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00:00This programme examines dermatological conditions and the procedures involved with treating
00:04them. Due to their graphic nature, viewer discretion is advised.
00:10Hi, is it Olivia? Yeah. I'm Dr Emma, do you want to come with me?
00:13Yeah. As my psoriasis has got worse, my weight has got bigger.
00:16Yeah, there is a link between the two actually.
00:19The more weight I've lost, the more prominent it's become.
00:22If it twists, that cuts off the blood supply, can actually lead to sepsis.
00:26It's like walking on glass. I'm getting fatter and less mobile and it makes me feel miserable.
00:34Every day I see people in despair and it's all because of their skin.
00:38I'm very scared of where it's going to spread to next.
00:41I was told the bigger you are, the more risks of dying on the operating table.
00:46So I wonder what you'll see.
00:48You'll get some answers, maybe.
00:50One thing that can really impact the skin is being overweight,
00:55putting on this extra weight is why, you know, I have quite a lot of these skin tags.
01:01Yeah.
01:02Often patients are given the unhelpful advice of just lose weight, which simply doesn't work.
01:09So they told me I needed to lose eight stones.
01:11Oh my gosh, that's a lot.
01:13Skin and size problems can go hand in hand and often lead to a vicious cycle of discomfort.
01:20My skin feels very tight and it bleeds.
01:23I've had psoriasis for so long that I don't remember what my skin looks like without it.
01:28So I'm on a mission to help those struggling with their skin and their size.
01:33This is to try and help tighten the skin.
01:36I'm looking forward to it, being able to walk around with no shirt on.
01:40Well, there's hundreds in there.
01:42That is absolutely amazing.
01:44I'm over the moon.
01:45I'm so pleased for you.
02:00Hello or welcome.
02:02There's a whole host of reasons why our skin might go wrong.
02:06But one thing people might not associate with skin problems is our weight.
02:13Gaining weight can be the cause of some skin conditions or might make other conditions worse.
02:20Hi, my name's Olivia. I've got an appointment with Dr. Emma.
02:23Lovely. You can take a seat.
02:27As dermatologists, tackling issues of weight where it's contributing to the underlying cause of the skin
02:32condition is essential because by not addressing the weight, we can often never get the skin fully better.
02:52I don't like looking in the mirror.
02:54I feel too big and I have the psoriasis on top of that.
02:58It just makes me feel even worse about my body.
03:01I've had it for so long that I don't remember what my skin looks like without it.
03:06My skin feels very tight. It just gets really, really itchy.
03:10And sometimes I have to scratch it and it bleeds.
03:16Where should I apply it first?
03:18I live with my boyfriend and he's very supportive.
03:22How is it today? Is it stinging?
03:24Yeah.
03:25I have to moisturise my skin about 10 times a day and it's still not enough.
03:30At its worst, it's really raging. It's looking quite bad today.
03:36Definitely my psoriasis has had an impact on my weight.
03:40Exercise makes my skin sweat and then it makes my psoriasis more itchy and it cracks.
03:46Tight clothing can rub and hurt.
03:50I've been to the doctors so many times. I just feel like they don't really listen to me.
03:56I'm very scared of where it's going to spread to next and my weight gain.
04:03Hi, is it Olivia?
04:04Yes. Nice to meet you. I'm Dr Emma. Do you want to come with me?
04:07Yeah.
04:08And this is Motti. He's our nurse. Coming out of a seat.
04:12So, Olivia, tell me about your skin. What's been happening?
04:15So, I have psoriasis. I have it on my scalp, my legs, my arms. I just hate my body
04:22because I see my psoriasis but then I also see my weight gain.
04:26Yeah. What happens is, is when your skin is bad, it's really difficult to exercise
04:30because it's painful, it's sore, it makes it flare and then that adds into increasing weight
04:36and that makes your skin worse and it just goes on in this vicious cycle, doesn't it?
04:41Yes.
04:41But I think you've also raised a really important point
04:45because there is a link between the two actually. Excess fat can make proteins and those proteins,
04:51when released into the bloodstream, can cause inflammation and that can trigger the psoriasis
04:57but actually it can also make it much worse. What kind of treatment have you had over the years
05:03for your skin?
05:03The only treatment I've ever had are steroid creams and they work for a little while and then they don't
05:10work anymore.
05:10Tell me a little bit about your general health.
