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00:06It's not me anymore, I just can't accept it.
00:11I 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.
00:23When our skin goes wrong, it can really ruin lives.
00:27It's extremely itchy. It's like a feeling 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 sort 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.
00:47If 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 more 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.
01:15Deflated.
01:17Thank you so much.
01:19Wow.
01:20It's gone.
01:32Hey!
01:33Good morning.
01:34Can we park here?
01:35Yeah.
01:36What a nice day.
01:37Isn't it?
01:37Did you ride in two?
01:39No, I didn't.
01:40I didn't wake up early enough.
01:45Do you like my helmet?
01:46I do.
01:46It's a pleasure.
01:47Yeah, that's what it's like.
01:48It was the same as the kids ones and I was like, have you got one of my size?
01:52Yeah.
01:59I think it's going this way, wasn't it?
02:02No, that's number three.
02:10Hey, would you like to see the baby scarf?
02:13Oh, yes!
02:15Oh!
02:15And we know the gender.
02:17What is it?
02:18Have a guess.
02:19Yes.
02:20Girl.
02:21Boy.
02:21It's a boy.
02:23Oh!
02:24Oh, yeah!
02:25Oh!
02:26Exciting!
02:27Thank you!
02:32Have you still got really itchy ankles?
02:34It's starting to itch.
02:36These itches are deep.
02:38It's like somebody's inside you with a needle, poking you like a voodoo doll.
02:44Hi, sir.
02:45I'm here to see Dr Emma.
02:47It's Will.
02:47Fantastic.
02:48Just take a seat.
02:49She'll see you soon.
02:55I feel a bit sad because my skin wasn't always like this.
03:00The actual little patches are very sore.
03:02It's so dry and tight that I'm almost trying to poke my finger through my hand because it really does
03:10itch that much.
03:12Lately, it's come back in such a force that it can't just be eczema or psoriasis, which is what the
03:20doctors always thought it was.
03:22Try and leave it.
03:23Try and leave it.
03:25Try and leave it.
03:25Try and go out to sleep.
03:26Yeah, I will do.
03:27You might be awake two or three times in the night, sticking to the sheets, itching, scratching.
03:34You all right?
03:36Yeah.
03:36I can't.
03:37I'm just itching.
03:38It's like, oh, my back.
03:41There's blood.
03:42There's pus.
03:43I don't want my wife to have to sleep in a bed that's covered in blood.
03:48All right, boys.
03:48Time to go.
03:49Let's make a hustle.
03:50Come on.
03:50Let's get a bolt in the sink.
03:52Shoes on.
03:53Coat's on.
03:54So being a stay-at-home dad, it's been a struggle due to the sort of lack of sleep.
04:02Come on.
04:03Come on.
04:03Come on.
04:04All right.
04:05Let's go.
04:08He's so sort of stoic and just gets on with everything.
04:11It makes me very sad to watch him struggle with it and suffer in silence.
04:18It's having a huge impact on you.
04:21It really is.
04:22Like you say, you're living it day to day, you just don't see it.
04:25You just don't realise.
04:27I don't think you'll know how much of an impact it's having until you don't have it anymore.
04:32It would be life-changing for him to actually get some kind of treatment and a diagnosis.
04:39Well, you can't keep on going like this?
04:40No.
04:41I can't keep on going like this.
04:42It's just...
04:44Hi, Will.
04:45Oh, yes, I am.
04:46Hi, nice to see you.
04:47I'm Dr. Emma.
04:48Come with me.
04:50Did you have to come from far away?
04:51No, we were only south London like Sidcup.
04:54Oh, so easy.
04:55Yeah, not too bad.
04:57And this is Yobani.
04:58He's our nurse.
04:58Hi.
04:59How's it doing?
05:00Very good.
05:00Very good.
05:02So tell me what's brought you to clinic today.
05:05So I've been suffering with some type of skin condition for going on, what, ten years.
05:11It first came about in 2015.
05:14Yeah.
05:15And I was covered from wrist all the way up my arm, most of my body, my legs.
05:24And did you speak to any doctors about your skin?
05:28Yeah, I mean, I did go and see a local GP.
05:31It was always just called eczema or psoriasis, really.
05:33It was courses of steroid cream, make sure you moisturise so many times a day.
05:41In the process, though, I scratched myself so hard, I gave myself MRSA.
05:45So then I was putting on antibiotics to cure that.
05:48And then, what, a year ago, it erupted again, and I got infected again.
05:54Obviously, I went to the GPs and stuff.
05:56Antibiotics kicked in.
05:57And it has sealed up, but it is still itchy.
06:00And, obviously, been on a quest to try and find out what it is.
06:04Mm-hm.
06:04Can I do something to prevent it?
06:06So when you were younger, did you have any problems with your skin at all?
06:11Do you remember...?
06:12I did have eczema.
06:13Yes.
06:13But really... Mild.
06:14It might come for a day or two, then go away.
06:18But that was it.
06:19But nothing like what this has been.
06:21Have you noticed the change in him with his skin getting worse?
