- 2 months ago
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00:00It's not me anymore, I just can't accept it.
00:12I worry that people might think, she's gross, wonder what's wrong with her?
00:17I feel trapped in my skin, I just want a normal life.
00:24When our skin goes wrong, it can really ruin lives.
00:27It's extremely itchy, it's like a feeling like ants are crawling all over you constantly.
00:32You do not need to keep living like this.
00:35We've spent 13,000 so far trying to start this out.
00:38So when people who are desperate come to see us, Mottie, 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.
00:55Rosie has used the fact that this is a cosmetic, isn't it, more than once.
00:59Every skin condition is cosmetic because we can see it, but there's a medical issue underlying
01:05it that needs understanding and treatment.
01:08This is so heavy and that's why you can't breathe through your nose, and that's where we come
01:12in.
01:13Squeeze.
01:14Deflated.
01:15Deflated.
01:16Thank you so much.
01:17Wow.
01:18It's gold.
01:19Hey.
01:20Morning.
01:21How are you?
01:22I'm good.
01:23Can you see you?
01:24Oh, thank you.
01:25Oh, they're absolutely gorgeous.
01:28For your birthday, add it to the collection of flowers.
01:43Morning.
01:44Good morning.
01:45How are you?
01:46Good, thank you.
01:47Good, thank you.
01:48Oh my goodness, I absolutely love those spring rolls you were making on your socials last
01:57night.
01:58Can I come and learn how to make them?
01:59Yeah, of course.
02:00Gary, look at the state of me though.
02:04Don't look.
02:05I know, but I can't help you, but look at the state of me.
02:08That's what I must look like to people.
02:09Come on.
02:10Don't look in the window.
02:11Look, don't keep doing it.
02:12Just look forward.
02:17I've had a really bad day today.
02:19I'm just burning all round here, all across my nose, here, everywhere.
02:26I'm swollen as well.
02:29My condition started six months after having derma fillers.
02:34So I've got a lot of swelling.
02:36It's red and burning always.
02:39It's just really, really painful.
02:42It's not just the pain that I go through.
02:45It mentally destroys me.
02:47Because how I look now to what I used to look like.
02:52Before all this happened, Jack was life and soul of the party.
02:58Wouldn't need a drink to make her get up and sing or do anything.
03:02But now, she's different.
03:04She just inwardly lost all confidence.
03:08Over the last two years, we've just been to so many different dermatologists.
03:14Tried all different treatments and nothing's helping.
03:17And I just feel like, you know, where's there going to be an end to it?
03:23You know, when am I going to get the help and everything that I need?
03:26Just keep everything crossed.
03:32Fingers crossed.
03:34And your toes.
03:38Hi, is it Jackie?
03:39Yes, it is.
03:40Hi, Jackie. Now, Dr Emma.
03:41Hello.
03:42Nice to see you.
03:43And you come through.
03:45Is this your little air cooler around your neck?
03:47Yes, it's my saviour.
03:48When I'm burning.
03:49Just, I constantly have to have, like, cold air blowing in my face.
03:53OK.
03:54Yeah.
03:55Nightmare.
03:59There we go.
04:00And this is Motti.
04:01Hello.
04:02Nice to meet you.
04:03Come and have a wee seat.
04:05So, tell me a little bit about what's brought you to clinic.
04:09So, I had a little bit of filler done, just there and there.
04:12That was it.
04:13OK.
04:14And then, about five months later, I had redness, like, here.
04:18I've always had a little bit of rosacea, but you wouldn't really know that I had rosacea.
04:23And then it all went to my nose area.
04:25Mm-hm.
04:26And then it's just got gradually worse and worse over my cheeks.
04:30We've literally been everywhere in the last two years to try and sort it out.
04:34OK.
04:35And when you went and had this filler done, it didn't swell up or get red or irritated at the time?
04:40No.
04:41Nothing.
04:42OK.
04:43So, tell me a little bit now about the kind of treatments that you've had.
04:46So, I've been on different medication.
04:48Yeah.
04:49That's where I've written everything down.
04:51OK.
04:52So, they started you on oxytetracycline.
04:55They then tried clonidine and doxycycline.
04:58Yep.
04:59That's another antibiotic.
05:00And you haven't found this helpful?
05:02No, not at all.
05:03No.
05:04I'm just going round and round in circles.
05:06That's all been private.
05:07Yeah, all private.
05:08Most of it's private.
05:09The NHS.
05:10We've got neurologists.
05:11We must have spent a fortune.
05:12We have.
05:13We've spent $13,000 so far trying to sort this out.
05:16What?
05:18Don't get upset.
05:19I know.
05:20Our life's gone on hold because I'm literally just stuck indoors.
05:24Under, like, fans and everything all day.
05:27I've just been sad for the last two years.
