was about six months ago that the spots came.
22:35It's red, big spots, very, very itchy,
22:39but then after a few weeks they become scabs
22:43and all sorts of blood and pus come out of them.
22:46They're not very attractive to look at.
22:49Stop scratching, love.
22:50You're not supposed to scrap.
22:51Oh, sorry, I forget.
22:52Which makes it worse.
22:53Every week I find more are appearing,
22:56so they are still spreading,
22:58and it worries me that there is no cure for it.
23:18Where did you go for your honeymoon?
23:20We haven't been on honeymoon yet,
23:21so if you've got any recommendations...
23:23Well, you like food, don't you?
23:25Yeah.
23:26Yeah, I'm thinking Spain, maybe the Basque region,
23:28and wineries, that's really good.
23:29Mm.
23:30But let me have a think.
23:35Hi.
23:36Is it Janet?
23:36Yes, it is.
23:37Hi, hi.
23:38Nice to see you.
23:39I'm Dr. Hermann.
23:39Come with me.
23:40Thank you very much for seeing me.
23:42Oh, my pleasure.
23:43You're looking pretty and pink today.
23:45Lovely.
23:46And this is Mottie, he's our nurse.
23:48Hello.
23:49Hello.
23:49Hello, Mottie.
23:51So tell me a little bit about what's been happening
23:53with your skin.
23:55It started in August.
23:57Itchy, itchy, itchy.
23:59Where?
24:00On my back, mainly, on the front, but my back was really itchy.
24:05And your head as well.
24:06And my head is still driving me mad.
24:08Yeah, so they start as little white spots, don't they, almost?
24:12Mm-hm.
24:12A bit sort of clear, and then they go red before they then have
24:16like a pussy head to them.
24:18Yes, but it also leaves quite a lot of scars at present.
24:21So before August last year, you had no problems with your skin.
24:26No problems whatsoever.
24:27Nothing at all.
24:28And then in August, all of a sudden, completely out of the blue,
24:32you started to get itchy.
24:33Yes.
24:34So I went to the GP, and she put me on steroids.
24:38She said, you have to see a specialist dermatologist.
24:42So we went within about five days.
24:45He took a biopsy.
24:46With the biopsy result, it was called...
24:49Let me think about this now.
24:52Reactive.
24:53Reactive.
24:53Reactive.
24:54Perforating.
24:54Perforating collagenosis.
24:56Collagenosis.
24:57You're just really struggling to remember that.
24:58I really am, yes.
24:59It's quite unknown words, isn't it?
25:01OK, what happened then?
25:03The infection took over and you ended up collapsing.
25:06And then I was rushed into hospital with septicemia.
25:10You were really, you know, not a well lady at that moment in time.
25:13Yeah.
25:13And you were admitted and had two days of IV antibiotics.
25:16What kind of an impact is it having on you and your family, do you think?
25:20I've had a very active life.
25:22My husband and I have both got bikes and we like cycling.
25:25But since this has come, I'm not fit to cycle at all.
25:29We haven't actually been to see friends, really, because I haven't really felt like...
25:32Holidays have been cancelled.
25:34You've not done things with the family because you've just not felt like it.
25:37So it has really...
25:38This is a big, big, big change, isn't it?
25:40And you had lots of interest.
25:42Everything has just sort of gone a bit.
25:44I do very little housework even now, don't I?
25:47No, Dad does it. That's no bad thing.
25:49Yeah.
25:50Okay.
25:52I would quite like to have a look at you.
25:53We want you to see it.
25:54We do.
25:55What's happening.
25:56So Mori will put you into your gown.
25:59Okay.
25:59And then we'll have a good look at it all, okay?
26:01That's fine, yeah.
26:06Okay.
26:07Right.
26:08Can I start off with looking at your hands?
26:10Yes.
26:11And so these ones are fairly newish ones, is that right?
26:15Yes.
26:16Yes, that's still...
26:17That's a new one coming, forming, isn't it?
