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The Bad Skin Clinic S08E05 Feels Like Ants Crawling on Me
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00:06It's not me anymore.
00:08Just can't accept it.
00:11I worry that people might think,
00:14she's gross, wonder what's wrong with her?
00:17I feel trapped in my skin.
00:20I just want a normal life.
00:23When our skin goes wrong, it can really ruin lives.
00:27It's extremely itchy.
00:28It'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,
00:41Mottie, 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
00:49because 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 problem.
00:57I've done it more than once.
00:59Every skin condition is cosmetic because we can see it.
01:02But there's a medical issue underlying it
01:05that needs understanding and treatment.
01:07This is so heavy.
01:09That'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.
01:31Oh, it's just gorgeous, isn't it today?
01:33It is.
01:34How's the baby?
01:34Yeah, good.
01:35But with this light, I need to get some blackout blinds.
01:37I know.
01:38I mean, I think that's a lifesaver when you put the blackout blinds in.
01:40How are you sleeping anyway?
01:41Good.
01:42Good.
01:42But it could be better.
01:54Should we get a coffee?
01:56Definitely.
01:56Morning.
01:57A new skirt.
02:08Do you know where you're going?
02:09Oh, it's just there.
02:10It's just there on the corner.
02:11Oh, we made it.
02:19Hello, dermatology department.
02:20How can I help?
02:28I will only leave the house if I am wearing a cap.
02:32Because that's what I hide behind.
02:39Hi, I'm Pfizer.
02:41I'm here to see Dr. Emma.
02:42Great.
02:42Just take a seat and she'll be with you shortly.
02:46My life's on hold because my skin controls everything that I do.
02:51If it's a bad day, I'll be housebound.
03:07When I look in the mirror, I see somebody that doesn't really look like me.
03:12Someone who is in pain, struggling with her skin.
03:18I just don't see myself.
03:21My skin is extremely dry and shedding.
03:26Very itchy.
03:27It's like a feeling like ants are crawling all over you constantly.
03:31All of my twenties, I had clear skin.
03:34And then I used a cream and then it's just been downhill.
03:40Well, can you see the cream there?
03:41They're still selling it.
03:42The cream was recommended by a friend of mine,
03:45as it gives you quite glowy skin.
03:47Online, a lot of people were saying it was great.
03:50And on social media, lots of people were saying it was amazing.
03:55So I brought a pot.
03:57£45?
03:59Cheaper than what I paid for it.
04:03Gradually, her skin became very blotchy.
04:05It started irritating her face a lot.
04:07So her face became red, swollen, itchy, dry.
04:13And once I'd stopped the cream completely, my skin exploded.
04:17It would just burn and it would ooze.
04:20So I looked into it further online and an article had come out
04:25where a mother had had it tested and it contained very potent steroids.
04:31Well, there's a question there as well.
04:33If I do any steroids in the cream, she said, oh, DM me.
04:37That was four years ago and my skin has never been the same since.
04:43I am a teacher and I love my job.
04:46I was working full time, but because of my skin, I've had to drop my hours.
04:52I only work two afternoons now.
04:55I just like to go back to being me, me before the skin condition.
05:04Is it really itchy?
05:05Yeah, it's quite bad.
05:07Well, I'll try not to.
05:13Hi, Pfizer.
05:15Hi.
05:15Hi, nice to meet you.
05:16Hi, I'm Dr Emma.
05:17Come with me.
05:19Hi.
05:20Hi, are you OK?
05:20Have a seat.
05:22And this is Yobani, who's our nurse.
05:23Hi, nice to meet you.
05:26So, tell me a little bit about what's brought you to clinic.
05:29I've got skin problems.
05:30Very dry, itchy, and then really hyperpigmented, as you can see.
05:35I've got really, like, thick skin.
05:38OK.
05:39So, tell me when did this all first start?
05:41I had severe eczema up until five.
05:44Uh-huh.
05:45And then I grew out of it.
05:46I had very clear skin up until 30.
05:49And then I used herbal cream that I didn't know had hidden steroids in it.
05:53Why did you use the cream in the first place?
05:55Because it was a moisturiser.
05:57Oh, you thought it was a moisturiser.
05:58Moisturiser, yeah.
05:59And were you using the cream all over your body?
06:01Um, mainly on my face and my arms.
06:04OK.
06:04Um, started off with blotches on my face initially once I stopped using it.
06:10If you look at my skin, it'd say, OK, that's 2012.
06:14Absolutely clear.
06:15Mm-hmm.
06:16What was the name of the cream?
06:17Uh, it was called the orange cream.
06:20It's not going to be that one, is it?
06:21It's not this one, is it?
06:24Yeah.
06:25Oh, it is?
06:25Yeah, it doesn't have a website.
06:27Just say to WhatsApp.
06:29Yeah.
06:30That's literally it.
06:32But do you think the reviews people are doing from this,
06:34are they doing it themselves or paying someone to do that?
06:37I have no idea.
06:37Yeah.
06:38I used about a tub.
06:39How much did you pay for it?
06:40£50 for a little tub about that big.