05:30And that must be hard to watch.
05:32It's very difficult because I can't help her.
05:34Yeah.
05:35I'm going to have a look at your skin now.
05:36Is that OK?
05:37Yeah, of course it is.
05:42You can feel this is just full of fluid, absolutely full of fluid, which is compressing those
05:48little nerves.
05:49So that is part of the problem with the pain that you're feeling and experiencing.
05:53OK, I'm just going to put this bright light in.
05:56So close your wee eyes because it is a bit bright.
06:00And is this part of the skin a bit stingy?
06:02It just, like, burns.
06:04Yeah.
06:06OK.
06:09So this is rosacea.
06:11And rosacea comes in different forms.
06:14Some people get something called a neurogenic rosacea where it affects the little small nerves.
06:19Some people get this erythrotelangiectatic rosacea that affects the blood vessels.
06:25And some people get a rosacea that blocks the lymphatic system.
06:30And therefore the fluid gathers behind it.
06:33And that's why you're seeing all of these areas of swelling appear.
06:36And you have these three features of the rosacea.
06:40And I think that you're somebody who's had rosacea grumbling along for a lot of your life.
06:47Something has triggered it.
06:51But actually, I don't believe that this has anything to do with the filler that you had.
06:56In your case, this was really far away from the area in which it's happened.
07:02Something has caused a change.
07:04And it might well be changes in your own immunity, changes in the lymphatics yourself, you know.
07:10OK, yeah.
07:11We do need to think about some protective topical skincare to try and help build up your skin barrier.
07:18Because I can see how raw and red it is all around the edges.
07:22And then a tablet called isotretinoin.
07:25So I want to start you on the isotretinoin straight away.
07:29Yeah.
07:30To start to bring the inflammation out of the skin.
07:32And then what I'd like to do is Botox injections to reduce the flaring episodes.
07:38There is another injection called hyaluronidase.
07:42And it's quite good for opening up the lymphatics and trying to help drain away the fluid that's there.
07:47Right, OK.
07:48The next thing is to think about is a laser treatment to get the redness down.
07:53We start with the other stuff first.
07:55And then in about six weeks, I can start you on the laser treatment.
08:00All right.
08:01Thank you so much.
08:02Does that sound OK?
08:03Yeah.
08:04So the aim is to get the redness down, get the swelling down and to get the pain down.
08:08Yeah.
08:09And we're going to get this much better for you.
08:11OK.
08:12Thank you so much.
08:13That's OK.
08:14It's going to be a long journey.
08:15I know.
08:17Jackie is a really complex case of rosacea.
08:21And it's not just one thing is going to fix this.
08:24We have to think of lots of different modalities, including injections, lasers, tablets.
08:29And it's actually that combination of things that is going to make her better.
08:33It might take about a year, but I love a challenge.
08:37So first things first.
08:38Right.
08:39Let's put the Botox in.
08:40OK.
08:41Yeah.
08:42Now, this is just a matter of me doing lots of little injections into the skin.
08:46If you want to have a break at any point.
08:48Yeah.
08:49We can.
08:50OK.
08:51But we'll just otherwise crack on.
08:52Is that OK?
08:53OK.
08:54Yeah.
08:56You scratch.
08:59So, Botox works directly on the skin vessel pathways and it communicates directly with pain pathways within the skin as well.
09:09So we're injecting it so that it will have an effect as a reliever of pain, reliever of the flushing and redness.
09:17Brilliant.
09:18Brilliant.
09:19Well done.
09:20You're hardcore.
09:21That's a source injection normally for people, right?
09:24I think you're really gentle.
09:25Oh, good.
09:26You are, honestly.
09:27OK.
09:28Good.
09:29The Botox takes about a week to work.
09:35Right, OK.
09:36It would be nice not to be burning.
09:38OK.
09:39OK.
09:40OK.
09:41OK.
09:42So this is an injection called hyaluronidase.
09:45Hyaluronidase essentially gobbles up hyaluronic acid.
09:50The lymphatics in this area are really, really quite congested.
09:53So the idea is to try and allow the channels to help the fluid drain away a little bit more easily.
10:01OK.
10:02OK.
10:03Thank you so much.
10:04Oh, my pleasure.
10:05Hope you're not crying because I'm hurting you.
10:08No, I'm crying because I'm happy.
10:10I just want to be happy again and...
10:13You will be.
10:14OK.
10:15Right.
10:16So the next time I see you, we're going to do the laser.
10:19Right.
10:20Lovely.
10:23All the different places we've gone to, wasted all that money.
10:27And she knew straight away what was wrong with me.
10:30Hopefully, I won't be looking at myself in the mirror, looking like this for much longer, Gary.
10:37Hey.
10:38No, I don't think you will.
10:42We'll go home and celebrate now.
10:43We can.