26:19Yes.
26:19Yes.
26:20Okay.
26:21And then these are what they looked like when they were the older ones?
26:25Yeah.
26:26Yeah.
26:27These ones are where the top's been scratched off,
26:30so you can actually see quite how deep the little holes are underneath the crusted bits.
26:35Then have a look at the chest.
26:37It's ended up leaving, I mean, quite marked scars on the chest, really, isn't it?
26:42Okay.
26:43And then we're going to have a look at your scalp.
26:46It's actually a little bit more at the back.
26:48You've got these.
26:49Yes.
26:51And then I'm just going to sit you forward, if that's okay.
26:54And we're going to have a look at the back.
26:58And we can see on the back where the scratching's been happening.
27:03Yeah.
27:03The disease has gone into the scratch.
27:06Yeah.
27:06But I think it's partly why we have such sparing in the central bit.
27:10She can't get to it.
27:11Can't get to it.
27:12Yeah.
27:13Okay.
27:13Very good.
27:17Okay.
27:18Well, I can see that this is a really, really troublesome rash, isn't it?
27:24Yes.
27:24Very.
27:25The biopsy that you had before showing this as being something called perforating collagenosis,
27:31what that really means is there's something within the skin, in the middle part of the skin, that perforates through.
27:38And usually it's because it is reacting to something else.
27:44And usually it's conditions like renal disease, diabetes, and actually sometimes trauma, weirdly, can set it off.
27:53And then for some people, we just don't actually understand why you've suddenly just got it.
27:58There's a number of different treatment strategies actually able to control the inflammation.
28:04That is what controls the itch.
28:06I want to definitely do a whole lot of blood tests just to try and understand are there any other
28:12kind of markers within the blood that might suggest why this has happened.
28:17Once we've got all of the tests back, then we'll make a decision about which tablet or sometimes injection that
28:23we give you to get this under control.
28:25In the meantime, I think that I'm going to give you some topical steroids to put on it to start
28:30getting at least calmed down a little bit.
28:34And then we'll get the blood tests arranged.
28:36I can even give you a call to go through this rather than bring you all the way back here.
28:40Lovely.
28:40That's brilliant.
28:41Thank you so much.
28:42OK.
28:44It's taken a weight off my shoulders, the anxiety of what this skin condition is.
28:51Oh, hello.
28:52Hello.
28:52Everything go well?
28:54It's been really, really helpful.
28:56Oh, good.
28:56It's been wonderful.
28:57Oh, I'm so pleased.
28:59Blood tests taken.
29:00We get more results in five days' time.
29:03All in all, it's been a very long day.
29:05I'm still waiting for some confirmation that some of the investigations have been taken today, but I will be getting
29:12that very soon.
29:14It has been useful coming here, hasn't it?
29:17Absolutely.
29:24Hey, I'm going to bring Will in here next.
29:27I think that he's been really struggling with all of the topical treatment.
29:31Yeah.
29:31Life's been getting in the way a little bit for him.
29:34Hi, afternoon.
29:35I'm here to see Dr Emma.
29:36It's Will.
29:37We might have to just have a chat again about how to use the creams.
29:41OK.
29:41Yeah, yeah, yeah.
29:42OK, I'll go get him.
29:45My skin seems to be improving, though a little bit up and down and itchiness is still quite severe.
29:55Hey, Will.
29:56Hey.
29:56How are you doing?
29:57Good, thank you.
29:57Yeah, good.
29:58Come on, darling.
30:00Come and have a seat over here, Will.
30:02Super.
30:03Let's have a wee peek.
30:06I mean, it's better, but it's not great.
30:09That is my concern.
30:11Just very up and down.
30:12And how much steroid are you putting on this?
30:16Wherever there's a patch, effectively, more or less.
30:19Which one are you using?
30:20The Elecon?
30:21Dermavate.
30:22Because these ones don't look like they're getting Dermavate on them every day.
30:26Oh, OK.