06:24He doesn't really say how bad it is,
06:27but he doesn't really sleep very well at all.
06:30And because of that, he's sore, he's itchy, he's tired constantly.
06:36There are nights where you start scratching one place
06:39and then you're moving on to the next.
06:42And then, well, before you know it, two hours have gone by.
06:45Yeah.
06:45And you'll suddenly look at your watch going,
06:46I can't be up at six.
06:48I've got to get some sleep.
06:50It's kind of all of his resilience is taken up just by dealing with this issue
06:56and there's nothing left.
06:58It sounds like this is having a pretty big impact.
07:03OK, well, I'm going to look at the skin all over if that's OK.
07:05OK, no problem.
07:06Can we get it going?
07:07Yes.
07:07Yeah, see you in a moment.
07:08Super.
07:15We can see it's arranged in these plaques,
07:18so they're raised and they're thickened.
07:21And around the edge of the plaques,
07:23it's where these little blisters have been.
07:25And then they get scratched.
07:27That's, yeah, I mean, that is me...
07:30Scratching it.
07:31Yeah, basically.
07:33So the back is interesting because we've got these patches again.
07:40Do you scratch with a back scratcher or do you scratch with an instrument?
07:44A spatula.
07:44A spatula, yeah.
07:46Because you can get a bit further down here actually than most people can.
07:50Okey-dokey.
07:52Fine.
07:53All of these patches here.
07:56And then you can see where you're just getting in
07:59and just scratching the top of these off.
08:01Because they're so itchy.
08:03Unfortunately, so, yeah.
08:05OK.
08:06Fine.
08:08Now, to me, this looks like an underlying chronic eczema.
08:14You're somebody who has this tendency to eczema.
08:17It's something that you've had all your life.
08:19OK.
08:20Now, that has gone away, but for some reason has been reactivated again.
08:25Yes.
08:26Sometimes it's things like some stressful events can trigger it off,
08:29sometimes medicines can trigger it off.
08:30But then because of the actual constant rubbing or the scratching,
08:35that then thickens up the areas of the skin
08:39and it's forming these hard plaques that you're seeing scattered all over.
08:44OK.
08:44I mean, this is the furthest I've ever come, knowing it is actually eczema.
08:48Yeah.
08:48Getting a definite answer for that.
08:50When it comes to the actual treatment of it, first of all, I need to give you a barrier
08:57and moisturising cream to use as an invisible barrier protecting your skin.
09:01OK.
09:01And some steroids to put on these individual lesions.
09:05Mm-hm.
09:05And I'm also going to give you a special dressing that you stick on top of them.
09:11OK.
09:11To hold the steroid in place means you won't be able to get at it to scratch it.
09:16Yeah.
09:16That's only a temporary thing we're doing.
09:18Mm-hm.
09:19That'll give you a chance to let the skin heal.
09:22Yeah.
09:22Because I think we have to give you a tablet to switch off this itchiness
09:28that you're experiencing all over the body.
09:29Right.
09:30But it is a multi-step treatment, you know, it's all of it together.
09:34Yeah.
09:34And I would like to think that once the skin is healed, the skin's not going to go back
09:38into this kind of state again.
09:40Mm-hm.
09:40Yeah.
09:40Hopefully not, no.
09:41It'd be nice.
09:42It really would be nice.
09:44OK.
09:44How does that all sound?
09:46Sounds marvellous.
09:47I'm loving it.
09:48I'm really excited.
09:49OK.
09:50Perfect.
09:56So, how'd you get on?
09:58Oh, yeah, really good.
09:59Well, so it's definitely eczema.
10:01Right.
10:02But it's like a real chronic form of eczema.
10:05It's been such a relief to actually get a proper diagnosis.
10:09Oh.
10:10Oh, yeah, brilliant.
10:12No, it's really good.
10:13Yeah.
10:13It's really good.
10:14Come on, let's get home.
10:15Come on, then.
10:16Let's get home, put our feet up.
10:19Will is a complex case.
10:21It's really hard to get on top of eczema whenever it is this out of control.
10:25And Will has a few things that he's going to have to do himself at home.
10:29He has to do his dressings.
10:30He has to do his creams.
10:32And he has to remember to take his tablet every single day.
10:34But if he sticks to this, I would say we'd start to see a difference in a few months.
10:40Dr. Emma has given me a lot of hope in that we can clear up this condition.
10:44I'm well on board.
10:54Rosie, do you need any help?
10:56Oh, yeah.
10:56Do you mind moving that?
10:57I'm just prepping for the next patient.
10:59OK.
11:12Excited to see Dr. Emma today.
11:14I am, yeah.
11:14Hopefully get some answers for the unknown.
11:18I've been in tears before with the pain.
11:20It makes you feel sick.
11:22It's just excruciating.
11:25Sticking out a lot today.
11:27Really noticeable.
11:28The cyst on my neck has definitely made me feel more self-conscious.
11:32I'm not somebody that likes to be looked at anyway.