06:42What?
06:43Yeah.
06:44And I've never had egg-sum on my face.
06:46And you've been using the orange cream on your face?
06:49The orange face, yes.
06:50So this is how it started.
06:52Can you see these patches?
06:55And then it just got progressively worse.
06:58Is it itchy?
07:00Yes, extremely itchy, especially at night.
07:02And then you've been tested for allergies now, is that right?
07:05I've had patch testing that came up with nothing.
07:08Mm-hm.
07:09I did try sex sporing.
07:10Mm-hm.
07:11Did it work.
07:12OK, how long did you try it for?
07:13Erm, three months.
07:15This is having a big, big, big impact on you, isn't it?
07:17Massive.
07:18I'm going to have a look at your face now, is that OK?
07:20Yes, please do.
07:25So let's have a wee look at you.
07:26Close your wee eyes for me.
07:29OK, so almost looks like a wrinkling of the skin, really, doesn't it?
07:33It's something called lichenification.
07:36And lichenification is where the skin has thickened up.
07:40And then the same thing's happening coming round the mouth,
07:44and especially round that top upper lip.
07:47OK, and again, so the palms of the hands are pretty good.
07:51But then on the back of the hand here,
07:54you just see this really marked lichenification.
07:58OK, so having looked at all of the skin and hearing all of the story,
08:03what I'm looking at is somebody who has a very chronic eczema.
08:09Most of the times, people who have this as a kid,
08:12they do grow out of it, and it never comes back to bother them again.
08:16Yeah.
08:16But in a small number of people, certain things can trigger it off,
08:21and then the eczema can return, and can return in quite a spectacular way.
08:26Because you've been using this orange cream,
08:29I think this has probably been the thing that's irritated your skin barrier.
08:32Yeah.
08:33And it's then allowed your kind of underlying eczema to just go absolutely crazy.
08:39Yeah.
08:39When it comes to treating eczema,
08:42there's a couple of different things that we have to think about.
08:45Number one is trying to get a better skin barrier in place.
08:51Yeah.
08:51So that is the most important thing.
08:53And the way we do that is to use certain emollients or moisturisers.
08:57I'm going to give you two lots of these ones to try.
09:00The next thing is the thing that's a bit trickier,
09:03because we have to switch off the inflammation.
09:07So it's your immune system is driving this.
09:10But the medicine I'm going to give you is something called dupilumab.
09:13Yeah.
09:13The injection targets a more specific point of the immune system.
09:19OK.
09:20Perfect.
09:21OK.
09:21Yeah.
09:22It's not going to be a quick fix.
09:23Like, in two weeks, it's going to be great.
09:25Yeah.
09:25It's going to be about a year of, you know, gradually changing things along.
09:29Yeah.
09:29And getting better bit by bit by bit.
09:32But this is a fixable condition.
09:34You do not need to keep living like this.
09:37Absolutely not.
09:38Yeah.
09:38That would be great.
09:40No, thank you so much.
09:41OK.
09:42Yeah.
09:43I'm happy for that.
09:44Sounds like a plan.
09:48Can you believe the screams are completely unregulated?
09:51It is just crazy, isn't it?
09:54It's so sad.
09:55My consultation with Dr. Emma was amazing.
09:58It's really nice that I've now got, like, a diagnosis
10:01and I know what's triggered it.
10:03I mean, all of these things that you buy on a social media channel like that,
10:07most of them aren't made in the UK,
10:09so they don't have to go through the regulations that we have
10:12to keep something safe.
10:14I mean, it just makes me so mad.
10:17We've got a plan in place now with the treatment
10:20and that should be starting soon.
10:30I saw Dr. Emma a couple of years ago
10:33and it changed my life.
10:37Last time, Dr. Emma removed 15 lipomas from my arms
10:40and it was quite a difference
10:43and I'm really, really grateful for the work that she's done.
10:48Hi there.
10:49My name's Adam.
10:50I'm here to see you, Dr. Emma, again.
10:51Fantastic, I'll let her know you're here.
10:54The locations of my lipomas right now
10:57is on my lower side
11:00and most of them are on my legs.
11:04I would describe it as ugly, awful and uncomfortable.
11:10They just shouldn't be there.
11:15This time I'm back
11:16and hopefully she's going to remove as many as she can.
11:19I would change my life.
11:21It would just be a different world for me.
11:24Hi, Adam.
11:25Hello.
11:26How are you doing?
11:26Good, nice to see you.
11:29I've got something for you.
11:30What have you got for me?
11:32What have you got for me?
11:36Oh, nice.
11:38Wow.
11:40Come with me.
11:41So that's like, what, two years ago now?
11:44Yeah, exactly.
11:45Do you remember if we were timing them if I could so we could get them out?
11:47Well, one came out in seven seconds, so that's still the record.
11:51Oh, my God.
11:52Come on in.
11:54Adam has familial multiple lipomatosis
11:57and that's where lots of lipomas appear all over the body.
12:01Now, these are benign and they don't necessarily need to be cut out.