10:44Perhaps we'll have a cheeky Chinese.
10:45Cheeky Chinese.
10:46Please.
10:56Can you pop Chris in room one?
10:58Oh, OK.
10:59Yep.
11:00I'm with him, right?
11:01Yeah, you're allocated to him.
11:02I'll see you later, then.
11:03Yeah.
11:04You all right?
11:05Yeah.
11:06Yeah, just a bit sore, that's all.
11:07OK.
11:08I estimate I've probably got about 40 altogether, mostly under both arms, between my legs.
11:24Some of them are as big as probably a small grape.
11:27Nearly there.
11:28Aye.
11:29Won't be long.
11:30They are very painful.
11:32It's like being stung by a bee, over and over and over again.
11:35I can't go on like this.
11:37They soar again today.
11:38Yeah, a bit.
11:39Yeah.
11:40Chris is just embarrassed.
11:44You don't really want to explain to other people.
11:50It's just sort of me and him that deal with it, so to speak.
11:55Well, Trisha's just embarrassed.
11:58You don't really want to explain to other people.
12:02It's just sort of me and him that deal with it, so to speak.
12:06Well, Trisha's my fiancée.
12:08We've known each other for 21 years, just over, and been engaged for, I think it's three
12:13years now.
12:14We went to an antiques fair, and I saw a lovely ring.
12:19Well, it's a pretty good engagement ring, says the assistant behind the counter.
12:24So he asked me there and then, in the middle of an antiques fair.
12:28You all right?
12:31Hi, Christopher.
12:35Hi.
12:36Hi, nice to meet you.
12:37I'm Dr Emma.
12:38Nice to meet you.
12:39Come with me.
12:41So are you a Christopher or a Chris?
12:42Oh, Chris definitely.
12:43A Chris.
12:44Yes.
12:45I was only ever called Christopher if I was in trouble.
12:47Yeah.
12:48I know that is what happens, is it?
12:50Christopher.
12:51That's it.
12:52That's exactly right.
12:53And this is Rosie.
12:54He's our nurse.
12:55Hi.
12:56Nice to meet you.
12:57What brought you to clinic today, Chris?
12:59I've got a big problem with skin tags.
13:01Okay.
13:02Particularly under my arms, but the worst ones are on the inside of my thighs here.
13:07When you're walking, they catch on each other, they catch on your clothes, and they really are sore.
13:12So when did they first start coming up?
13:14Probably about 15 years ago, and they just increased in number.
13:17I've been to the doctors, but they just say it's a cosmetic problem and basically won't do anything about it.
13:24I mean, it's just so annoying to hear that, isn't it?
13:26Because you're like, well, it's not a cosmetic problem.
13:28It's what they feel like is the problem.
13:29Yes.
13:30Now I'm retired, I do play golf a little bit more.
13:32And when I come off the course, I can be in quite a bit of pain.
13:34Yeah.
13:35Would it be okay if I have a little look at these?
13:37Is that all right?
13:38Yes, fine.
13:39Very good.
13:42Right.
13:43Let's start, I think, with the ones that are the most annoying for you.
13:46Yeah.
13:47These ones on the inner part of your leg.
13:48Is that all right?
13:49Yeah, fine.
13:50Yeah.
13:51Oh, yeah.
13:52Okay, I can see why they're annoying.
13:55Some of these are quite big, actually, aren't they?
13:57Mm-hmm.
13:58So you can see how easily they're going to kind of stick to fabric.
14:01And then the same thing on this side as well.
14:04Okay.
14:05And then can we have a look at the ones in the armpits as well?
14:10They're nice little pink ones here, aren't they?
14:13Okay.
14:14You can see why they can be irritating.
14:17Well, these are most definitely skin tags.
14:23Yes.
14:24The reason why they often come in areas where they have done is often to do with friction and the skin rubbing together.
14:31One of the things that can also sometimes make them grow is if your body's insulin levels are a bit high.
14:38Yes.
14:39And so sometimes that can be related to something called type 2 diabetes.
14:43Mm-hmm.
14:44Have you ever been tested for that?
14:45I've been tested for diabetes.
14:47I was diagnosed as pre-diabetic.
14:49Mm-hmm.
14:50Put on some cholesterol tablets at the time.
14:52Okay.
14:53Because sometimes controlling that means that you're then less likely to get them getting worse or getting more of them in the future.
15:00Okay.
15:01But the wonderful thing about skin tags is that they're very, very quick and easy to remove.
15:07Brilliant.
15:08What we do is we go along just as if you're trimming a little hedge in your garden.
15:14Right.
15:15And all the bits that are sticking out, you just snip them off one by one.
15:18And then they're gone and it's all smooth.
15:20Great.
15:21Should we just do it today?
15:22Yeah, that'd be great.