11:34Let's do this.
11:36We've got it.
11:38It does upset me.
11:39It breaks my heart for him.
11:41I don't think he'd admit to me that it's making him as low as it is,
11:43but I know it is.
11:46To get a diagnosis is everything.
11:49Whether it's treatable, curable, just an answer is all I want.
12:07Good morning, Dr. Creighton's office.
12:10The kids have massaged.
12:12Wishing you good luck for today.
12:14Bless them.
12:16Hello, Ryan.
12:17Hi.
12:18Nice to see you.
12:19And you.
12:19Come with me.
12:21Hello.
12:22Nice to meet you.
12:23And you as well.
12:24Was it an early start for you this morning?
12:26Yeah, definitely.
12:27Could have done with an extra hour at bed.
12:29Aw, come on in.
12:32This is Rosie.
12:33He's our nurse.
12:34Hi.
12:34Come and have a seat.
12:37So what's brought you to clinic, Ryan?
12:38Ah, well.
12:40I can see.
12:41Yeah.
12:41Bit of a lump on the old neck.
12:42Been there for a few years now.
12:44Bit fed up of people looking at it and talking about it.
12:47And I also get growths in my sort of groin onto my scrotal sac and they are just beyond painful.
12:55Okay.
12:55Let's think about the one on the neck, first of all.
12:58Have you been to see the doctor about it?
12:59They always see it and they just, oh, what is it?
13:02I'm like, I don't know.
13:03How long have you had it?
13:04Five years.
13:04Oh, it's all right.
13:05Oh, that's it.
13:06Basically.
13:08All right then.
13:09Yeah, because I've had it for so long.
13:11And tell me a little bit then about what's happening in the groin.
13:14Uh, so it just starts a little bit of itching or whatever and then small sort of pea-sized
13:20lump.
13:20It can be 24 hours, 48 hours.
13:22It can go to like three inches long, two inches wide and it's just stupid pain.
13:28Like early twenties is when they really started down there.
13:30It's steadily got more and more frequent and the worry is it's just going to become
13:35a constant and I won't be able to move.
13:38Yeah.
13:38Essentially and then what?
13:40So just so I've got this right, you've had this problem in the groin really for most
13:46of your adult life.
13:47Yeah.
13:48But you haven't had a diagnosis or any long-term treatment plan for these?
13:52No.
13:53I've had a few surgeries done on them, get left with an open hole.
13:56That's one of the sort of things I end up with.
13:59Yeah.
14:01Oh yeah, that looks angry.
14:02It's real boil-like, yeah.
14:03So and it's just discharging this kind of hussy material and then it gets very red and
14:10inflamed all the way around it.
14:12Yeah.
14:13Okay.
14:14Now you have to clean it.
14:15You have to look after me and the kids and the house and everything in between because
14:18I just can't do anything.
14:21I can see that this is something that's having a big impact not just on you but
14:25probably both of your, all of your family.
14:28Yeah.
14:28It's just horrible, you know, having to shoot the kids, oh dad can we do this?
14:32Can't, can't even walk, never mind, come and do whatever you want to do, you know.
14:36It's hard.
14:37Okay.
14:38Do you smoke?
14:39Yeah.
14:40And how much do you smoke?
14:41Probably about 15 square feet a day but I am trying to, trying to quit.
14:46Yeah.
14:47Okay.
14:48Well, I really do need to have a look if that's okay?
14:52Yeah, that's fine.
14:52Yeah?
14:52Okay, good.
14:58Well, let's start with the groin area, is that okay?
15:01Yeah, that's fine.
15:02Because I think this is the area that, from the story, is bothering you the most really.
15:06When I'm in a flare up it's beyond ridiculous.
15:09Okay, let's have a little look.
15:13Okay, so no flare up right now.
15:19That's happy at the minute.
15:20I can see you've had some here.
15:23Yeah.
15:24But you've also got some of these areas that we call bridged comedones.
15:29They're like little blackheads but there's a little tunnel going between the follicles.
15:34And then let's have a look at this side.
15:37You can see where the redness and purple has been.
15:39But then I can see some of the scarring as well.
15:43Actually, I'll take this opportunity to look at your chest.
15:45Yeah.
15:45So you get some of the little spots appearing on the chest area.
15:49All part of the same kind of problem.
15:53I can tell that you had quite a bit of acne whenever you were younger.
15:56Yeah.
15:56Because you've got all of the little tiny white scar marks where it was.
16:01Then I'll let you lie back and I'm going to come around and have a look at this one on
16:05your neck.
16:05Yeah, no worries.
16:07Okie doke.
16:08So on your neck as well, I can see where you've got some of these areas of dipped acne scars.
16:14Yeah.
16:15And then what we have here is a cyst.
16:20OK.
16:23I think all of these things are all related together.
16:27And it's all part of something that we call a follicular occlusion.
16:33In other words, the follicles on our skin become blocked.
16:38They either make a spot like you have with your acne.
16:41They make a cyst like you have on your neck.
16:44Or they make these boils that you have in the groin area.