05:13A lot of the time I get belly aches, diarrhoea, constipation, so yeah, I don't have very good gut health.
05:20OK, is it OK if I get you into a gown and then I can start my detective work?
05:25Yeah.
05:25All right, OK.
05:29Okey dokey, this really is everywhere, isn't it?
05:32Yeah.
05:32Right, so we've got along here a very classic type of a psoriasis plaque with the colour of it
05:40and then the scale overlying the top and then the nape of the neck. You can see this plaque
05:45that's a pinky colour and then it's got these scale areas.
05:49Plaque psoriasis is the commonest form of psoriasis. It typically presents with these red,
05:55large, raised patches and they've got an overlying scale. Essentially the body's immune system is
06:01overperforming and it's causing these inflammatory changes within the skin. And in Olivia's case,
06:08it's covering more than 80% of her body. OK, so yours is certainly this chronic plaque psoriasis
06:16that can't be cured but certainly it can be controlled. So what I want to do is give you
06:22different creams to what you're used to and also either a tablet or to give you an injection to
06:30try and clear this away for you a little bit better. And we also know that our weight is a
06:35very important thing so we'll see the dietician to get some help with that as well. Yeah. How does all
06:42of that sound? I feel very hopeful. Yeah, I can see that little glimmer of hope on your face there.
06:51Hi. Hi. How did it go? It went really well. Dr. Emma created a treatment plan for me so
06:56we're going to get somewhere.
07:09The skin is really quite remarkable. It covers our whole body and it stretches as we grow due to
07:17its elasticity. Hi, I'm Harry. I'm here to see Dr. Emma. No problem, Dixie. But not all of the body
07:25copes quite so well with these weight changes. It feels more like a hotel than a clinic. Well, it's wonky.
07:34Because when we gain weight, it's not just what you see on the outside. Fat also gathers around our
07:41internal organs and that can cause other problems.
07:56When I look in the mirror, I'm quite proud of how far I've come with my weight loss.
08:01It's been six stones so far and I've noticed a big change in my body.
08:06But there's one part of me that doesn't change no matter how much weight I lose.
08:12I suffer from an umbilical hernia. An umbilical hernia is the stomach pushing past the muscles
08:20which have given weight around my belly button and protrudes out the front. It's quite hard.
08:26The skin is very tight around it so it's very painful. Five years ago, I was larger back then, 23
08:33stone.
08:34I was out of pride and I was topless and my sister said, oh, your belly button looks really weird.
08:40There was a lump there. I decided I would go and speak to a GP about it because it was
08:45getting
08:46bigger very rapidly. He said, I'm going to need an operation. He referred me to a specialist.
08:55He looked me up and down and just said, you're fat. I was told being overweight was a contributing
09:02factor to this hernia. They wanted me to go away and lose eight stone. A specialist said,
09:07the bigger you are, the more risk factor of dying on the operating table.
09:14My current weight is 17 stone two.
09:18It's hard for me as his partner to sort of see him try and cover up so much. The more
09:24weight he loses,
09:25the bigger the hernias get him which is the knock-on effect on his confidence.
09:29My main job is a waiter. My other job is a drag queen. I'm putting a mask on, in a
09:37sense,
09:38because I don't want people judging or looking at the hernia.
09:43Hello, group. They haven't seen your face before. Not in this bar, but I've seen you in this bar.
09:52Although I have lost a lot of weight, I'm still too big for the operation. Hopefully,
09:57Dr. Emma will be able to fix this for me. Maybe I will be able to get the operation done
10:01at the
10:02current weight that I'm at.
10:13Hi, Harry. I'm Dr. Emma. Hiya. Nice to meet you. Do you want to come with me?
10:17Yeah, sure. And this is Nurse Rosie. Hiya. Nice to meet you. Nice to meet you. Have a seat.
10:22So, Harry, other than the most amazing moustache I've seen ever, what else have you come with today?
10:27I've come to speak to you because I have a hernia. It's on my stomach. Yeah.
10:31Just started off as just a misshaping belly button and as time's gone past, it went from an innie to
10:36an outie.
10:37Yeah. My kids did that to me.
10:39I have a lovely innie and now it's an outie.
10:42I think with the weight loss as well, it's made it a bit more prominent with losing a bit of
10:46weight.
10:46I've lost six stone in the past year. Oh, my gosh. That's a lot.