12:04However, when they're at sites that everybody keeps looking at,
12:08or if they're painful and uncomfortable,
12:11then the best thing to do is to surgically remove them.
12:15All right.
12:15Let's have a look at the legs then.
12:17Okay.
12:18Yeah.
12:19There's loads in there, isn't there?
12:21Quite a few.
12:22Okay.
12:23That's a fabulous one.
12:25Tell me about it.
12:26You said you have some on the side as well?
12:29There you go.
12:30I have these.
12:31Oh, yeah.
12:31I think that's probably the biggest one of all.
12:34Mm.
12:35Yeah, and I bumped it.
12:36Yeah, you've got a bruise over this one.
12:39Okay.
12:40So, there's only a certain amount we can do,
12:42because we're only allowed to put a certain amount of anaesthetic into you.
12:46Yeah.
12:46But I'm happy to do whichever area seems most problematic to you.
12:50I think this would be better because it would let me sleep properly
12:54without, you know, having pain sometimes.
12:58Yeah.
12:58Yeah.
12:59Should we do that then?
12:59I think so, yeah.
13:00Yeah?
13:00Perfect.
13:01Good.
13:01And then you can always come back for more.
13:04I seem to like it.
13:05Yeah.
13:09Okay, if you lie yourself here, Adam.
13:13So, I'm just going to put the anaesthetic in.
13:18We tiny scratch.
13:21And then after that, it goes all nice and numb.
13:24Yeah, I'm a bit nervous about this, because, you know, well, you know,
13:27I'm being worked on.
13:30I think the biggest problem is that I've been here before,
13:33and I know what's going to happen.
13:37Yeah.
13:48Ready?
13:50We'll start on the top one, small to big.
13:54Now, I'm just going to touch the area and you just tell me if you feel anything sharp or sore
13:59or uncomfortable.
14:00Yeah.
14:00That feel okay?
14:01Yeah.
14:01Good.
14:02Good thing about you is you have hardly any fat anywhere, so when you hit a bit of fat on
14:06you, it's a lipoma.
14:09I'm going to give you a wee squeeze, and here we go.
14:14Out you pop.
14:16What was on the inside is now on the outside.
14:21The last little bit.
14:23You want to see him?
14:24It's a little bit like a shamrock, isn't it?
14:27Yeah, I like you one.
14:28That's good luck for the rest of them.
14:30There we go.
14:33That's okay?
14:34Yeah. Good.
14:37I'm just listening out around the area.
14:43Yeah.
14:44Okay, should we give this one a squeeze now, Rosie?
14:47Yeah.
14:49Hey.
14:50Out you pop.
14:52We've had the baby, now we've got the mummy, and then we'll have the daddy.
14:57There's another little lipoma over here, so we're going to avert the skin so we can find it, which is
15:03here.
15:04And if this one will pop out, there it goes.
15:09Beautiful.
15:11Right, now we'll have the daddy.
15:13Anything at all, you just let me know.
15:16Does that all feel okay?
15:18Yeah, it's all good.
15:19Always good when the anaesthetic works.
15:24I think we're going to go digging.
15:26I don't think we're going to have to go digging.
15:28I think it's going to come jumping.
15:32Quite happy to be leaving you.
15:35You've got really strong hands.
15:37This actually looks like it's a hand coming out of you.
15:41Oh, my God.
15:42That's the biggest one so far, isn't it?
15:46You're very relaxed, Adam.
15:47It's like you're lying on a beach.
15:51How would that hurt?
15:53Yeah, it's coming to this little bit where the bruise is just tethered, yeah.
15:58Shall we put a little bit of this anaesthetic on the trunk?
16:01Yeah, you can feel that it's tugging, can't you?
16:04Yeah, that's where the bruise is.
16:06And it's all out everywhere, apart from where you bruised it.
16:11OK.
16:12That's what this is all about.
16:15Ah, it's the bruise that it has.
16:17Yeah.
16:17Yeah, yeah, yeah, probably.
16:19It's very nearly out.
16:25Look at that.
16:26Oh, hi there.
16:27Hi.
16:29There we go.
16:31There's another little lipoma over here.
16:35Again, we're removing one from the inside.
16:39The reverse.
16:39And there's a wee secret bonus.
16:42So we've removed five lipomas.
16:45Oh, my God.
16:46Oh, this is going to be so nice.
16:49It's already nice.
16:50It already is, yeah.
16:52OK, right.
16:54And then here are your little friends.
16:58Well, there's your little friends.
17:02Right, picture time.
17:03That was from the top one.
17:05And that was from the middle.
17:07Quite a lot, eh?
17:09She's a magician.
17:10It's amazing.
17:11Oh, my God.
17:13Wow.
17:16It's really, really, really fabulous.
17:19The good thing whenever you've removed a whole lot of lipomas from one side and they're not on the other,
17:25is that you immediately get this sense of symmetry back.
17:29The procedure was just straightforward, nearly painless.
17:34Removing Adam's lipomas are incredibly satisfying and particularly that last big one.
17:42I'm really massively grateful to all the team and Dr. Emma is going to help me just live life a
17:50lot better now.
