35 Devonshire Place, London, W1G 6JP
The following questions aim to provide you with all the information you should need for before, during and after your scheduled appointment.
A dermatologist is an expert in diagnosing and treating diseases of the skin, hair and nails. To become a consultant requires between 8-12 years of additional training after completing five years of medical school. One third of this time involves training in general medicine and becoming a member of the Royal College of Physicians (MRCP) or Paediatricians whilst the other two thirds are spent specialising in skin disease. This training period may include undertaking a further research degree such as a PhD, and culminates in receiving a Certificate of Completion of Specialist Training in Dermatology.
At the Harley Street Dermatology Clinic we know how big an impact skin disease can have on your life and consequently how important the right treatment can be. This is one of the reasons why our doctors are all consultants and not junior doctors or trainees.
Consultant dermatologists spend their professional life exclusively treating skin disease. Consequently, in addition to the training outlined above, this gives them the highest level of expertise and experience in the field of dermatology. An accurate and early diagnosis is more likely to lead to an appropriate treatment and a great improvement in your quality of life.
All of our consultants are trained in paediatric dermatology (skin disease in children) and about a quarter of our work is with children. We recognize how much disruption to family life an unwell child can cause and early accurate treatment and diagnosis is often the perfect solution.
The Harley Street Dermatology Clinic is located in the centre of London. If you are uninsured (i.e. self-funding), you can book an appointment directly by Phone or byemail.
If you have medical health insurance, you will need a referral from a General Practitioner and to obtain an authorisation code from your insurance company before you can be seen or treated. Without these, you may find that your insurer will not reimburse your costs.
Our doctors are registered with all the major insurers in the UK and internationally.
The chance to meet with an expert dermatologist with a view to answering some important questions:
What is my diagnosis?
What can be done about the condition?
Is there a cure or not?
What happens in the consultation?
The first consultation comprises 3-4 components: the interview, examination, investigation and treatment.
The interview is more like a friendly discussion during which time you will have the chance to explain all your symptoms to the doctor. The next step is an examination.
The examination may simply be a case of the doctor looking at one small part of you (e.g. in the case of a wart) or a complete skin check (e.g. in case of a mole check). In some cases, usually for more complex conditions, this may include examining other areas such as the hair, nails, mouth, genitals, organs and lymph nodes. A light, magnifying glass and dermatoscope (mini-microscope) might be used.
Investigation is not always necessary, but may include blood tests, patch tests, skin or hair scrapings, swabs or occasionally, for complex cases, a skin biopsy. Please note there is an additional cost incurred for each of these services.
Treatment often involves education in the form of an information leaflet about your condition and how to manage it. For medical skin conditions (e.g. acne, psoriasis etc.) there is often a prescription issued. Other treatments include cryotherapy, hyfrecation, cautery or skin surgery. Please note, there is sometimes an additional charge for these services. Occasionally, pre-treatment photographs will be taken.
If you are uninsured or self-funding, you can book an appointment directly by phone or email. If you have medical health insurance, you will need a referral from a General Practitioner and to obtain an authorization code from your insurance company before you can be seen or treated.
As all consultations are for individuals with different conditions, they may vary in time from only a few minutes for simple condition like viral warts, to forty minutes for more complex cases.
Minor surgery may be part of the treatment or investigation of disease or cancer. There are several procedures that may be undertaken: Skin biopsy, Shave biopsy, Excision. Each procedure is carried out under local anaesthetic
A sample of skin is removed using either a special skin hole-punch (a punch biopsy) or a scalpel. The subsequent wound is closed with sutures which may be dissolvable or require removal.
A protuberant lesion (e.g. mole, wart, skin tag etc) can be flattened to be confluent with the surrounding skin. This is achieved by shaving off the protruding component. The subsequent scar is not much bigger than the original lesion and usually heals to become almost invisible.
This procedure involves removal of an entire lesion. If the lesion is small enough, a hole punch might be used (punch excision). For larger lesions, removal is undertaken with a scalpel in the operating theatre. The wound is usually closed with stitches, sometimes combining deep dissolvable with superficial non-dissolvable. Typically the scar that remains will be 2 – 3 times longer than the lesion excised.
Before surgery, the area to be excised or treated will be numbed with an injection of local anaesthetic. For large area, this may amount to several injections. There is a stinging sensation when the anaesthetic is administered, but this rapidly gives way to numbness. The effect of the anaesthetic will last around 3 hours.
What to do
Following surgery you will usually have a dressing.
Keep the dressing in place for 24 – 36 hours and then commence this daily routine:
Discard any plaster or dressing.
Wash your wound gently with warm soapy water to remove any debris. This can be done in a basin or in the shower, but preferably not the bath, as soaking the wound too long might weaken the skin.
Pat the wound dry with a towel being careful not to disturb any stitches.
Apply fresh Vaseline to the wound.
Apply a new plaster.
Repeat the process every day until the day the stitches are removed. For wounds without stitches, continue until the scab has come away; usually around 7-10 days.
What not to do
Avoid strenuous exercise and heavy lifting for the first 10 days after surgery.