15:23I think so.
15:24Absolutely fantastic.
15:25We need to get you better on that golf course.
15:26That's it.
15:27I need plenty of practice.
15:29So we're going to start with these wee ones.
15:46What's your bets, Chris, of how many there are here?
15:49I thought there was about 40 altogether on my body.
15:52I think there might be 40 just in this armpit alone.
15:55Oh.
15:56This is incredibly satisfying.
15:59Yeah.
16:06That's 40 already, Chris.
16:08There.
16:09Okey-doke.
16:10That's one side done.
16:12OK.
16:13So in that armpit there was 27.
16:26So now we're going to move down to the groin.
16:39It's amazing how the skin grows like that, isn't it?
16:53It's extraordinary.
16:54So this is the biggest one.
17:00And the bigger they are, the bigger the little kind of vein
17:04that's kind of helping them grow is.
17:07There we go.
17:15That's it.
17:16Good.
17:17So now the other side where I believe that one of these ones
17:21looks even bigger.
17:23Not too long now.
17:36OK.
17:37There's a double big one at this side.
17:42OK.
17:43All done.
17:46Brilliant.
17:47Yeah, so there's about 120 there, Chris.
17:50A little bit out.
17:51Yeah.
17:54Like, look at that one.
17:56Wow.
17:57It's like a prune.
17:58It is like a prune.
18:00I should be glad to see the back one.
18:01Yeah.
18:06I've finally managed to get rid of them.
18:07Hello.
18:12Hold on.
18:15How are you?
18:17Not bad at all.
18:19How many has she done?
18:20How many do you think?
18:2355?
18:25120 altogether.
18:27Are you joking?
18:28No.
18:29Oh, my God.
18:30You are certainly growing a good crop there.
18:33I'm feeling great now.
18:34Can't wait to get back to doing things I wanted to do.
18:37You OK?
18:38Yeah?
18:40Oops.
18:51When you've been used to looking at a face for so long,
18:54and there's a sudden change, it's quite hard to accept.
18:58Look.
18:59Look up there.
19:00We're in London.
19:01Look how high that building is.
19:04Wow.
19:09I have a condition called vitiligo.
19:12What it means is I've got a big white patch on my face.
19:16There was quite a dramatic change overnight.
19:20It started in 2021, and it's spread ever since.
19:26I'm Sam. I'm here to see Dr. Emma.
19:27Fantastic. You take a seat. She'll see you soon.
19:32Emotionally, the impact this condition has on me is for lack of confidence.
19:38But it feels like I'm powerless to really do anything.
19:42I feel like my job is more about supporting him and kind of telling him that it doesn't matter.
19:51At work, someone said, oh, you've left toothpaste on your cheek.
19:56It's not toothpaste. It's not shaving foam. It's a skin condition.
20:03Hi, is it Sam?
20:04Hiya.
20:05Hiya. Do you want to come down?
20:06Hello.
20:07And come and have a seat.
20:08And this is Motti.
20:09Hello.
20:10Hiya.
20:12So Sam, what's brought you to clinic today?
20:14So I have a condition called vitiligo.
20:17Mm-hm.
20:18It started out as a small 5p coin kind of size in 2021.
20:24OK, so four years ago.
20:25Yeah.
20:26Yeah.
20:27And then over time, it just spread out more.
20:28Yeah.
20:29And it's just got bigger.
20:30So when we think about vitiligo, usually we think of it as something called an autoimmune response,
20:37where your immune system is attacking the pigment cells,
20:43and then it means that they're not able to make melanin properly.
20:47So it's an overactivity of the immune system, in your case, in this one particular area.
20:53OK.
20:54And do you think that this is still growing and getting larger?
20:58Yeah, it's started to move towards my chin now.
21:01Yeah.
21:02Because at first it was growing upwards, but now it's starting to grow downwards as well.
21:06I went to see a dermatologist and they gave me a steroid cream.
21:11Mm-hm.
21:12It had no effect whatsoever, so I went back and he just said,
21:15there's nothing more we can do for you really.
21:17How does it make you feel that it's there and everybody can see it every day?
21:22Does it have an effect?
21:23When you're used to your face and suddenly it changes drastically,
21:27it's hard to accept.
21:29I think it can be very kind of psychologically bothersome.
21:34Yeah.
21:35Can I have a close-up look at it?
21:37Is that OK?
21:38Yeah, no problem.
21:48So, yeah, we've got this patch and then within it, it almost looked like there's patches of hair loss,
21:55but it isn't the hairs there.
21:57It's just that they're also white, they have lost their pigment because of this condition called vitiligo.
22:04Now, melanin is what's responsible for our skin colour, but also responsible for the colour of our hair.
22:11So, the hair, instead of growing as the black colour, it doesn't have melanin right down deep where the hair is being made,
22:18and that's why it's coming out white as well.