17:52As I told her, she's a magician.
17:53Because she just makes people's lives way better.
18:06I have noticed a massive difference and I can see a lot more clear skin coming through.
18:14This is a facial wash that has been recommended by Dr. Emma as it cleans the skin without leaving it
18:22dry.
18:24It heals the skin barrier and then I'm good to go.
18:29So the injection I take every two weeks and I'm really, really strict with it.
18:34It has taken a while to kick in.
18:36However, I have seen a turning point after my last injection.
18:42So, I heard the first click, count to ten.
18:46It is less inflamed and more receptive to moisturisers.
18:52I'm able to sleep better, which means that I've got more energy and I can spend time with the children.
18:57And I'm just a lot happier.
19:10I really can't decide what colour to paint my hallway.
19:13Well, this is my special subject.
19:15What's yours?
19:16Mine is this one, this green and this white together.
19:19Yeah, that looks really nice.
19:20But I actually think that your hallway would be beautiful in this slightly pinky colour.
19:25Yeah. I love all these greens.
19:27Any of these look gorgeous. Yeah.
19:29So hard.
19:30Which one?
19:34Is it all right? It's all right.
19:35Yeah.
19:36Are you all right?
19:37Just got to get it protected.
19:38Oh, no.
19:39I would prefer to be completely stark naked than someone being stood right behind me looking at it.
19:45That's how strongly I feel about it.
19:51It's painful.
19:53It's embarrassing.
19:55And it rules my life.
19:59The door's opening.
20:03Hi, I'm Jim.
20:03To come see Dr Emma.
20:05Fantastic.
20:05If you'd just take a seat, I'll be with you shortly.
20:07Super, thank you.
20:12He's a lovely, big, confident, happy chap and he has lost so much confidence because of this.
20:18I never really had an answer to what it is.
20:21I look at illnesses that you can get and skin conditions that you can get and people seem to get
20:25answers.
20:26They know what it is.
20:27And then you've got this on the back of my head and I just can't get rid of it.
20:30Dr Emma is, without a shadow of a doubt, the last, my last hope.
20:35If nothing can happen with it, then, yeah, I'll just accept it. It's on there forever.
20:41Hi, Jim.
20:42Hiya.
20:42Hi, nice to see you.
20:44I'm Dr Emma.
20:45Hiya, nice to meet you.
20:46Come with me.
20:46Thank you very much.
20:49Just down this way.
20:52Come on in and have a seat.
20:53Thank you very much.
20:54This is Mottie, he's our nurse.
20:55Hi, Martine.
20:56Nice to meet you.
20:56Nice to meet you.
20:58So, tell me a little bit about what's brought you to clinic today.
21:01So, basically, I've got on the back of my head, I've had it for, it's got to be around about
21:0620 years, I would say.
21:07I call it a rash, but it's more of a lumpy, horrible marks across the back of my head, so,
21:12yeah.
21:13Okay.
21:14Is it painful?
21:15Extremely painful, yeah.
21:16It can go from one, it can be crazily itchy, all the way up to not even being able to
21:20touch it.
21:21That painful.
21:22One extreme to the other.
21:23Yeah.
21:23And do you find that you're, when it's itchy, you're scratching it?
21:26Absolutely, yeah.
21:26Do you ever wake up with blood and stuff on the pillow?
21:28Yes, yeah, yeah, yeah, there's blood on the pillow.
21:29My partner, Caroline, she's always telling me off because I'm scratching it.
21:32And I see you're wearing your collar up.
21:35Is that because you're trying to hide it?
21:36Yeah, that's standard, yeah, that's what I do.
21:37Yeah, either that or hoodie, or kind of walk with my head slightly back like that because
21:42it creates like a bit of a crease in my head, so you can't see it as bad if I
21:45do that.
21:45And so quite often whenever somebody's hiding things like that, actually it ends up rubbing
21:50as well because a hoodie's going to rub, a scarf's going to rub, a hat's going to rub.
21:54Yeah, yeah, yeah.
21:54Have you seen a doctor about it?
21:56I have seen, I've seen a couple of doctors about it.
21:58I've had antibiotics that didn't really, didn't do anything.
22:02I've had some creams that I've tried and things like that.
22:04Just nothing that seems to touch it.
22:05It's just impossible to get rid of us.
22:07I get very sort of anxious about it.
22:09I can feel my body, it's very tense.
22:11Yeah, so the anxiety of it is quite extreme, really.
22:15I try and convince myself that it's not as bad as what it is.
22:18I think, deep down, I know people can see it.
22:21I'm even getting nervous about you looking at it.
22:22I know you have to look at it, but...
22:24I can see your head is starting to slip because you're worried that everyone's going to look at it.
22:27Yeah, yeah, yeah.
22:28So it's just the whole, yeah, having someone look closely, that's it.
22:31Yeah.
22:34Um, yeah.
22:35I apologise for it now when you say it and say.
22:37You don't need to apologise for it at all.
22:40Yeah, it's not nice.
22:41It's not.