30:27I mean, like I say, it's patchy.
30:28I'd be honest.
30:30I had visions of me being more every day.
30:34Yes, but it's hard.
30:35I'm doing it, I'm doing it.
30:37Yeah.
30:37But like I say, I can only be honest.
30:39I mean, this is still all very active.
30:42Like, around each one of these is very active and you're scratching every single one of them.
30:47So you've not got the dressings on them anymore?
30:51I sometimes put the bandages on a bit.
30:54I'll be honest with you, it just depends on how life goes.
30:57Yeah.
30:57I mean, this has been a crazy year.
30:59Yeah.
31:00So from, you know, with home looking after two kids.
31:04Can I have a wee look at your legs?
31:06Yeah.
31:06That's how your wee leggies up.
31:07With the death of a father and other things going on.
31:13But the death of your father, that is a big thing.
31:16You know, stress impacts the skin for sure.
31:18And sometimes it's impacting other bits of us and we don't even realise that we're stressed with it, you know?
31:24Well, I think my problem, my wife says a lot, I keep it all in.
31:28Yeah.
31:28I mean, maybe that's...
31:30Your skin is giving your secrets away.
31:32Well, essentially, yeah.
31:33But it's really not where I want it to be.
31:38I mean, the way to switch these off is definitely having the steroid onto them.
31:44And if you find that you're starting to pick at any of these ones, then that's when you need to
31:49put the dressing over the top of them.
31:52Yeah, okay.
31:52But I really importantly want you to prioritise you for 15 minutes every day, rather than the kids, rather than
32:00the whatever it is.
32:01It just means also that everyone else will be better, because you're better.
32:04Yeah, true, true.
32:05If you do that every single day, like I've said, in six weeks you will not be itchy anywhere and
32:11there will be no excoriation things here.
32:14I'm glad to be able to have seen you today so that we can work out just how things are,
32:19where we are, and to focus things a little bit more and challenge you for the next six weeks.
32:27And then I'll see you back in six weeks and see where we are with this, okay?
32:32Yeah, super.
32:34Emotional issues and stress can definitely have a big impact on how our skin heals.
32:39And in Will's case, with the death of his father and his busy life, he's kind of neglecting himself and
32:46his skin.
32:46So I'm really hoping that after the consultation, we'll be able to just find 15 minutes in his day that
32:54he thinks about himself and his skin and applies his creams and treatments in a very regimented way.
33:02I've been set a challenge and I'm going to stick to it.
33:04And so when I come back in six weeks, I really want to surprise them all with how my skin's
33:10turned around.
33:21Oh, Emma.
33:22Yeah?
33:22I've got Janet's blood results, yeah?
33:24Brilliant.
33:25I'm going to go video call her right now.
33:26Okay, great.
33:36Hello.
33:37How are you both?
33:38A bit okay.
33:39Good.
33:40So, I've got all of your blood tests.
33:58So, I've got all of your blood tests back.
34:01You've been blood tested inside and out.
34:03And I suppose the very good news is, is that there isn't anything untoward going on.
34:10Oh, I'm really, really pleased.
34:12Now, the medicine that I'm most keen to use is something called dupilumab.
34:18It's a drug that controls a certain part of the pathway that's related to inflammation.
34:24And it's particularly the point that's related to itching.
34:29And that's why I want to use that medicine for you.
34:32I'm sure it will be greatly helpful.
34:35Okay, brilliant.
34:35So, I'll organise dupilumab for you.
34:38And then I'll see you back in the clinic, okay?
34:42Okay, bye.
34:43Bye, guys.
34:43Bye, bye.
34:44Bye, bye.
34:45Bye, bye.
34:51You're a dad's boy, aren't you?
34:54It's been five months since I've seen Dr. Emma.
34:58I'm sleeping!
35:00It's just incredibly surreal not to have something there.
35:05Even the scar itself is so faint you can barely see it.
35:10Since starting on the medications and things, the groin's been fantastic.