22:21So, we're going to turn the lights out and use the woods light.
22:24OK.
22:26Perfect.
22:28It essentially allows us to be able to see hypopigmented patches in the skin.
22:34So, you see it appear very white if there's no melanin within the skin.
22:40And then when we tip your head forward, let's have a little look and see.
22:45We can see a few patches of, again, of hypopigmentation.
22:50And I can feel something here.
22:54You put the light back on.
22:58It's a bit scaly.
22:59Do you get itchy at the back of your scalp here?
23:00Uh, sometimes, yeah.
23:01Shall we take a little scraping?
23:02Scraping?
23:03Yeah.
23:06Good.
23:23OK.
23:24Okay, so when I was looking through the rest of your scalp, I also noticed you have another
23:32condition called seborrheic dermatitis, and that is a condition that makes the skin a
23:38little bit itchy in some places, and you get a bit of a scale with it, and that's why you
23:42can maybe feel that at the back of your head.
23:45Okay.
23:46Why that's important is that you can also sometimes get that in the beard area.
23:50So, you do have vitiligo, and the interesting thing about vitiligo is that it goes to the
23:59areas where damage is happening, and the seborrheic dermatitis can be making the vitiligo worse,
24:06so we do need to treat that as well as treating the vitiligo.
24:10It's pretty easy to get the seborrheic dermatitis under control.
24:14I'm going to give you a shampoo, so three times a week with that.
24:18When it comes to the actual treatment of vitiligo, there is a drug called ruxolitinib.
24:25Ruxolitinib is something called a JAK inhibitor.
24:28What it's doing is it's stopping that pathway of destruction where the immune system is attacking
24:35the pigment cells, and it's a once-daily cream, so you'll just put it on in the evening.
24:40Okay.
24:41We'll know whether it's going to be effective, really, in around about 12 weeks' time.
24:46So, if this treatment works, is it the case you need to keep using it, or after a certain
24:53period, would it just go forever?
24:55So, it's a little bit like eczema or rosacea, in the sense that you have the condition, and
25:03you can keep it under control.
25:05Sure.
25:06But, there would always be a tendency that it might come back.
25:10It's never going to cure things, you know, put it on, it's gone, it's gone away forever.
25:14I thought there was no hope for anything, so, um, a potential lifeline, I'll definitely
25:20take it.
25:21So, should we go get the prescription sorted?
25:23Yeah, let's do it.
25:24Let's do it.
25:25Come with me.
25:25The consultation was really great.
25:31I was told that it was completely incurable.
25:34Daddy.
25:35Daddy.
25:36Hello.
25:38Mwah.
25:39Hello.
25:40Hello.
25:41Daddy's here.
25:42Hi.
25:43Mwah.
25:44How was it?
25:45It was amazing.
25:46So, yeah, there's a chance the symptoms will improve.
25:49Sam's vitiligo on his face looks really subtle to us, but to him, it's really having a big
25:55impact on his quality of life.
25:56Well, head off.
25:58Come on.
25:58Whenever you get vitiligo on your face, it does disproportionately affect how you feel about
26:03it.
26:04Yeah.
26:04But hopefully this cream is going to help him.
26:07Yeah.
26:07Also for me.
26:09Hi.
26:10Come on, gorgeous.
26:12This has given me new hope.
26:14If there's a chance that this could work, I'm very grateful for that.
26:19I'll go over there, look.
26:21So, I'm in a good place.
26:30Doors opening.
26:32Hello.
26:33Hello.
26:34I've come to see Dr Emma.
26:35The top of my nose, I think that's not so swollen, but it's just constantly burning all
26:41the time.
26:43Ready to be zapped?
26:44Yes.
26:45I just hope the lasering will help.
26:51And we'll get you up on the bed.
26:53Okay.
26:55So, we're using this laser to specifically target the redness.
27:00And especially those little tiny vessels that are making up a lot of this bulk of redness
27:05for you.
27:06So, that's it just warming up.
27:10Dee, dee, dee, dee.
27:12Here we go.
27:15How does that feel?
27:16Yeah, fine.
27:16Okay.
27:17Very good.
27:20A laser is a single wavelength of light.
27:23It gets absorbed by something we call the chromophore in the skin.
27:28The chromophore sucks in that energy and converts it from the light to heat.
27:33And it's the heat that causes the destruction of the red blood vessels.
27:37Done.
27:43There we go.
27:45We might put a bit more of those other injections in the next time I see you.
27:51Okay.
27:51It's lovely.
27:52Good.
27:53So, I can see already that the face is getting smaller.
27:57Yeah.
27:57It is getting smaller because the fluid's starting to go.
28:00You have to keep up with all of the cream stuff that you're doing at home.
28:04Yeah, I will do.