22:42So can I have a look at it, is that okay?
22:44You can have a look at it, yeah, let's go for it.
22:45You don't want me to really, do you?
22:47No, I don't, no.
22:48Yeah.
23:03Okay.
23:04Now it looks like you've had hair removed.
23:07Yeah, yeah.
23:07From a bit off it, that's right, is it?
23:08Yeah, that's correct.
23:09Yeah.
23:10And actually in the area where the hair is removed, there's not as many of these forming.
23:15Okay.
23:15But where the hair still remains is actually where you then have a lot more of the inflammation.
23:22Within the lumps you can see little bits of pus, because that's inflamed.
23:26And then that gets itchy, and then you scratch it, and then that breaks the surface of the skin.
23:33Okay.
23:34Okay.
23:35Whew.
23:35Well.
23:37How did you feel whenever I was round there again?
23:40It was terrible.
23:40My body was extreme, that was extreme, yeah.
23:43How do you feel now?
23:45I feel, I'm relaxing again now, I feel very hot and clammy.
23:49Okay.
23:49So this condition is called acne keloidalis nooky, and it typically starts with a bit of inflammation
23:56around a follicle.
23:57Yeah.
23:58Sometimes it's just the type of skin that you have, that's all that it is.
24:01Sometimes it's because of rubbing, so the hair follicle gets inflamed.
24:05And what happens then after the inflammation is that the hair struggles to get through.
24:11Right.
24:11And that's when they start to group together.
24:14Yeah.
24:14We have to switch off the inflammation that's already there.
24:17Yeah, yeah.
24:17The best way to do that is with a combination of antibiotics.
24:20Yeah.
24:21The next thing that we need to do is think about the actual bumps that are there.
24:25We can start to flatten some of those bumps down.
24:28Yeah.
24:28I can do that with a combination of a laser treatment and steroids.
24:32The next thing is, is that we want to think about the hair removal looks like it's done a good
24:37job.
24:38The bit where the hair has been removed, there's not very many lesions.
24:43And I really think that extending the area that's had the hair removed is something that we should do.
24:48Yeah, that's fine with me.
24:49Yeah.
24:50So how do you feel now?
24:51I feel really happy.
24:52But yeah, I'm over the moon.
24:53I really am.
24:55I'm buzzing.
24:56Good.
24:57Yeah, we're really good.
24:58Yeah.
24:58This is a condition that needs lots of different kinds of treatments.
25:02So I think we'll start with some lasering today.
25:05Is that okay?
25:05Sounds great.
25:06Okay.
25:06Well, I think we'll get some cream put on the back of your neck then because that makes everything go
25:10all numb.
25:11Brilliant.
25:11Yeah.
25:12Yeah.
25:12Perfect.
25:19Jim has had acne, Keloidalis, Nuki for over 20 years.
25:23And this is causing infections.
25:25It's resulting in scarring.
25:27And so my treatment for him is going to involve injections with some steroids, some antibiotics.
25:33And then I'm going to use two lasers.
25:35One of them a carbon dioxide laser to control the bumps that he has.
25:39And the other laser over the next few months is going to remove the hair in the area that's contributing
25:45to the problem.
25:47Right, Emma.
25:48So I've got the cream on, Jim.
25:50Good.
25:51I thought he was going to have a panic attack whenever I was going to have a look at it.
25:55He really is so petrified of anyone looking at the back of his neck.
25:58Oh, yeah.
25:58He was so anxious.
26:00That sweat.
26:01You could see the sweat beads just glistening away as soon as you were like, can I have a look
26:04at it?
26:04I know.
26:05Just like, poor guy.
26:07Yeah, it's always the big burly men though, is it?
26:09Always the big burly men.
26:18It's obviously important to know that this is a permanent form of hair removal.
26:22Yeah.
26:22OK, so I'm just going to do a little test first.
26:27What did that feel like?
26:29Yeah, it's absolutely fine.
26:30Yeah, nothing.
26:31Just call me the hairdresser.
26:32Right, OK.
26:33So the way the laser works is that it converts light energy into heat.
26:39And it's the heat that really kills the bulb at the bottom of the hair follicles.
26:44You have to repeat it in about six weeks' time.
26:46Very good.
26:47How did that feel?
26:48I didn't feel it.
26:49It was just, I just felt the air and maybe a little tap, but there was no pain or anything.
26:53It was painless, I would say.
26:55Wow.
26:56Yeah.
26:56That is great.
26:58Great.
26:59OK, well, let's get you upstairs to do the CO2 treatment.
27:05It probably will get you to lie on your side, if that's OK.
27:08Yep.
27:12OK, so a bit of beeping from my lovely laser.
27:16Here we go.
27:17How did that feel?
27:19Yeah, that was a little bit more painful, but it's not exactly fine.
27:28So this is just flattening some of these little bumps that have already started to form.
27:35So this laser is essentially vaporising the skin.
27:39And so we're using it to debulk the skin and start to flatten it down.
27:44And it's going to facilitate getting the steroid in as well.
27:48So we can drill tiny little holes into the skin with the laser that are pretty painless.