10:50So, I lost all the weight because I went to speak to a specialist.
10:54So, they told me I needed to lose eight stones in order to have this operation to have it fixed.
10:59So, I went away, lost the weight and I'm still not near that mark yet.
11:04Yeah. OK. And have you ever had any intense pain within it?
11:09Recently, a couple of weeks back while I was at work, I had to go and sit outside for 10
11:13minutes
11:13and take a breather because I was doubled over in pain with it.
11:16And that's not something that would normally happen to you?
11:18No. So, this was different to what you would normally...
11:20Yeah. OK. That's important.
11:22OK. Can I have a look at it? Is that OK?
11:24Yes, of course.
11:26So, as you can see... Yeah, you can just see it pouching out there.
11:29Oh, yeah. Indeed, this does look like an umbilical hernia.
11:33OK. So, an umbilical hernia occurs whenever there is increased pressure on the intestines
11:39and they bulge through an opening in the abdominal wall, right here by the belly button.
11:45And in your case, it's probably caused by this extra sick stone and weight
11:49that you've been carrying around. And it just leads to increased pressure in this area.
11:56So, this is not going to get better by itself. Something has to be done to repair this for you.
12:02And in terms of the weight that you are, I can't see any of the surgeons who I work with
12:07thinking the weight that you are is a problem. Not at all. How does that sound?
12:11I want it gone. Yeah. I just don't want this as part of my life anymore.
12:14I just want it to be gone and just move on and be happy again. OK, good.
12:22Harry's hernia is really worrying me because he's been telling me about some excruciating pain
12:27in this area. That can sometimes happen before a hernia might strangulate. That's very dangerous.
12:34And ultimately, people could end up very, very unwell in hospital and actually potentially die.
12:40We don't have any more time and this surgery really needed to happen yesterday.
12:46I'm quite nervous about the prospect of actually going in for surgery.
12:50But it's the end goal of getting this sorted out and moving on.
13:02The medicine has resulted in the improvement of my psoriasis, which has made me so much happier.
13:10But the tablets caused me to feel sick, like as soon as I take it. But side effects could have
13:18been worse.
13:20The other day I had an appointment with the gut health clinic and the doctor basically said that I
13:30don't have enough fiber in my diet. So I've made sure to incorporate some fiber in my diet and changing
13:37white pasta to whole grain pasta. That will help my skin and also help me to lose weight.
13:56Here you go, my love.
13:57Oh, thank you so much. Enjoy.
13:59I don't want to stand up today. How's your foot?
14:02Oh, it's scabby.
14:06It's like walking on glass, where you just get this sudden, sharp, horrible pain.
14:15Bottom of my foot, it's lots of dry skin, lots of blisters. It's very itchy. Oh, it's horrible.
14:26How are your feet holding out?
14:28Er, yeah.
14:30When I've seen Renata's foot, I just feel so sad that it's impacting so much on her life.
14:35She has put some weight on because it's impacted how she's able to do exercise.
14:42She then loses her confidence.
14:45I think just have a little rest. Since my foot's got worse and my activity's gone down,
14:55I've gained three, four stone. I've gone up two dress sizes.
15:01This is the biggest I've ever been in my life.
15:05When we first met Renata's foot was fine. There was nothing wrong with it, but it's gradually got
15:10worse over time. And then the last few years, it's got really bad. It's really annoying her.
15:17We got together about eight years ago, and we only got married two months ago.
15:21We have a lovely wedding, but it'd have been amazing for us to wear her favorite shoes on our
15:26wedding day. It hurts to wear high heels, so I bought a pair of Doc Martens. Over the years,
15:34I've been backing to the doctors numerous times, and each time it's been a different set of creams
15:41or a medication. One doctor tell me it's an eczema, another doctor say it's homoplantipostulosis,
15:48and another just say it's just dry skin. I worry that if I don't get the condition sorted,
15:56it becomes quite debilitating. The mood weight is just going to keep spiralling.
16:12Hiya, I'm Renata. I'm here to see Dr Emma. Lovely. Would you like to take a seat? Thank you.
16:21I've just seen two magpies outside. Oh, that's what time it is. Two for luck.
16:29Hello, Renata. Hiya. Hi, nice to meet you. I'm Dr Emma. Do you want to come with me? Thank you.