28:06The laser went very well today, but that is just one piece of this very complicated jigsaw puzzle
28:12that is Jackie's rosacea.
28:14It's going to take the tablets and the injections.
28:17It's not a quick fix.
28:19All right.
28:21I've got faith in the process.
28:23Everything's just going to take time, but it's made me feel more positive.
28:29Oh, lovely.
28:29It's raining.
28:30Nice and cool.
28:32Nice and big face.
28:40So, did you end up doing something nice for your birthday?
28:42Yeah.
28:43We all just went out as a family and we all had a pizza.
28:45It was really lovely.
28:47But we are out dancing, remember, next weekend.
28:49Dancing next weekend.
28:51Oh, yes.
28:52No, it's in the diary.
28:52It's in the diary.
28:53I forget.
28:54We were dancing all night.
28:56You never remember what's in the diary.
29:05Hi.
29:05One whale back, please.
29:07Come in.
29:09I do notice people having a quick glance.
29:13Really busy, can't you?
29:15Yeah, it's very busy.
29:16People are going to look and maybe say something or have a wee whisper in a point.
29:23Hello.
29:25The thing that bothers me is that it upsets her.
29:28It really gets to her.
29:29It makes her really anxious.
29:30It does have an effect on my confidence.
29:41It would be great to have it just, it gone.
29:46Hi, Carol.
29:50Hi.
29:50Hi.
29:50Nice to see you.
29:51Come with me.
29:52Okay.
29:54Just down this way.
29:56Hi.
29:57Hi.
29:58Come on through.
29:59And this is Mottie, who's our nurse.
30:01Hiya.
30:02So tell me what's brought you along the clinic today.
30:06I've come to see about a lump that I have.
30:11I've not really been told what it is.
30:14As a few years have went past, it's gotten bigger.
30:18Whereabouts is this?
30:19So it is.
30:20Oh, yeah.
30:21Oh, yeah.
30:21Actually, your hair is perfectly placed to cover it.
30:24But when you take your hair back, it's quite obvious, isn't it?
30:27I'm normally sat like this.
30:28Yes.
30:29Or my hand covering it or my hair.
30:32Does it make you feel very self-conscious then and think about what you're wearing?
30:36Yeah.
30:36I normally don't wear lower cut tops.
30:40And I'm a swim teacher and we'll have to wear wear T-shirts when I'm working.
30:44Like, over wear swimsuits.
30:46And also when that's wet, you can see the bump sticking through the T-shirt.
30:51It's just destroyed our confidence.
30:53Yeah.
30:54It's really awkward, just where it is.
30:57But it's quite a size, really, isn't it?
31:00Yeah.
31:00And have you ever tried to do anything yourself to get rid of it?
31:03So when it first appeared, I went to the doctor.
31:07He told me it was the spot.
31:10He grabbed it quite painfully to try and squeeze it.
31:13And I said, I don't think it's the spot.
31:16He said, yeah.
31:17Home, hot flannel, as hot as you can bear.
31:20Burst it.
31:21Oh, goodness.
31:22Okay.
31:23So I'd done that a few times.
31:25It made it very angry.
31:27Infected.
31:28I had to go back, seen a different doctor.
31:31And she was like, oh my goodness.
31:33No.
31:33Yeah.
31:34Do not do that.
31:35I was badly infected now.
31:37And I was on antibiotics.
31:39And then as times went on, it's just got bigger and bigger and bigger.
31:45Okay.
31:46Okay, can I get in and have a look at it?
31:48Yeah.
31:48Okay.
31:51It's like a little egg, isn't it?
31:54Okay, so this feels fairly firm, actually.
31:57You can feel that it's all held together in some kind of a casing inside the skin.
32:04It looks redder over the surface.
32:06When the skin stretches, the skin has to get the blood vessels to help it grow.
32:12And that's why it looks a little bit redder as well.
32:14Okay.
32:15Okay.
32:16So this feels like something called an epidermoid cyst.
32:20We all have these glands within our skin.
32:23And sometimes the outlet pipe off it gets a bit blocked.
32:27It can then accumulate all of the dead skin cells on the inside rather than on the outside.
32:34Okay.
32:35And you're right, these just get bigger.
32:38Squeezing only really ever ends up in inflammation and infection.
32:43The only way to get it out is to make a little cut on the surface
32:47and then take that egg-like little cyst out.
32:53We can do that today for you.
32:54Yeah, that'd be great.
32:55Shall we do it?
32:58Big smile.
33:00Okay, well, I think we'll just take you down to the room now, yeah?
33:04Yeah, that'd be good.
33:04Yeah, come with me.
33:15I'm just going to put a little bit of the numbing stuff in now, if that's okay.
33:19Yeah.
33:19You just wriggle your toes for me, wriggly jiggly toes.