27:53And then push the fluid in so you don't need an injection.
28:00There we go.
28:01And stand by.
28:03And now I'm going to put the steroid in.
28:07So the steroid works as an anti-inflammatory agent.
28:11These go very, very deep within the skin, these small little laser beams.
28:15And so we push the steroid down then.
28:19Sorry for the pushing.
28:20That's all right.
28:21It's a nice little massage, Ella.
28:23Yeah.
28:25There we go.
28:30I went really well with Dr. Emma.
28:32I'm just over the moon that someone has actually been able to finally tell me what it's called.
28:37Oh, yeah.
28:37Oh, yeah.
28:38Did it go?
28:39Yeah, all done.
28:40But yeah, I'm ready to rock and roll.
28:42Yeah, you want to go home?
28:42Yes.
28:43That's good.
28:44Done good.
28:45OK.
28:45Now I've started my treatment and I'm on the road to recovery.
28:50Just feeling great.
29:00Rosie, who have I got?
29:02You've got Gabrielle in room three.
29:04OK, great.
29:04Thanks.
29:06Doors opening.
29:07Ready?
29:08Yeah.
29:09Hi, it's Gabrielle.
29:10See Dr. Emma.
29:11Take a seat.
29:12We'll see you shortly.
29:17I don't actually know what my condition is.
29:20It's a large lump on my cheek, just under my eye.
29:24It feels quite soft to touch.
29:28Well, me and Gabrielle have been together for seven years and a year ago we got engaged.
29:34All right?
29:35Good.
29:36It makes me feel sad that she's thinking about it all the time, that she's worrying.
29:41You'll be all right.
29:43When we first got engaged and we was getting married, I was really excited.
29:46But then in the back of my mind, it was always a sort of, I've got this lump on my
29:49face.
29:50Look, you can barely see it there.
29:54Yeah, there's basically nothing there.
29:56OK, she'll be able to tell us what it is.
29:58Yeah, hopefully.
30:03Hi, Gabrielle.
30:04Hi.
30:04Hi, nice to see you.
30:06I'm Dr. Emma.
30:06Come with me.
30:07Hello.
30:08Hi.
30:09Come on through.
30:11Oh, nice to see you both.
30:14Come on in.
30:16This is Mottie, who's our nurse.
30:18Hi.
30:20So, I think I can guess why you've come to see us in clinic today.
30:23Yes.
30:24How long have you had this for?
30:25The second one I've had for about seven years.
30:28The second one?
30:29Yeah.
30:29I had a previous one removed.
30:30You can just see the scar there underneath.
30:32OK.
30:33And did they get it all out the first time, do you think?
30:36I don't know.
30:37They never told me what it was.
30:38They removed.
30:39They just removed it.
30:41It's frustrating because I'm in my late 20s.
30:44What, a 20-year-old would want this on the face all the time?
30:47Not many people, would they?
30:48No.
30:49We're getting married next year and I haven't even booked a photographer yet because I don't
30:53want to think of having wedding photos with this being on my face.
30:57I think it's ugly.
30:58I think people think I'm dirty and it's just embarrassing because I don't know what it is
31:04and I don't know how to stop it.
31:06Can I have a look at it up close?
31:08Is that all right?
31:09Thanks.
31:12OK, let's have a wee look.
31:15OK, so this feels like a very firm but slightly bit of a squidge in it whenever I press my
31:24fingers
31:24against it.
31:25You can always feel it like a little trampoline.
31:28And it's actually whenever I'm pressing against it, it's ever so slightly tethered to that
31:33little scar.
31:34OK, and well, this is something called an epidermoid cyst.
31:40It comes from a gland that's in our skin that makes sebaceous materials, which is all the
31:46grease that comes up onto the surface of our skin.
31:48And sometimes those little glands can be blocked at the top.
31:53Under the skin, it looks like a little balloon.
31:56But instead of air being inside the balloon, it's dead skin cells.
32:01Right.
32:02Undoubtedly, this is from the one that you had before.
32:06Right.
32:07I suspect that they got the entire contents out.
32:11OK.
32:12But I think they've left the balloon wall behind.
32:15Right.
32:15And the balloon wall has just started to refill back up again.
32:19OK.
32:19So in order to get rid of it for you, it is another little operation.
32:26Yeah.
32:26So you're replacing this sticky out cyst.
32:29Yeah.
32:30With a little scar.
32:32I can cope with the scar.
32:33Yeah?
32:34Yeah.
32:35Now you know what it is, do you want to keep it and you can tell people what it is
32:38or
32:38you want to get rid of it?
32:39I know.
32:39Let's just get rid of it completely.
32:41Let's...
32:42Be gone.
32:43Be gone.
32:43Yeah, I don't want to ever, ever see it again.
32:45Would you like to do that today?
32:47Yes.
32:48Shall we just get it done?
32:49Yes.
32:50Come with me.
32:56I finally got a diagnosis of an epidermoid cyst.
33:01I don't think it's fully sunk in yet that it's actually going to be removed.
33:05I think this is going to make such a difference to Gabrielle, isn't it?