16:34OK, come on in. This is Mottie, who's our nurse. Hiya, Mottie. Tell me the story,
16:42what's been happening with your skin? So, it was about eight years ago, I got a couple of really
16:47itchy spots on the bottom of my foot, and over time, it's grown and grown, so now it's the entire
16:54base of my left foot. The scales are that hard that they cut back into me and make my foot
16:59bleed.
17:00Oh, gosh. And the itching is awful. So, is it just on this one foot? Yeah. OK,
17:06so nothing at all has ever happened on this foot? Nothing on that foot. No. Do you mind to tell
17:09me
17:09about what you're not able to do because of how it's feeling? I used to enjoy doing walks. I used
17:17to
17:17go to the gym in the morning before work to get an hour in. Gosh, that's good. I was still
17:22overweight,
17:23but not this overweight. Is this the most overweight you've been? Yeah. Yeah. I've put on about four
17:27stones since my foot got bad. OK. So... I want to be fit and healthy, but I'm getting
17:37fatter and less mobile and it's a vicious circle. Yeah, because one just feeds into the other.
17:46Can I give you a hug? Sorry.
17:54OK, let's have a look. Is that OK?
17:57I mean, it's very, very striking how this is just one foot.
18:04I can see lots of these tiny, tiny little blistery, like, vesicles.
18:12Now, we do have one here that is a pustule, but it's got quite a red, angry border.
18:19And you can see these fissures that have been created because the scale is just breaking away.
18:24And then you've got these almost like ledges of dead skin. It's so tempting just to pick.
18:33Do you pick it? Yeah. Yeah.
18:35I mean, I would do exactly the same.
18:40OK, so this is very unusual because this is only on one foot. Yeah.
18:46To me, this looks like something called a hyperkeratotic eczema.
18:52Hyperkeratotic eczema is a type of eczema that typically occurs on the hands or the feet.
18:58We know that this is something that we see in people who are obese.
19:02In fact, about 50% of people who are obese have this on the soles of the feet.
19:06And this is usually because of that extra pressure that's pressing down on the skin.
19:13OK, so in the very first instance, I need to look at the different creams that you've been using.
19:19What I want to do is give you a selection of new creams and we're going to give you some
19:24dressings as well.
19:25And actually, even themselves, these dressings control the itch that you've been experiencing.
19:30So that's a real benefit from it as well. Great.
19:33Does that sound OK? That's great. OK.
19:35I'm really excited. I might treat myself to a pair of high heels if I can get this sorted and
19:39get some weight off.
19:40It'd be nice to celebrate my one year wedding anniversary in the shoes I would have bought for my wedding.
19:46You're right. That's good.
19:54Hello. Hi.
19:56How did it go? Oh, I cried, of course.
19:59It's me.
20:00But I've got a new cream regime and some dressings.
20:04OK.
20:04And I'll be dancing for my anniversary.
20:07OK.
20:08I can see you get... I know, I can see you're getting emotional.
20:10And if you cry, I cry.
20:26I'm...
20:27I currently weigh 16 stroke.
20:29I'm very self-conscious about it.
20:32It's not nice.
20:33I'd like to be slimmer.
20:35It's difficult being confident, having two issues side by side.
20:40Being overweight and my skin.
20:44So I wonder what she'll say.
20:45I don't know.
20:47Well...
20:47We'll get some answers, maybe.
20:49Uh-huh.
20:50The skin of people with big bodies often have their own unique constellation of signs.
20:56And if you know how to look and read the signs that are there,
21:00you can find out what's going on inside the body.
21:06Hi, is it Lesley?
21:07I'm Dr Emma.
21:08Do you want to come with me?
21:10I like your necktie.
21:12It's very fabulous.
21:15Have a little seat up on the bed.
21:17So what have you come to see me about then?
21:20I've come to see you about my skin tags.
21:23I've got lots and lots of them.
21:24And where are they?
21:25They're all around my neck.
21:26Oh, that's why you're wearing the very fashionable Parisian scarf.
21:31And when did they first start coming?
21:35About six or seven years ago.
21:36There was five or six, and then there was ten or twelve.
21:40And then there was like hundreds of them.
21:42And they just kept coming.
21:43And they just kept coming.
21:44When it first came six years ago, had anything else different happened with you?
21:49I had pneumonia when I had number three child.
21:52OK.