16:49OK.
16:50We call this a condition called hydradonitis superativa.
16:54It's a condition that's a little bit like acne and the two are related together.
16:59OK.
16:59But the main thing that happens is the follicles become blocked.
17:04Right, OK.
17:05So now we know what it is, we're able to then start the right kind of treatment
17:11to get it under control for you.
17:13Amazing.
17:14It's what I've been waiting for for so long now, so it's just perfect, thank you.
17:19So you know what it is.
17:20Yeah.
17:20That's the thing is sometimes not knowing why you get these.
17:23Always being in the unknown, isn't it?
17:25Yeah.
17:25Once you've got a cyst like the one you have on your neck, there's no amount of tablets
17:29or anything else that's going to get rid of it other than surgery.
17:33OK.
17:33How we deal with the rest of the skin elsewhere is usually by tablets and it's usually by a
17:40tablet that you end up taking for sometimes even a couple of years to try and get things
17:45under control.
17:46Yeah.
17:47But there is one really, really important thing that you have to do and there is no point
17:53me doing any of this treatment unless you do it.
17:57You're going to say stop smoking.
17:58Yeah.
17:58Yeah.
17:59Because your smoking is part of the reason why you have this.
18:05All right.
18:05OK.
18:06So when people smoke, one of the things it does to the skin is cause the follicles to become
18:11more blocked more easily.
18:13So, yeah.
18:15Pack it in.
18:16Right.
18:17OK.
18:18Have we a deal?
18:19Deal.
18:20Done and dusted.
18:21OK.
18:22Since you're going to pack it in, I'm really happy to remove this for you today if you
18:27like.
18:27Yeah.
18:28Yeah.
18:29Magic.
18:31OK.
18:31Ready to do it right now?
18:33Yeah.
18:33OK, let's do it then.
18:34Come on.
18:41So I'm just going to pop the anaesthetic in.
18:46You scratch.
18:49That's all the injection done.
18:51I can't wait to be honest with you.
18:53It's just one of them.
18:54I've lived with it for years now.
18:59I'm just going to check the area before we do anything, OK?
19:03And your only job is to tell me if you feel anything sharp, anything sore or anything
19:09uncomfortable.
19:10How's that?
19:10That's fine.
19:11Good.
19:13Good.
19:19And there you can see the lovely little cyst.
19:23So this will be an epidermoid cyst.
19:25And these epidermoid cysts have a much kind of softer sack wall.
19:33So the little balloon lining...
19:35Yeah.
19:35..is much softer.
19:39Give it a go.
19:41You ready for a wee squeeze?
19:42Yeah, go for it.
19:46I'll be gutted not to do that.
19:49Is that what she was hoping to do?
19:51Dying to do it.
19:52This is the most beautiful, shiny, pearly white.
19:57You've created a beautiful cyst in here.
19:59You know that?
20:01Lovely.
20:01You can keep it.
20:02I'd quite like to, actually.
20:05When the whole sack comes out, it means it's not coming back.
20:09There we go.
20:14There we go.
20:15There we go.
20:16So that's it all removed.
20:18And we'll pop a couple of little stitches in.
20:21And then you can go and have your lunch.
20:22It's as easy as that.
20:27Perfect.
20:29OK, let me show you what it now looks like.
20:34There you go.
20:35You can take the mirror.
20:36Oh, wow.
20:37It's gone.
20:38It's mad how much of a difference it makes, isn't it?
20:40Isn't it?
20:41Yeah.
20:42Lovely.
20:43Thank you very much.
20:43Does that feel good?
20:44Yeah, it's amazing.
20:45Shall we get Ellie to come in so you can see as well?
20:48Oh, yeah.
20:48She'll be just.
20:49Oh, hello.
20:50Hey.
20:51There we go.
20:52Oh, wow.
20:52Look at that.
20:53It's gone!
20:54You don't care about that.
20:55You want to see what's in it, don't you?
20:57You know me too well, but it's gone.
20:59Do you want to see what's in it?
21:01Oh, yeah.
21:01We did save it for you.
21:02I told you.
21:04There it is.
21:05It's a good one, isn't it?
21:08You can give it a poke if you want.
21:10Gloves are important.
21:13Oh, that's what's inside.
21:15Oh, it's a good one.
21:18It was great to be able to remove Ryan's cyst today, but it's the problem he's having in
21:24the groin is going to take a little bit longer.
21:26That's your side.
21:27Thank you very much.
21:29But now that we know he has hydradinitis suppurativa, I can start him on the right medication for
21:35this condition and get his skin under much better control.
21:39The best thing of it is I know now that I'm not going to be waiting for pain or in
21:44pain.
21:44You're not going to have things holding you back now, are you?
21:47No.
21:47You can move forward rather than being stuck.
21:51Finally getting an answer, knowing what it is and that there's a way to move forward
21:55with treatment, then that's amazing.
22:07How many minutes to the next patient?
22:09I think you've got 20 minutes.
22:1020 minutes?