33:08Yeah.
33:08I mean, she's such a pretty girl.
33:10I know.
33:10Imagine having that for all of your 20s.
33:13You know, that's a time even when you get like little spots, you feel embarrassed.
33:16Yeah.
33:16And it's right there.
33:17Well, we're going to get it better for a wedding, aren't we?
33:19I can't wait to do this one.
33:21I know.
33:27Okay, I'm just going to mark this up now, okay?
33:32What are the chances of this going back?
33:35If we get the whole thing out and the cyst wall, I can pretty much tell you it will not
33:41come back.
33:42Of course.
33:48All I do at this part is just put the anaesthetic in to make it go numb.
33:51Yeah.
33:52So if you want to wriggle your toes, wriggle your toes as fast as you can for me.
33:56Wriggle, wriggle, wriggle those toes.
33:57Well done.
33:58Very good.
33:59Well done.
34:02I'm just going to check the area before we do anything, okay?
34:05Yeah.
34:06So your only job is to tell me, do you feel anything at all that is uncomfortable?
34:11No.
34:13Brilliant.
34:19It's desperate to come out.
34:22It's a nice white color.
34:25I'll try and get this bit away and then we'll do a big squeeze.
34:28Okay.
34:29One, two, three.
34:42You can see here, this is the cyst.
34:45And I described it as a little bit of a balloon.
34:48And then inside here is where all the dead skin cells are.
34:52It is ready and waiting.
34:56One, two, three.
35:03There we go.
35:05Deflated.
35:09Could you feel the release?
35:10Yeah.
35:12Then what you can see now here, this is the cyst wall itself.
35:16We don't want any of this left behind.
35:21And you can actually see where it's tugging a little bit here.
35:24That's where the surgery was before.
35:27So I am sure that this is just left over from the last surgery.
35:39There we go.
35:40All out.
35:42Cyst wall completely removed.
35:44I can't see it out of the corner of my eye any more.
35:46It's weird.
35:47Shall I put it back?
35:48No.
35:49No.
35:50So, we're just going to pop the stitches in.
35:53We're just getting this just so perfect for you.
35:57Okay.
35:57What made you, like, start doing all this?
36:01Erm, well, I kind of like taking things and making them pretty again.
36:07I suppose, in truth.
36:10Emma was always really good at stitching.
36:13She made her own dresses.
36:17Best stitch of all.
36:20Good.
36:21Okay, you want to sit yourself out?
36:24No, I'm going to let you have a little look, okay?
36:27Okay.
36:27Okay.
36:27And then you've got a little sterile strip on that's twice the length of what the scar is.
36:32Okay.
36:32Yeah?
36:32Ready?
36:33Sure.
36:35Oh, look.
36:37It's gone.
36:42It's gone.
36:43It's gone.
36:44It's gone.
36:44It's gone.
36:45Back to you.
36:47Thank you so much.
36:48Oh, my pleasure.
36:52It's so frustrating whenever procedures aren't done completely the first time because she's had her cyst drained.
37:00She hasn't had the sac removed.
37:03So, unfortunately, hers kept growing for another seven years.
37:06And now we've done it in ten minutes, removed the sac, and it's not coming back.
37:11It's better than I ever thought it would look.
37:15Wow.
37:15Yes.
37:17I look normal again.
37:18Everything okay?
37:19Yes.
37:21Right, let's go see the kids.
37:23Yeah, get them back.
37:24It means everything to me because I can now enjoy planning the rest of my wedding.
37:30I'm so glad I've seen Dr. Emma.
37:32She's well and truly changed my life.
37:37Emma?
37:38Yeah?
37:39Lunch for us.
37:39Oh, amazing.
37:40What'd you get?
37:41Sushi.
37:48Yes.
37:48It has been six months since I've seen Dr. Emma.
37:52My skin has improved.
37:54I can sleep at night, not itching as much.
37:57I can just get on with day-to-day life that I was struggling with before I came here.
38:01But, unfortunately, I've had to stop the injections for the time being.
38:05The good news is, is that Pfizer and her husband are expecting another baby.
38:11Hi, we're here to see Dr. Emma.
38:13Yeah, go around and take a seat.
38:15So, number three is on the way.
38:17And so, we've brought her off the dupilumab and I'm going to manage her skin topically until the end of
38:23the pregnancy.
38:28Hiya, Pfizer.
38:29Hi.
38:30Come with me.
38:30Hi.
38:31Hi.
38:31You okay?
38:32Come with me.
38:33Come on through.
38:34Okay.
38:35So, come on in and have a seat.
38:36And this is Motti, our nurse, who you haven't met before.
38:39Hi, Motti.
38:39Hiya.
38:40Oh, well, nice to see you back.
38:42And congratulations on the amazing, lovely news.
38:46Thank you very much.
38:47The new arrival that will be coming.
38:49Yeah.
38:50But it kind of has had a little bit of interference.
38:53It has.
38:53On treatment.
38:54Yeah.
38:55On the journey.
38:56But that's fine.