21:52And I put on a lot of weight then that I've never really lost since then.
21:56Quite aware that I'm extra fat now.
21:59Well, I wouldn't say you're extra fat.
22:01I think that's been a bit hard on yourself.
22:03Compared to what I used to be.
22:05I think putting on this extra weight actually is probably a lot to do with why,
22:10you know, I have quite a lot of them.
22:12There's also some people who have an early onset of type 2 diabetes,
22:18actually can sometimes get some of these as well,
22:21which simple interventions can actually help with.
22:25So I don't know if you've had a blood test done for that.
22:27I think it would be worthwhile doing.
22:29OK, well, let's have a little look then.
22:31Do you want to take your scarf off for me and get your hair tied back?
22:36OK, so they're like little cuckoo pops.
22:39That's fabulous.
22:41And then...
22:42That's not fabulous, is it horrible?
22:43I don't find it horrible in the slightest.
22:46I promise you, not a single bit of me finds it horrible.
22:50There are quite a lot of these wee guys, aren't there?
22:52I counted the other night and I got to 90.
22:5590, I think, is an underestimate.
22:58But this is...
22:58And actually, you can just see that here.
23:00You see that much?
23:02This kind of slight thickening of the skin here,
23:06I would say that this is this condition,
23:08acanthosis nigricans, related to insulin resistance,
23:11and that's very much tied in with the weight changes that you've had.
23:17And then because the skin is thicker,
23:19then you get the little skin tags jutting out.
23:24Acanthosis nigricans is a thickening of the skin.
23:27Often it can appear as a darker-looking patch,
23:31but it feels really quite velvety.
23:33This is really heavily associated with insulin resistance
23:37and therefore is a strong marker for somebody who might be diabetic.
23:42So these are definitely skin tags.
23:45And why people get skin tags is not entirely understood.
23:50When our skin is stimulated, it can suddenly grow in certain places.
23:54And one of the things that can stimulate it is things rubbing together.
23:58And instead of just ignoring the rubbing, it starts to replicate
24:02and then makes these little things that we call skin tags.
24:06We also know that we often get more skin tags in areas,
24:11perhaps where there is a condition called acanthosis nigricans.
24:15Now, what I want to do are some blood tests to see if you have a pre-diabetic state
24:21because you can make interventions now that will make a big difference to your ongoing health.
24:27But how do we deal with what you've got right now?
24:30Well, it's very easy and straightforward because it simply involves us going over
24:35each one of these skin tags and just snip them off.
24:39How does all that sound?
24:40That's superb.
24:41Great.
24:42Let's do it.
24:43Let's go.
24:46There you are.
24:47How did that go?
24:49That was quite amazing.
24:50I saw Dr Emma.
24:51Uh-huh.
24:52She's saying I'm going to treat it today.
24:54Today?
24:55Yeah.
24:55That's great.
24:56That's amazing.
25:00I'm seeing signs on Lesley's skin to suggest that diabetes might be driving all of this.
25:06Type 2 diabetes is caused by problems with a chemical in the body called insulin.
25:11The blood sugar levels being too high and it's usually associated with being overweight,
25:18inactive or having a family history of type 2 diabetes.
25:22So, I'm putting anaesthetic cream on the neck.
25:26Now, I just want to see what you feel like in terms of anything sharp or sore.
25:30How's that?
25:31I've never felt a thing.
25:32Good.
25:33First one, gone.
25:34The first one is the trophy one, isn't it?
25:37It is the trophy one, except it's the second one that looks a bit more trophy-like.
25:43Nothing's hurting you, is it?
25:44No, it's fine.
25:45Well, that's great.
25:46There's lots of different ways to remove these by what we're doing here, this SNP excision.
25:52You can remove them by hyplication, cryotherapy and carbon dioxide laser.
26:03So, we've taken off the bigger ones by snipping them off and these ones that we've removed shouldn't
26:08come back and now what we're going to do is use the carbon dioxide laser for the wee tiny ones.
26:17Okay, you might feel the slight little bit of heat, but it shouldn't be anything too uncomfortable
26:21for you, okay?
26:24How did that feel?
26:25That was okay.
26:26The main target of the laser is anything with water in it, and that's why it heats it up.
26:31So, this is essentially them just being evaporated away.
26:35It should look nice for you, Leslie.
26:38We're good?
26:39Yeah.
26:39Yeah?