22:11Yeah.
22:11Enough time for a break?
22:12Yeah.
22:12Oh, do you mind filling up my water bottle?
22:14Can I grab mine as well?
22:15Yeah.
22:15Thanks.
22:23Oh, it's started to rain.
22:25Oh, it's only spots, isn't it?
22:27Yeah, just a few spots, not many.
22:30It's itching, grotesque and very debilitating.
22:34So looking forward to seeing Dr. Hermann.
22:38It was about six months ago that the spots came.
22:42It's red, big spots, very, very itchy.
22:46But then after a few weeks they become scabs and all sorts of blood and pus come out of them.
22:53They're not very attractive to look at.
22:55Stop scratching, love.
22:57You're not supposed to scrap.
22:58Oh, sorry, I forget.
22:59Which makes it worse.
23:00Every week I find more are appearing, so they are still spreading.
23:04And it worries me that there is no cure for it.
23:18Yeah.
23:26Where did you go for your honeymoon?
23:28We haven't been on honeymoon yet, so if you've got any recommendations.
23:32Well, you like food, don't you?
23:34Yeah.
23:34Yeah, I'm thinking Spain, maybe the Basque region and wineries.
23:37That's really good.
23:38Mm.
23:38But let me have a think.
23:43Hi, is it Janet?
23:45Yes, it is.
23:45Hi.
23:46Hi.
23:46Nice to see you.
23:47I'm Dr. Hermann.
23:48Come with me.
23:48Thank you very much for seeing me.
23:50Oh, my pleasure.
23:51Looking pretty and pink today.
23:53Lovely.
23:55And this is Motti, he's our nurse.
23:56Hello.
23:57Hello, Motti.
23:59So tell me a little bit about what's been happening with your skin.
24:02It started in August.
24:05Itchy, itchy, itchy.
24:07Where?
24:07On my back, mainly, and my front, but my back was really itchy.
24:14And my head as well.
24:14And my head is still driving me mad.
24:16Yeah, so they start as little white spots, don't they, almost?
24:20Mm-hmm.
24:20A bit sort of clear.
24:21And then they go red before they then have like a pussy head to them.
24:26Yes.
24:27But it also leaves quite a lot of scars at present.
24:29So before August last year, you had no problems with your skin.
24:34No problems whatsoever.
24:36Nothing at all.
24:36And then in August, all of a sudden, completely out of the blue, you started to get itchy.
24:42Yes.
24:42So I went to the GP and she put me on steroids.
24:47She said, you'll have to see a specialist dermatologist.
24:50So we went within about five days.
24:53He took a biopsy.
24:54With the biopsy result, it was called, let me think about this now.
25:00Reactive.
25:01Reactive.
25:02Reactive.
25:02Perforating.
25:02Perforating.
25:03Collagenosis.
25:04Collagenosis.
25:05I'm just really struggling to remember that.
25:06I really am.
25:07Yes.
25:08It's quite odd words, isn't it?
25:09Okay.
25:10What happened then?
25:11The infection took over and you ended up collapsing.
25:15And then I was rushed into hospital with septicemia.
25:18You were really, you know, not a well lady at that moment in time.
25:21Yeah.
25:21And you were admitted and had two days of IV antibiotics.
25:25What kind of an impact is it having on you and your family, do you think?
25:28I've had a very active life.
25:30My husband and I have both got bikes and we like cycling.
25:33But since this has come, I'm not fit to cycle at all.
25:37We haven't actually been to see friends, really, because I haven't really felt like.
25:41Holidays have been cancelled.
25:42You've not done things with the family because you've just not felt like it.
25:45So it has really.
25:46This is a big, big, big change, isn't it?
25:48And you had lots of interest.
25:50Everything has just sort of gone a bit.
25:52I do very little housework even now, don't I?
25:55Yeah.
25:55No, Dad does it.
25:56That's no bad thing.
25:57Yeah.
25:59OK.
26:00I would quite like to have a look at you.
26:01We want you to see it.
26:03We do.
26:03What's happening.
26:05So Mario put you into your gown.
26:07OK.
26:07And then we'll have a good look at it all.
26:09OK?
26:10That's fine.
26:10Yeah.
26:14OK.
26:15Right.
26:16Can I start off with looking at your hands?
26:18Yes.
26:19And so these ones are fairly newish ones.
26:23Is that right?
26:24Yes.
26:24That's still.
26:25That's a new one coming, forming, isn't it?
26:27Yes.
26:28OK.
26:29And then these are what they look like when they were the older ones?
26:34Yeah.
26:34Yeah.
26:35These ones are where the top's been scratched off.
26:38So you can actually see quite how deep the little holes are underneath the crusted bits.
26:43Then have a look at the chest.
26:45It's ended up leaving, I mean, quite marked scars on the chest really, isn't it?
26:50OK.
26:51And then we're going to have a look at your scalp.
26:54It's actually a little bit more at the back.
26:56You've got these.
26:57Yes.
26:59And then I'm just going to sit you forward if that's OK.