33:23Very good.
33:24Well done indeed.
33:28Very good.
33:33Okay.
33:35Now, I'm just going to check the area before we begin.
33:41Did you feel anything sharp?
33:42No, no, nothing sharp.
33:45Good.
33:46Well, we'll just go down to see if we can see the little lining.
33:51But this is beautiful.
33:52Absolutely beautiful.
33:54Okay, okay.
33:55You can see here, this is the cyst.
33:59We've just come right down on top of the cyst.
34:01And this part here, that is the cyst wall.
34:05And then inside here is where all the dead skin cells are.
34:09I'm just loosening the cyst wall up from the normal skin,
34:13so that it will be a bit easier to get the cyst wall all out.
34:17And then we're going to give it a good squeeze in a moment.
34:21It is ready and waiting.
34:25That's quite nice, isn't it?
34:26Okay, so now we can see that we've got the content of the cyst in the slide opening.
34:35Okie dokie.
34:37Okay.
34:39One, two, three.
34:41How long have they been growing for?
34:56About 12, 13, yeah.
35:03There it goes.
35:05That's the contents all coming out.
35:08Do you feel a sense of relief?
35:12You can probably smell it a little bit.
35:14Yeah.
35:16I was going to say I can smell something,
35:18and I don't know if it's just any of the medical stuff or if it's that.
35:22That is that.
35:23There we go.
35:26Okay, so we're just getting the rest of it all out,
35:28because it's a right deep one.
35:31They run deep, these.
35:32Okay, so if I could get the forceps now.
35:38Good.
35:41Perfect.
35:44So now we're just getting all the little cyst wall out,
35:47so that it doesn't cause any issues.
35:51It's a very strange sensation, isn't it?
35:53Yeah, it's strange, like, feeling a pool and a thing.
35:56Tugging.
35:57Mm-hmm.
35:58You can actually see how deep that goes.
36:01Here is the opening of this cyst, and this is the cyst wall.
36:04Strange, because it...
36:06The feeling does feel like you're quite far in.
36:09Yeah?
36:10Yeah.
36:13Ta-da!
36:15Would you like to see how deep it was?
36:17Yeah, go on.
36:18There we go.
36:19Oh, my gosh.
36:20So that is what the inside of it looks like.
36:25That's the bit that has to come out,
36:26so it's not going to come back now.
36:27Oh, my God.
36:31There you go.
36:31So you can see inside.
36:32See, it's all nice and clear.
36:34Very good.
36:39Just putting in the stitches in a slightly layered way,
36:42because it was deeper.
36:45That's the inside stitches all done,
36:47so I'm just running the little stitches on the outside.
36:49And then you are going to be plastered by Motti.
37:00There we go.
37:02OK.
37:03Good.
37:04So that's the stuff that you could smell.
37:07Do you see how there's sheets of dead skin?
37:09It's like cheese porridge.
37:10Mm.
37:12So here we go.
37:15There we go.
37:16Oh, my.
37:20And that's your wee tiny scar that's just going to be there.
37:24Happy with that?
37:25Yes.
37:27I'm just amazed that it's gone.
37:30Yeah, that's just great.
37:31That's great.
37:31I always enjoy removing cysts.
37:35They're slightly different every single one of them.
37:38The walls are different.
37:39The contents are different.
37:40The smells are different.
37:42I'm really pleased for Carol.
37:43I think this is going to make a big difference.
37:46It's something that she just doesn't have to think about now.
37:48It was great with Dr. Emma.
37:51I was ecstatic that she was able to do it for us.
37:54You all right?
37:55Oh, good.
37:56Happy?
37:57Yep.
37:57Very happy, yes.
37:59I'm feeling great.
38:01I'm over the moon and so happy and pleased.
38:05I'm so relieved that it's gone now.
38:07It's been really great since I last saw Dr. Emma.
38:20My family's definitely noticed a difference.
38:22I'm feeling better in myself.
38:26Hi, Sam.
38:27Hiya.
38:27How are you doing?
38:28Good, how are you?
38:28Good, come with me.
38:30It's gorgeous out there, isn't it?
38:32Yeah.
38:33Come and have a seat.
38:34You remember Molly from the last time.
38:36Hiya.
38:37Oh, good to see you.
38:38How are you doing?
38:39I'm doing great, thank you.
38:40One of the good things whenever somebody has had something on their face
38:43is I get to see it as we walk down the corridor.
38:46I think this cream is doing the trick by the looks of things.
38:50Yeah, it's been amazing.
38:51I'm really happy.
38:52Well, usually it really takes around about three months, four months
38:56until we're really seeing a difference.
38:57So you've been using it now for, what, two and a half months, is it?
39:00Yeah.
39:01Yeah, so this is really super early days.