26:42Fabulous.
26:43We've got a wee pot of them here.
26:45Oh, wow.
26:46I know.
26:47Unfortunately, we can't even count them all out because we vaporised so many of them.
26:51That is absolutely amazing.
26:53Pleasure.
26:56It's been quite amazing.
26:58I was expecting it to be very painful and it wasn't, so it's actually quite fabulous.
27:03They're all gone.
27:08I've just finished Leslie's surgery and it's all looking great.
27:12The problem is, is that she can still go on and develop more skin tags.
27:16So, it's really important we work out what's going on with her blood.
27:19So, we can really prevent these coming back in the future.
27:25Well, that's a lovely necklace.
27:29Yes.
27:39So, I'm currently sat in a hospital ward.
27:42Basically, the hernia had strangulated my gut or my lower room testing.
27:47Like Dr. Romo had said in our consultation.
27:51And it was one of those it needed to be operated on immediately.
27:53Otherwise, it would start to kill off that part of the gut that was pushing through the hernia.
28:00So, he had to do my operation immediately.
28:06Hi.
28:07Hi there.
28:08So, Harry, you've had a rather dramatic turn of events.
28:13Yes, I have.
28:14What we've been talking about as the worst case scenario actually did happen to you.
28:20You were in, you know, immediate danger there.
28:22Exactly.
28:23You know, I've never felt pain like it before in my life.
28:26It was like someone would have just grabbed my insides and just, yeah.
28:30And then within three hours, I was operated on.
28:34Yeah, it's lucky that you listen to your own body to say, this isn't right, I need to go in.
28:39It's being stapled at the moment.
28:41So, there's about a four-inch scarring around the belly button.
28:45And the staples do come out on Wednesday.
28:48Well, Harry, I also have lots of lasers and things to help scars heal up a bit more quickly.
28:52And it would be great if I can, you know, do something like that to help out as well.
28:57Yeah.
28:58Okay, perfect.
28:59Well, look, rest up and then I'll see you soon.
29:03I'll see you soon.
29:03Thank you, bye.
29:04Bye.
29:11So, it's been a couple of weeks that I've been using the creams and dressings that Dr Emma gave me.
29:18I'm already seeing massive improvements.
29:21I've seen an increase in the number of steps that I'm taking.
29:25Just out for a little walk now that I can, now that my foot's feeling much better.
29:30Just a little one-miler last weekend to see how it went and doubling it this weekend.
29:46Guys, have you got the list for procedure room one?
29:49Thanks.
29:55Are you excited to see Dr Emma?
29:57Yeah, I'm really excited to see what she says about my skin.
30:04Olivia's coming back to see me today.
30:06Now, the tablets I put her on were working brilliantly for her psoriasis.
30:10Hi, I'm here to see Dr Emma.
30:12But she's had a bit of a setback and they've started to cause problems with her gums.
30:17So, I need to stop the tablets and come up with a new plan.
30:21OK, come on in with me, Olivia. Tell me how you've been getting on.
30:25When I first started the medication, I noticed a big difference.
30:28I was just surprised because I hadn't had clear skin for so long.
30:33And then, a few months into the medication, it started to affect my gums.
30:38They just got so swollen and red. But then, as soon as I completely stopped the medication,
30:44I started getting psoriasis.
30:47Gum hypertrophy is something that happens with cyclosporine,
30:50and that's a side effect that we're not happy to accept for people.
30:54Yeah.
30:54So, it's really important that we get you on to another treatment,
31:00which will be the injection, and that will be able to keep things under control.
31:04What did it feel like having that little glimpse of how good the skin can be?
31:08Yeah, I feel a lot more energised.
31:10I went swimming for the first time in, like, over seven years.
31:13And to be able to do that and feel comfortable and in less pain,
31:18I was just really happy, and I wanted to continue doing that.
31:21So, I think in the future, I will lose weight.
31:24And you will?
31:25Yeah.
31:25You will?
31:26Definitely, yeah.
31:27Yes, because it's very hard to do anything when your skin is not working.
31:31But that's not you now.
31:33I mean, just strutting down that corridor for a start,
31:36and your lovely little skirt and your lovely top and your hair up.
31:39Like, it's quite different, isn't it?
31:41Yeah.
31:41Okay, I want to have a little look.
31:43Is that okay?
31:44Yeah, that's okay.