Blood flow increases massively during exertion and this can lead to bleeding from the wound. Repeated muscle expansion will stretch the scar over time and can result in stitches rupturing.
Avoid until the stitches have been removed.
Soaking can soften the skin and cause swelling of the keratin layer (the surface). This can increase the risk of wound infection and stitches rupturing.
Avoid soaking the wound in the bath for prolonged periods (although bathing is fine if you can keep the wound out of the water – i.e. it is on an arm, leg or face).
As for swimming, soaking can soften the skin and cause swelling of the keratin. This can increase the risk of wound infection and stitches rupturing.
Clean the wound as outlined above, NOT by applying antiseptics and disinfectants.
Antiseptics and disinfectants can cause an irritant reaction, redness and swelling.
Consuming excess alcohol
Do not drink to excess for the first 10 days after surgery
Alcohol thins the blood and increases the likelihood of bleeding.
Bleeding: Risk 20%
Surgical wounds often bleed as the result of a small blood vessel opening up. This is commoner on lower legs and can occur up to a week after surgery.
What to do?
If bleeding occurs, apply pressure with tissue or gauze. If possible, elevate the wound (e.g. if it is on the leg or arm). Bleeding will usually stop within 30 minutes. If it has not stopped within an hour, contact us and we will arrange an urgent review. Alternatively, you can attend your local emergency department if it is more convenient for you.
Bruising: Risk 1-50%
Bruising immediately after surgery is very common as the local anaesthetic injection ruptures small blood vessels as do surgical instruments. Operations on the forehead or around the eyes often result in a ‘black eye’. This can occasionally affect both eyes.
What to do?
There is no treatment for bruising and it should resolve in time. If you are at a higher risk for bruising (i.e. due to have surgery on the face or around the eyes), it may be worth scheduling some time off after the procedure. Foundation can be applied over bruised areas, but not over fresh wounds.
Infection: Risk 1-5%
If the wound becomes painful, red, swollen and there is pus exuding it is most likely infected.
What to do?
Contact us immediately and we will organise some anti-biotic treatment. Alternatively, if more convenient, use your general practitioner.
Scarring: Risk 100%
Surgery always leaves a scar. In some areas, this might become almost invisible over time (e.g. the face). In other areas, where there is a lot of movement and muscle stretch, the scar will gradually stretch and widen over time (e.g. backs, and shoulders). This is because scarred skin is only about 70% as strong as healthy skin.
What to do?
Follow all the wound care guidelines listed on these pages to optimise your scars appearance. For facial scars, massaging the scar gently with Vaseline for 10-20 minutes per night can help improve the scar.
Keloid and hypertrophic scar formation: Risk – variable
Occasionally the scar might become swollen (hypertrophic) and rarely, might become purple and itchy, gradually growing in size to extend beyond the original wound (keloid). The reason that this occurs remains a mystery. It is commoner on the shoulders and upper chest and in patients with black skin.
What to do?
Seek treatment EARLY – contact us if you have any concerns. These scars can respond to anti-inflammatory steroid treatments in cream or tape form but this is a slow process. A better treatment is to inject the scars directly with steroid. This occasionally needs to be repeated every 6-8 weeks and reduces the redness, itching and swelling.
Cryotherapy or cryosurgery involves the use of super-cold gas to destroy superficial skin lesions, essentially by causing localised frostbite. The gas used is nitrogen, the major constituent of air.
The procedure can be undertaken during a routine consultation and takes a few seconds. Liquid nitrogen is usually applied using a very fine jet from a spray canister. This allows application with pinpoint accuracy. After treatment, the lesion will usually crust, scab and heal over with minimal scarring. This usually takes 7 – 10 days
What can be treated with cryotherapy?
The lesions that can be treated with cryotherapy are superficial skin lesions such as warts, skin tags, sun-damage, freckles and liver spots. Certain cancers and pre-cancers are also amenable to treatment, namely superficial basal cell carcinomas and Bowen's disease. Most lesions respond very well to a single treatment, but occasionally lesions can recur or require more than one treatment.
What are the side effects?
Immediate side effects: Pain – akin to a very cold, pricking, biting or stinging sensation that is mild to moderate in nature. Often, the treated areas can feel like they are throbbing for a few minutes afterwards. Swelling and redness – like a small mosquito bite affecting each treated area, these can last for a few minutes and can occasionally blister.
Later side effects:
Colour change – occasionally cryotherapy can leave a lighter or darker area behind which can be very slow to return to normal. For this reason, a test area is always undertaken prior to any cosmetic procedure. Scarring, numbness and wound infections are all rarely encountered complications.
How should I look after the wound?
Cryotherapy wounds heal swiftly and require little care. You can wash normally in the bath and shower and should wash the wounds. Take care when drying them not to tear off scabs. Any blisters should be ruptured using a sterile pin or needle (simple dip a needle in boiling water for a few seconds and allow it to cool). If a scab forms, apply Vaseline regularly (preferably morning and night at least) to help gently lift the scab away. Do not pick scabs as this may lead to scarring. Plasters only need to be used if the lesion is weeping and under clothing which may become stained.