27:03And we're going to have a look at the back.
27:06And we can see on the back where the scratching's been happening.
27:11Yeah.
27:12The disease has gone into the scratch.
27:14Yeah.
27:14But I think it's partly why we have such sparing in the central bit.
27:19She can't get to it.
27:19Can't get to it.
27:20Yeah.
27:21OK.
27:22Very good.
27:25OK.
27:26Well, I can see that this is a really, really troublesome rash, isn't it?
27:32Yes.
27:33Very.
27:33The biopsy that you had before showing this as being something called perforating collagenosis,
27:39what that really means is there's something within the skin, in the middle part of the skin,
27:44that perforates through.
27:47And usually it's because it is reacting to something else.
27:52And usually it's conditions like renal disease, diabetes, and actually sometimes trauma, weirdly,
28:00can set it off.
28:01And then for some people, we just don't actually understand why you suddenly just got it.
28:07There's a number of different treatment strategies actually able to control the inflammation.
28:13That is what controls the itch.
28:15I want to definitely do a whole lot of blood tests just to try and understand, are there
28:20any other kind of markers within the blood that might suggest why this has happened?
28:25Once we've got all of the tests back, then we'll make a decision about which tablet,
28:29or sometimes injection, that we give you to get this under control.
28:33In the meantime, I think that I'm going to give you some topical steroids to put on it
28:38to start getting at least calmed down a little bit.
28:42And then we'll get the blood tests arranged.
28:44I can even give you a call to go through this rather than bring you all the way back here.
28:48Lovely. That's brilliant. Thank you so much.
28:50OK. Thank you.
28:52It's taken the weight off my shoulders, the anxiety of what this skin condition is.
28:59Oh, hello. Hello. Everything go well?
29:02It's been really, really helpful. Oh, good. It's been wonderful.
29:05Oh, good. Oh, I'm so pleased.
29:07Yeah. Blood tests taken. We get more results in five days' time.
29:11All in all, it's been a very long day. I'm still waiting for some confirmation
29:16that some of the investigations have been taken today,
29:19but I will be getting that very soon.
29:23It has been useful coming here, hasn't it? It has. Absolutely.
29:32Hey, I'm going to bring Will in here next.
29:35I think that he's been really struggling with all of the topical treatment.
29:39Yeah. Life's been getting in the way a little bit for him.
29:42Hi, afternoon. I'm here to see Dr. Emma. It's Will.
29:45So we might have to just have a chat again about how to use the creams.
29:49OK. Is that OK? Yeah, yeah, yeah. OK, I'll go get him.
29:53My skin seems to be improving, though a little bit up and down
29:58and itchiness is still quite severe.
30:03Yeah. Hey, Will. Hey. How are you doing?
30:05I'm good, thank you. Yeah, good. Come on down.
30:08Come and have a seat over here, Will. Super.
30:12Let's have a wee peek.
30:14I mean, it's better, but it's not great.
30:17That is my concern. Just very up and down.
30:21And how much steroid are you putting on this?
30:24Wherever there's a patch, effectively, more or less.
30:27Which one are you using? The Elecon? Dermavate.
30:30Because these ones don't look like they're getting Dermavate on them every day.
30:34Oh, OK. I mean, like I say, it's patchy. I'll be honest.
30:39I had visions of me being more every day.
30:42Yes, but it's hard. I'm doing it. I'm doing it.
30:45But like I say, I can only be honest.
30:47I mean, this is still all very active.
30:50Like, around each one of these is very active
30:52and you're scratching every single one of them.
30:55So you've not got the dressings on them anymore?
31:00I sometimes put the bandages on a bit.
31:02I'll be honest with you, it just depends on how life goes.
31:05Yeah.
31:06I mean, this has been a crazy year.
31:08Yeah.
31:08So, from, you know, with home, looking after two kids.
31:12Can I have a wee look at your legs?
31:14Yeah. That's when your wee leggies up.
31:15With the death of a father and other things going on.
31:21But the death of your father, that is a big thing.
31:24You know, stress impacts the skin, for sure.
31:27And sometimes it's impacting other bits of us
31:29and we don't even realise that we're stressed with it, you know?
31:32Well, I think my problem, my wife says a lot, I keep it all in.
31:36Yeah.
31:37I mean, maybe that's...
31:38Your skin is giving your secrets away.
31:41Well, essentially, yeah.
31:42But it's really not where I want it to be.
31:47I mean, the way to switch these off is definitely having the steroid onto them.
31:53Mm.
31:53And if you find that you're starting to pick at any of these ones,
31:57then that's when you need to put the dressing over the top of them.
32:00Yeah, OK.
32:00But I really importantly want you to prioritise you for 15 minutes every day,
32:06rather than the kids, rather than the whatever it is.
32:09It just means also that everyone else will be better,
32:12because you're better.
32:13Yeah, true, true.
32:13And if you do that every single day, like I've said,
32:16in six weeks you will not be itchy anywhere
32:19and there will be no excoriation things here.