35:14It's had a little flare up, but nothing anywhere near what I'm used to.
35:20It's an indescribable feeling, really, after living with it for so long.
35:23Going to take him down the park for a kick about you coming?
35:26Yeah, I'll come. This is a nice change, isn't it?
35:28One of the things I was told by Dr. Emma was that smoking enhances the condition.
35:34You ready, Cole?
35:35Come on, mate.
35:37It's been extremely difficult for me to quit smoking.
35:40Come on then, lad.
35:41Gone from, you know, 15, 20 fags a day, maybe, to a couple of fags a week at a push.
35:48So, getting there slowly.
35:50Are you ready, Cole?
35:52It's changed everything massively.
35:55Now I can actually get involved, help out with everything.
35:59I'll be your keeper.
36:02I never thought I'd be able to just sort of, like, get into a field with the kids again.
36:06Rather than being stuck on the couch in absolute agony, being more active and involved in their lives.
36:13It goes to show how much I was probably missing out on as well, really.
36:17Go on, Cole.
36:18Still got it.
36:20It's made our relationship a lot stronger because I don't have to be a nurse any more.
36:24Take a touch on.
36:25It's all just fun now.
36:27Well done.
36:28Good lad.
36:29Now I'm definitely happier, more confident.
36:32There's no limit to what I can do now.
36:39Oh, my gosh, I love that.
36:50I love the view of London from up here.
36:52It's so good, isn't it?
36:53It's so nice.
36:54How long have you lived here for, your bunny?
36:5523 years so far.
36:57Oh, goodness.
36:58I've lived here for 14 years.
36:59Wow.
37:00I'm still not bored of it.
37:01That's amazing.
37:06Hi.
37:07I'm Will.
37:07I'm here to see Dr. Emma.
37:09It's gone really well.
37:10My skin's so much better.
37:12It's really starting to calm down.
37:15Hi, Will.
37:16Oh, hello.
37:17You good?
37:17Yes, good.
37:19Super.
37:21And you remember Motti?
37:22Hi there.
37:23Yeah, you did.
37:26So when I saw you six weeks ago, I set you the challenge.
37:30How did that challenge go?
37:32Fine.
37:32Absolutely fine.
37:33Good.
37:34I found the 15 minutes, which was always there really.
37:37Yes, but it's sometimes hard to make it.
37:39Yes.
37:40Well, I think I've been doing really well.
37:42How does your skin feel?
37:43Because when you came in last time, you were scratching and itchy.
37:46You just wake up and you're just not doing that habit anymore.
37:49You're not scratching, you're not picking.
37:52And what about your wife?
37:53What has she noticed about your skin?
37:55She must have noticed that you're scratching a lot less.
37:57Well, there's definitely a lot less nagging going on, so I must be scratching a lot less.
38:02But this looks great.
38:03It's going to leave these brown marks behind for some time.
38:07Right.
38:08But once the inflammation is gone, actually, the pigment itself then starts to return to normal.
38:14OK, well, let's get you in a gown and we'll have a look at all of the skin now.
38:18Is that OK?
38:18Yeah, no problem.
38:22You know, eczema is hard to get on top of, particularly when it's got as severe as what yours is.
38:27Yeah.
38:28You also had a lot of issues happening, you know, at home that were very sad.
38:32So all of those things get on top of it, which makes eczema even more difficult to get in control
38:37of.
38:38Oh, my goodness!
38:40Yeah, so it's...
38:41This is brilliant!
38:42That's really, er...
38:44That's great.
38:45I mean, it's flat, yeah, it's...
38:48That is absolutely brilliant.
38:50That's constantly, always had a patch on it, so...
38:54Yeah.
38:54I can see because of your tan.
38:56Yeah, that's OK.
38:58So last time, I mean, this was all incredibly active, but it's very, very calm now.
39:04Yes, it does.
39:04It's not at all.
39:11I'm going to look at your back now, if that's OK.
39:13Yeah, no problem.