31:44I'll get you into a gown.
31:45It's okay.
31:48Right, let me have a little look at your arms.
31:51So, you can see where this big angry patch was.
31:55Yeah.
31:55But now, it's gone, but you can see the little islands starting to appear.
32:00So, this is the same.
32:02You can see the outline of where things were.
32:04Yeah.
32:04Yeah.
32:05And then the nape of the neck, it's here a little bit, but not much.
32:09And then the legs, we're starting to get the little raindrops of psoriasis coming back in.
32:15But it's much better than it was.
32:18Yeah.
32:18Much better.
32:19Yeah.
32:19So, that's brilliant.
32:21The injection that you're going to move on to is actually selective and targeted to a particular
32:27part of the psoriasis to switch it off.
32:30Yeah.
32:31Okay, I'll let you get changed now.
32:35One day in the future, there will be personalised medicine where you know the right drug straight
32:40away, but at the minute, it's very much trial and error. So, although this drug hasn't worked,
32:46I'm going to start her on an injection and we'll see what happens there.
32:50I'm really excited. I'm feeling very hopeful. I know how clear my skin can get,
32:55so I feel a lot more motivation to just look after my body because I appreciate it more now.
33:01The future is looking a lot brighter for me.
33:13Daisy, are Lesley's test results back in yet?
33:16Yes. So, why don't I send them over to you now?
33:19Lovely. Yeah, great. Thanks.
33:21See ya.
33:22I sent Lesley for some blood tests because I suspected that she might have insulin resistance or pre-diabetes
33:29and this would have implications for her long-term health. So, I've got the results and I'm going
33:35to give her a call and tell her the news.
33:38Hi, Lesley. Nice to see you.
33:40You too.
33:42And how have things been for you now after we removed all of the little taggies from the neck?
33:47It's fabulous. I don't have any of the worry. I don't have any of the pain discomfort.
33:52And I've got smooth skin for the first time for years and years. And I just feel so much more
33:58confident
33:59as well now. And I realised that a lot of the main foods that eat potatoes, rice and pasta have
34:06been
34:06working to cut those down as well. That's really good. I've got the blood test results back now.
34:12Right.
34:12And actually your insulin levels are a bit high. Yes.
34:16Now, what that means is it's not type 2 diabetes yet, but actually it's heading almost on the way that
34:24it possibly could be so.
34:25Yes.
34:26It's almost been like the little skin tags were just a little warning just to say,
34:30hello, this is going on inside. So, Lesley, keeping your weight to a more healthy level,
34:38following a very healthy diet and exercising is going to prevent problems in the future.
34:43Yeah.
34:44I also think as well that with the extra confidence that you get now, you know, even things like
34:50exercise or the way that we view ourselves, that will probably change a lot for you as well.
34:56And only in a very positive way.
34:59It has essentially been a miracle, Dr. Everett. Everybody has.
35:03Good.
35:03I can't thank you now.
35:04My pleasure. Bye.
35:06Bye.
35:09Lesley's skin tag removal has worked brilliantly.
35:12So, let's hope having noticed these signs early on,
35:15it means that she's not going to go on and develop diabetes in the future.
35:31About a month ago, I was rushed into hospital for an emergency operation.
35:37The hernia was removed.
35:40And then got a scar running from the top to the bottom of my belly button.
35:45And hopefully, Dr. Emma will be able to do something for me.
35:51Harry.
35:52Yay!
35:54Come on down.
35:55Nice to see you.
35:56I did.
35:58Oh, you're having a bit of an adventurous time.
36:01Yes, I have.
36:02It's been emotional to say the least.
36:07Well, you look different.
36:08Thank you so much.
36:09You look like you've lost more weight.
36:11Yes, I have.
36:12Yeah.
36:12I've lost about another stone.
36:13Yeah, yeah, you can see that.
36:15And are you able to wear different drag outfits now?
36:18Yes, I am.
36:19I'm fitting into a lot more fitted and nicer dresses.
36:23I'm not self-conscious anymore about the hernia poking out.
36:26Big giant ballgams, big hair, lots of glitter.
36:28Amazing.
36:29OK, let's have a look at the scar.
36:31Go on.
36:36Oh, where's my friend?
36:38It's gone.
36:39That's amazing.
36:41Yep, they've done a great job.
36:43It's brilliant.