32:22I'm glad to be able to have seen you today
32:24so that we can work out just how things are, where we are,
32:29and to focus things a little bit more
32:32and challenge you for the next six weeks.
32:36OK.
32:36And then I'll see you back in six weeks.
32:38Definitely, yeah.
32:38And see where we are.
32:40Are this OK?
32:40Yeah, super.
32:42Emotional issues and stress can definitely have a big impact on how our skin heals.
32:47And in Will's case, with the death of his father and his busy life,
32:51he's kind of neglecting himself and his skin.
32:54So I'm really hoping that after the consultation, we'll be able to just find 15 minutes in his day,
33:02that he thinks about himself and his skin and applies his creams and treatments in a very regimented way.
33:10I've been set a challenge and I'm going to stick to it.
33:13And so when I come back in six weeks, I really want to surprise them all with how my skin's
33:18turned around.
33:30Oh, Emma. Yeah?
33:30I've got, um, Janet's blood results, yeah?
33:32Brilliant. I'm going to go video-call her right now.
33:34OK, great.
33:44Hello.
33:45How are you both?
33:47Bit OK.
33:48Good. So, I've got all of your blood tests.
34:08So, I've got all of your blood tests back.
34:11You've been blood tested inside and out.
34:13And I suppose the very good news is, is that there isn't anything untoward going on.
34:20Oh, I'm really, really pleased.
34:22Now, the medicine that I'm most keen to use is something called dupilumab.
34:28It's a drug that controls a certain part of the pathway that's related to inflammation,
34:34and it's particularly the point that's related to itching.
34:38And that's why I want to use that medicine for you.
34:42I'm sure it will be greatly helpful.
34:44OK, brilliant.
34:45So, I'll organise dupilumab for you, and then I'll see you back in the clinic, OK?
34:52OK, bye. Bye, guys. Bye, bye.
34:59Give me the dad, eh?
35:00You're a dad's boy, aren't you?
35:04It's been five months since I've seen Dr Emma.
35:08I'm sleeping!
35:10It's just incredibly surreal not to have something there.
35:15Even the scar itself is so faint you can barely see it.
35:20Since starting on the medications and things, the groin's been fantastic.
35:24It's had a little flare up, but nothing anywhere near what I'm used to.
35:30It's an indescribable feeling, really, after living with it for so long.
35:33I'm going to take him down the park for a kick about you coming.
35:36Yeah, I'll come. This is a nice change, isn't it?
35:38One of the things I was told by Dr Emma was that smoking enhances the condition.
35:44You ready, Cole?
35:45Come on, mate.
35:47It's been extremely difficult for me to quit smoking.
35:50Come on then, lad.
35:51Gone from, you know, 15, 20 fags a day, maybe, to a couple of fags a week at a push.
35:57So, I'm getting there slowly.
36:00Are you ready, Cole?
36:02It's changed everything massively.
36:05Now I can actually get involved, help out with everything.
36:08I'll be your keeper.
36:12I never thought I'd be able to just sort of, like, get into a field with the kids again.
36:16Rather than being stuck on the couch in absolute agony, being more active and involved in their lives,
36:22just goes to show how much I was probably missing out on as well, really.
36:27Go on, Cole.
36:28Still got it.
36:30It's made our relationship a lot stronger, cos I don't have to be a nurse any more.
36:34Take a touch, then.
36:35It's all just fun now.
36:37Well done.
36:38Good lad.
36:39Now I'm definitely happier, more confident.
36:42There's no limit to what I can do now.
36:49Oh, my gosh, I love that.
37:00I love the view of London from up here.
37:02It's so good, isn't it?
37:03It's so nice.
37:04How long have you lived here for you, Bunny?
37:0523 years so far.
37:06Oh, goodness.
37:07I've lived here for 14 years.
37:09Wow.
37:10I'm still not bored of it.
37:11That's amazing.
37:16Hi, I'm Will.
37:17I'm here to see Dr. Emma.
37:18It's gone really well.
37:20My skin's so much better.
37:22It's really starting to calm down.
37:25Hi, Will.
37:26Oh, hello.
37:27You good?
37:27Yes, good.
37:29Super.
37:31And you remember Motti?
37:32Hi there.
37:33Yeah, how you doing?
37:35I did.
37:36So when I saw you six weeks ago, I set you the challenge.
37:40How did that challenge go?
37:42Fine.
37:42Absolutely fine.
37:43Good.
37:43I found the 15 minutes, which was always there, really.
37:47Yes, but it's sometimes hard to make it.
37:49Yes.
37:50Well, I think I've been doing really well.
37:52How does your skin feel?
37:53Because when you came in last time, you were scratching and itchy.
37:56You just wake up, and you're just not doing that habit anymore.
37:59You're not scratching.
38:01You're not picking.
38:02And what about your wife?
38:03What has she noticed about your skin?
38:05She must have noticed that you're scratching a lot less.
38:07Well, there's definitely a lot less nagging going on,
38:09so I must be scratching a lot less.
38:12But this looks great.