39:03Even with the sun we've had, there's more of a contrast now to when I was last here,
39:07but still it's really shrunk, the vitiligo.
39:11Can I come in and have a look?
39:12Is that okay?
39:13Of course you can.
39:13Go for it.
39:13Let's have a good look at this.
39:17I mean, the first thing that's so striking, isn't it, is this whole area that was on the chin.
39:23All of this is now completely filled in, this whole area.
39:26The chin area.
39:27And that's all filled back in with your pigment cells.
39:31And the same was true where this had otherwise been all the way up towards the mole.
39:35That's all filled in.
39:36And then you're just seeing these islands of pigment coming up from where these follicles were
39:43and reinstating themselves back on the skin again.
39:47The cream is definitely working here.
39:50It really is.
39:50It's probably about 50% better if we kind of look at the area difference.
39:56Well, this is really pretty remarkable for just a couple of months in, isn't it?
40:00Yeah.
40:01So I think that carrying on with this, and we'll look at it again in a year's time,
40:06and I'm really hopeful that this is all going to be completely gone.
40:09It could all be gone.
40:11That's amazing.
40:12Yeah, I'd be very surprised if it wasn't.
40:16Should we go get you another prescription?
40:17Yeah, let's do it.
40:18Let's do it.
40:20It was a life-changing experience coming to see Dr. Emma.
40:26I didn't think anything would work with Vitiligo.
40:28Everything I saw online was, it's incurable.
40:31But clearly, the pigmentation has come back with this treatment.
40:37The future looks great for me now.
40:47Hey, Molly, who have we got next?
40:49Let me have a quick look.
40:50So we've got Jackie.
40:52Oh, good.
40:53I can't wait to see her.
40:54Her rosacea was so difficult, and I think it just requires a lot of patience
40:59and lots of different aspects of treatment with the injections and lasers every few weeks.
41:04I can't wait to see how she's getting on.
41:05Yeah.
41:05Where is she?
41:06She's out there, but you're in room 16.
41:08I think it's the first time we've been here and had the fans on.
41:14I think you're right, actually.
41:20Hi, Jackie.
41:21Hello, Dr. Emma.
41:22Good to see you.
41:23And you.
41:23Come with me.
41:24Come with me.
41:26Gosh, it's hot out there, isn't it?
41:28It is hot out there.
41:31You look absolutely brilliant, Jackie.
41:34I know, it does.
41:35It looks amazing, doesn't it?
41:36How much the redness has gone down.
41:38But even you gliding in, you look like you've just gone off a cruise ship or something with
41:43your lovely hat and your nice bag.
41:46You're nice, wouldn't it?
41:47I love a cruise ship.
41:48That's a hint.
41:50So, tell me a little bit about how you feel now.
41:55I feel so much better in myself because the redness has gone down so much, hasn't it?
42:01And it's made such a difference.
42:03That's brilliant.
42:03And in terms of the flushing and flaring, how have they been?
42:07I haven't had the fan on one little bit.
42:10How does it feel different on the inside of your face?
42:12Because before, you had a lot of pain kind of over the kind of sinus-y areas.
42:16Yes, nowhere as near what it was before.
42:19That makes me really happy to hear.
42:21Well, you can see the shape of your nose again.
42:23Exactly.
42:24And the shape of your cheekbones starting to come in.
42:26Because you've got these amazing cheekbones that were just kind of swamped by all of that
42:31tissue swelling.
42:32Desperate to get in and have a good look at your skin.
42:34Is that okay?
42:34Yeah, of course it is.
42:35Let's have a peek at you.
42:38What a difference.
42:39Oh, it just looks so good.
42:42I wouldn't have even been touching your skin like this the last time.
42:47This feels soft and bouncy.
42:49It was really rock hard, wasn't it?
42:51It was rock hard.
42:51The skin's a lot less red.
42:54It's a lot less swollen.
42:56It's really, really brilliant.
42:58I mean, it's fair to say, Jackie, your condition was definitely a challenge.
43:03But the wonderful thing is, we have so many things at our disposal to try.
43:09Yes.
43:10We can just see the difference that that makes.
43:11It's amazing, isn't it?
43:12Thank you so much.
43:13Thank you very much, yes.
43:14Thank you very much.
43:15I mean, if we hadn't got to see, I don't know what we would have been doing.
43:19Exactly.
43:20Exactly.
43:21And I don't cry now, do I?
43:23I didn't think I'd get to this stage, so I'm just absolutely over the moon.
43:33Of course, Gary, look, I can't believe it.
43:36Can you remember the first time we'd come here?
43:38How red I was.
43:40I do feel like a different person, a completely different person.
43:44It's made me a lot more happier.
43:46It has completely transformed my life.
43:49I'm forever grateful to Dr. Emma.
44:10Thank you very much.
44:25I'm fine.
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