39:14OK, so lovely and clear at the top.
39:17And then these ones that were really angry down the bottom, they're doing well as well.
39:23And then these arms.
39:25The arms.
39:26Great.
39:27Yeah, again, the arms have been... I've been trying to treat the arms.
39:34Well, this is 100% going in the right direction.
39:37Oh, good, I'm glad.
39:37I'm...
39:38Yeah.
39:38Me too.
39:39Me too.
39:41I'm pleased.
39:42I'm pleased you're pleased.
39:43I'm pleased that.
39:47I'm ever so grateful to Dr Emmer and the team.
39:50I can just get on my day as normal and not think about how itchy or sore my skin is.
39:57The future's definitely looking brighter.
40:09Do you want to see something funny?
40:11Yes.
40:11Yeah.
40:12I've got a medical school reunion in two weeks' time and it's from 30 years ago.
40:17Right.
40:17And so these are all the people in my class, but that was me.
40:21Wow.
40:21Whoa.
40:23Look at that pixie cut.
40:24It was very fashionable back in the day, I'll have you know.
40:27HE LAUGHS
40:39Life has improved immensely.
40:44Hello, I'm Janet.
40:45I've come to see Dr Emmer.
40:50Dr Emmer will definitely see a big difference in your skin.
40:54Hi, Janet.
40:55Hello, Dr Emmer.
40:55How are you?
40:56Do you want to come through?
40:57Hi, guys.
40:59Okay, come on in and have a seat.
41:01Well, nice to see you both.
41:03It's nice to come back.
41:04Okay, so it's been about seven months now since I first saw you,
41:09whenever you came in with this perforating collagenosis,
41:12and we started you on a treatment called dupilumab.
41:15How have things gone?
41:17I am so, so much better.
41:19So, so much better.
41:21It really has calmed everything down.
41:24So, no, life is a lot, lot more comfortable than it was.
41:27You're going out again.
41:28You're socialising again.
41:30You've just had a few days away with Dad in the Orchard Dale.
41:33Lovely.
41:34I'll book to Thailand in January, February, if you're okay about that.
41:38Brilliant.
41:39Yes, absolutely.
41:40Good news to me.
41:41I was going to say, Carol doesn't move like this.
41:43There's nothing tells me that somebody's feeling better
41:45than booking a sneaky holiday to Thailand.
41:48I know.
41:49Perfect.
41:50I want to live life, how long I've got, you know.
41:52You don't know, so...
41:53I'm not even sure.
41:54I need to look at your skin, because clearly you're better.
41:56I don't know.
42:01Okay, I'm excited to see this.
42:03Now, it was your chest area, which I remember was the worst of all.
42:08That's right.
42:08So, let's have a wee look there, if that's okay.
42:13So, there's nothing active at all here.
42:17And these arms.
42:21That's so good.
42:22I'm going to set you forward, and I want to look at all of the back now,
42:26if that's okay.
42:30This is completely shut down, this disease now.
42:35Do you think it will come back?
42:37I don't think that this is going to come back.
42:40Really?
42:40Normally, the disease comes and it stays active
42:43until you can find the thing to switch it off.
42:46Okay.
42:47And then, often, it wanes and just disappears.
42:50So, I suspect that this is not going to come back.
42:54Fabulous.
42:55Well, that's the best news.
42:56You're a miracle worker.
42:58Well, dupilumab's pretty good.
43:00Thank you for all you've done for me.
43:03My pleasure.
43:04Go and enjoy Thailand.
43:09I'm so, so happy Dr. Emma has given us this news.
43:14So, mum's got no active disease at all, anywhere.
43:18So, it's gone.
43:20Give me a hand.
43:21Marvellous.
43:21Give Carol a kiss.
43:24Oh, that's wonderful.
43:26Wonderful.
43:26And I'm going home in a very happy frame of mind.
43:31Well, there you go.
43:32Isn't that good?
43:37Hello, Sarah?
44:02Sounds good.
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