38:56You just adapt the journey because these things happen.
39:00Tell me, how was your skin on that dupilumab part of the journey?
39:04I was using it and my skin was clear.
39:08The skin on the face was looking pretty clear.
39:11Yeah, yeah, yeah.
39:12The itch had reduced massively.
39:14So, my hands are doing so much better.
39:16I'm sleeping.
39:18Yeah, just doing a lot better, really.
39:20Good.
39:20How do you feel that she is, feel that she's calmer in her skin?
39:24Yeah, I think at night she's snoring now.
39:27And I'm sleeping.
39:28I'm sleeping!
39:30One, four, three, legs.
39:33She's normally itching a lot on her hands and her arms,
39:36but she's not itching at all.
39:37So, which is quite good.
39:38And I think with all the routines that you've told her to do,
39:42she's keeping on top of them as well and that's helped massively.
39:45Good.
39:46Yeah.
39:46But with the pregnancy, we decided, okay,
39:48let's try and manage the skin with the topical treatments.
39:52We combined this topical immunosuppressant
39:55and we're combining that with some of the topical steroids,
39:59but in a controlled way.
40:00Yes.
40:01Not like the crazy way.
40:03Yeah, yeah.
40:03That you were kind of tricked into with the orange cream.
40:06Yeah, yeah.
40:06So, tell me how that journey was going.
40:09In general, I feel like it's doing really well.
40:11And you did say that it would take up to about 12 months.
40:14It will take up to 12 months and obviously we have to adjust things.
40:18Now it might even be longer.
40:20Can I have a close look?
40:21Is that okay?
40:22Right, let's have a look at the skin of your face.
40:25Yeah.
40:25Oh, it's a lot calmer.
40:26Yeah.
40:27Isn't it?
40:27Yeah, yeah, yeah.
40:28Compared to...
40:29What it was.
40:30Yeah.
40:33Before where there was kind of a lot of scratching happening and broken skin.
40:37Yeah.
40:38It's not as much.
40:42There's not a lot of inflammation there actually.
40:44No.
40:45It's still much better than whenever we first met.
40:48Yeah.
40:49Yeah, so all of the inflammation is settled here.
40:55Well, I'm really pleased where we are for many reasons.
40:59But the main thing we're really trying to do is just get to the end of the pregnancy.
41:05Yeah.
41:05By being able to manage things topically.
41:08Yeah.
41:09So, number one is the moisturisers going on every single day.
41:13Yeah.
41:14But then every single day we have to put on the topical anti-inflammatory.
41:20Yes.
41:20And I think it's actually quite a good idea putting the steroid treatment on.
41:25Just to get it under control.
41:26Just for a short period of time.
41:28Yeah.
41:28And this kind of delicate balance we just have to get until we get to the end of the pregnancy.
41:34Yeah.
41:34Sounds great.
41:35Okay.
41:35Good.
41:36Yeah?
41:36Good.
41:37Okay, come with me and we'll get the creams.
41:41I am really confident I can get back on track.
41:45I'm looking forward to it.
41:46I know I have a plan going forward.
41:50Very positive vibes.
41:51And all in all, I'm really happy.
41:53Yeah.
41:54Ooh.
41:55I was going to hit the door just then.
41:58What an idiot.
42:08I can't believe looking back now how long I live with that anxiety for.
42:12It's just crazy.
42:13I've been suffering it for 20 years now.
42:15When it was at its worst, it was a very lumpy, oozy, bloody mess on the back of my head.
42:24And now it's gone.
42:27Getting it finally healed after all these years makes me realise how kind of depressed I was before with it.
42:33I have noticed a massive difference in gym from the beginning of the treatment to now.
42:38It's been really quite a joy to watch.
42:41It's so much better now.
42:42I don't have to wear collars and hoodies and what have you.
42:47Caroline, ready?
42:50Before the condition was treated, anything that we did socially was quite an anxious moment for Jim.
42:56How are you feeling?
42:57Yeah, all good.
42:58Not nervous.
42:59Looking forward to it.
43:00Brilliant.
43:02Generally now, he just seems so much more relaxed.
43:04Sounds like it's busy in there, Jim.
43:06Yeah, it's all good.
43:06It's all good.
43:07Let's do it.
43:12You can order.
43:13Yeah, absolutely.
43:15One of the best things now is being able to go to the bar and be able to order drinks
43:18without worrying that people are going to be stood behind me.
43:21Yeah, a glass of white wine and a pint of beer, please.
43:24When it was at its peak, I preferred to be naked rather than having someone stood behind me.
43:28Looking at the condition, that's how bad it was.
43:31Here we go.
43:32Cheers.
43:34Yeah, incredible.
43:36Six months to clear and 20 years of stress, really.
43:41It was fantastic to see, definitely, that's for sure.
43:44It is life changing.
43:45It does sound cheesy, but it is life changing.
43:47I have got the big, happy, confident Jim back.
43:50Dr Emma has done an amazing job.
44:12fineajstone.
44:13And I have got the business in Africa.
44:20Yeah, everybody.
44:22We'll see you soon.
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