36:44Absolutely brilliant.
36:46It looks a little bit angry at the moment where it is quite red.
36:49Yeah.
36:49When we treat these scars in the early stages,
36:52then that can help it blend in a little bit more.
36:55As a dermatologist, I'm never going to be able to help repair
36:58an umbilical hernia.
37:00But what I can do is help make scars look as good as possible.
37:04And since I couldn't even help Harry with the urgent referral that we did
37:08because events took over,
37:09I really wanted to be able to have some input into his healing.
37:13So this is where I can help.
37:15This is just to help out with the redness of things
37:17and then we'll swap to the other one, OK?
37:19One, two, three.
37:21There we go.
37:23And again.
37:24And again.
37:25It is a light rather than a true laser.
37:27Energy goes into it and it's picked up by the red
37:30and helps to clear it away.
37:33Well done.
37:34How was that?
37:35Fine.
37:35I didn't even notice it.
37:37The smell is just the hair.
37:42Singed.
37:42It'll grow back.
37:44So the second laser is to try and help tighten the skin in the area.
37:49If you want to tighten anywhere else, feel free.
37:54OK, here we go.
37:55One, two, three.
37:59You can use this one for things like stretch marks as well.
38:04There we go.
38:05Perfect.
38:06So that's going to look redder for the next few weeks.
38:11I'm looking forward to it, being able to walk around with no shirt on.
38:13Oh, I'm so pleased for you.
38:15Yeah, thank you.
38:18Part of the problem with Harry is it's his larger body size that contributed to getting the hernia in the
38:23first place.
38:24And actually, it was the larger weight that meant that there was a delay in getting the hernia repaired.
38:30So it's nice to have him back without his hernia so that I can help with the redness of the
38:35scar and tightening up of the skin.
38:38I'm just really happy Dr. Reverend was able to have that last bit of aftercare and help me out.
38:43I'm going to carry on with my weight loss journey because I want to see it through to the end.
38:48I can just put this chapter behind me and get on with the rest of my life.
39:01Done some walking today.
39:03We have all over Oxford Street.
39:05Yeah.
39:09Here, I'm here to see Dr. Rammer.
39:11Lovely.
39:11Would you like to take a seat?
39:18Well, that's nice to see you back.
39:20Yeah.
39:21And you've got your two nails painted, which means you must be happier with your feet.
39:24Absolutely.
39:25Yeah, definitely.
39:26It's looking so good.
39:28Right, let's have a look and see where we are.
39:31Oh, I mean, it's so much better, isn't it?
39:33It's amazing, isn't it?
39:34There aren't any of the blisters or anything here.
39:36There's just nowhere near as angry as what it was before.
39:40So you can see the left side is virtually clear now.
39:43Oh, look at that.
39:45Yeah.
39:45That is just fabulous.
39:46Yeah.
39:47Because this was the part that was really yellow.
39:50Yeah.
39:51I mean, that's just great, isn't it?
39:52Oh, it's fab, that.
39:53So good.
39:54Yeah.
39:55You look like you've lost some weight.
39:57I've lost a stone so far.
39:59OK, that's brilliant.
40:00It's fabulous.
40:01Isn't it?
40:01I'm over the moon.
40:03I feel like I'm getting back to me.
40:05Yeah.
40:06I mean, I think we underestimate quite a lot how much weight can have an impact on things
40:12that happen in the skin.
40:13It's like the chicken and the egg is in terms of the skin disease kind of having an impact
40:18on the weight and the weight then having an impact on the skin disease.
40:22But now both are going the right way.
40:25Well, it's great to see that you're doing so well.
40:27Not just your skin, but, you know, you as well.
40:31It's lovely.
40:31It's really lovely to see.
40:33I promised myself I wasn't going to cry and I'm going to cry now.
40:36But yeah, it's just been amazing.
40:38Thank you so much.
40:39Oh, it's my pleasure.
40:40I mean, it really, really, it really is.
40:42Oh, I'm so pleased for you.
40:45Thank you so much.
40:51Feel really happy.
40:53I'm losing weight.
40:54I'm going to continue to lose weight.
40:56Feeling really positive about the future.
40:59I don't know.
40:59We might even get remarried on our anniversary.
41:05With Louboutins.
41:26I don't know.
41:27I don't know.
41:28I don't know.
41:30I don't know.
41:31I don't know.
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