38:13It's going to leave these brown marks behind for some time.
38:17Right.
38:17But once the inflammation is gone, actually the pigment itself
38:22then starts to return to normal.
38:24OK, well, let's get you in a gown and we'll have a look
38:27at all of the skin now.
38:28Is that OK?
38:28Yeah, no problem.
38:32You know, eczema is hard to get on top of,
38:35particularly when it's got as severe as what yours is.
38:37Yeah.
38:38You also had a lot of issues happening, you know, at home
38:41that were very sad, so all of those things get on top of it,
38:44which makes eczema even more difficult to get in control.
38:48Oh, my goodness!
38:50Yeah, so it's, um...
38:51This is brilliant!
38:52That's really, uh...
38:54That's great.
38:55I mean, it's flat, yeah, it's...
38:57That is absolutely brilliant.
39:00That's constantly, always had a patch on it, so...
39:04Yeah.
39:04I can see because of your tan.
39:06Yeah, that's...
39:08So, last time, I mean, this was all incredibly active,
39:12but it's very, very calm now.
39:14Yes, it does.
39:14It's not at all.
39:21I'm gonna look at your back now, if that's okay.
39:23Yeah, no problem.
39:24Okay, so lovely and clear at the top.
39:27And then these ones that were really angry down the bottom,
39:31they're doing well as well.
39:33And then these arms.
39:35The arms.
39:36Great.
39:37Yeah, again, the arms have been...
39:39I've been trying to treat the arms.
39:44Well, this is 100% going in the right direction.
39:47Oh, good, I'm glad.
39:47I'm...
39:47Yeah, me too.
39:49Me too.
39:50Thank you, I'm pleased.
39:52I'm pleased you're pleased.
39:57I'm ever so grateful to Dr. Emma and the team.
40:00I can just get on my day as normal
40:02and not think about how itchy or sore my skin is.
40:07The future's definitely looking brighter.
40:19Do you want to see something funny?
40:21Yes.
40:21Yeah.
40:22I've got a medical school reunion in two weeks' time,
40:25and it's from 30 years ago.
40:27Right.
40:27And so these are all the people in my class,
40:29but that was me.
40:31Wow.
40:31Whoa.
40:33Look at that, pixie cut.
40:34It was very fashionable back in the day, I'll have you know.
40:50Life has improved immensely.
40:54Hello, I'm Janet.
40:55I've come to see Dr. Emma.
41:00Dr. Emma will definitely see a big difference in your skin.
41:04Hi, Janet.
41:05Hello, Dr. Emma.
41:05How are you?
41:06Do you want to come through?
41:07Hi, guys.
41:09OK, come on in and have a seat.
41:12Well, nice to see you both.
41:13It's nice to come back.
41:14OK, so it's been about seven months now since I first saw you
41:18whenever you came in with this perforating collagenosis,
41:22and we started you on a treatment called Dupilumab.
41:25How have things gone?
41:27I am so, so much better.
41:30So, so much better.
41:31It really has calmed everything down.
41:34So, no, life is a lot, lot more comfortable than it was.
41:37You're going out again.
41:38You're socialising again.
41:40You've just had a few days away with Dad in the Orchard Dales.
41:42Lovely.
41:44I'll book to Thailand in January, February, if you're OK about that.
41:48Brilliant.
41:49Yes, absolutely.
41:50There's news to me.
41:51I was going to say, Carol doesn't know about this.
41:53There's nothing tells me that somebody's feeling better
41:55than booking a sneaky holiday to Thailand.
41:58I know.
41:59Perfect.
41:59I want to live life.
42:00How long I've got, you know, you don't know, so...
42:03I'm not even sure I need to look at your skin
42:05because clearly you're better.
42:10OK, I'm excited to see this.
42:13Now, it was your chest area, which I remember was the worst of all.
42:18So, let's have a wee look there, if that's OK.
42:23So, there's nothing active at all here.
42:27And these arms.
42:31That's so good.
42:32I'm going to sit you forward
42:34and I want to look at all of the back now, if that's OK.
42:40This is completely shut down, this disease now.
42:45Do you think it will come back?
42:47I don't think that this is going to come back.
42:49Really?
42:50Normally, the disease comes and it stays active
42:53until you can find the thing to switch it off.
42:56OK.
42:56And then often it wanes and just disappears.
43:00So, I suspect that this is not going to come back.
43:04Fabulous.
43:04Well, that's the best news.
43:06You're a miracle worker.
43:07Well, dupilumab's pretty good.
43:10Thank you for all you've done for me.
43:13My pleasure.
43:14Go and enjoy Thailand.
43:19I'm so, so happy Dr. Emma has given us this news.
43:24So, mum's got no active disease at all, anywhere.
43:28So, it's gone.
43:29Give me a hand.
43:30Marvellous.
43:31Give Carol a kiss.
43:33Oh, that's wonderful.
43:36And I'm going home in a very happy frame of mind.
43:41Well, there you go.
43:42Isn't that good?
44:12Thanks, everyone.
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