Oh hi there how are you doing it’s good to see you today I’ve just been checking on the computer and I see you’ve been referred as you have a couple of problems with your skin at the moment on your face yeah well you’ve come to the right place um obviously your GP felt that it was something that we.

Look at yeah doesn’t mean to say it’s anything.

Serious it’s just that they would have felt that we were the best people to take a close.

Look at it because we have better lights and equipment to check these things okay right I’ve checked on the system and you’ve had some blood work done and all that is absolutely fine so that’s good you know that’s not indicating to us that you’ve got anything else on toward like an inflammatory condition going.

On yeah okay well before I get started checking your skin it’s okay if I just do a quick general check just check your breathing and have a palpate if your lymph nodes yeah okay power me a second okay I’ll just warm this up for you okay so I’m just gonna pop this on your chest okay and take a nice deep breath in for me and.

Out and in and out okay I’m just gonna hold this on to the chest just to check your heart rate okay but everything sounds normal there that’s good that’s what we’d expect to hear so you’ve not had any recent infections or anything like that okay well.

You blood certainly don’t show any infection so that that’s good but you’ve not got a cold water thanked it’s just worth knowing before.

I check your lymph nodes because lymph nodes obviously they’ll react to infections so you won’t.

Expect to find them maybe swollen a little bit particularly around the.

The throat areas if you’ve got something like a cold or sore throat okay so I’m gonna start by palpating lymph nodes in and indeed everything seems fine now okay just okay just open your mouth for me I’m just kind of a little quick luck it down into.

Your mouth area okay I’m not going to press your tongue I don’t need to do that but just open wide for me I’m sticky tongue out and just say oh hey and our again that’s fabulous no problem is bad okay well I’m happy with that so you.

Seem all fit in a well as far as that is concerned on your blood work so we’re okay there the referral is telling me that you’ve got a patch on your forehead just here which I can see and also you’ve been suffering for.

Some redness and swelling across your nose yeah yeah I can see that – how’s your GP explain what it might be yeah yeah there’s a strong possibility that it is an rosacea on your nose but I will take a.

Closer look at that for you but first what I’d like to do is do a general skin examination of your face if that’s okay with you yeah it just helps me.

Get a clearer picture of everything in this area and I can also just check to make sure that this nothing else on toward going on as well.

Whether you’ve got a little moles or or any hyper.

Pigmented lesions areas anything like that okay all right so just relax nothing I’m gonna do is gonna be painful okay so I’m just gonna start by looking at one your forehead all right check okay your skin seems.

Really supple a nice it seems well hydrates it just little look around that one the chin area looking pretty good so what I’ll do you know I’ve got a light and I will just be shining the light on to areas of your skin and I’ll be looking through the magnifying glass and that will get me an even closer detailed look in the areas that may have a little bit of concern but I’m just going to look at the area that.

You’ve been referred for this this area of the top I’m pretty sure I know what this is but I’m gonna have.

A close look now I okay yeah okay how to come.

Down a little look on this areas and those yeah alright that’s certainly looking like rosacea across the nose area there they just have a little look over here just know I’ve got a.

Different type of light now.

Um it may have a slightly blue showing to it it’s only very subtly blue but it it just lets me look at things it’s a slightly different way so I think what I’m going to do with the area on your top right here um it looks to me like that is natural fungal infection it’s the thing to worry about it can be easily treated okay but I just like to take a little sample of that if that’s okay we can get that tested very quickly the.

Results will be back within 24 hours but I’m pretty sure I know what that is so I’ll get that check now for you okay okay so.

I’m just have a little sample that’s not uncomfortable is it so that will go off to the lab and we’ll get the results too quickly we’ll give you a call with that one okay now while we’re here is there anything else you’d like me to look at right okay on your chest area right okay we’ll just bear with me I’ll change my gloves.

And we’ll have a look at that for you okay all right.

Okay I’m gonna pop a clean pair of gloves on now just a check any of your skin I’m just gonna check I’m just gonna pop my lights on yeah is it sore there at all the spots feel sore yeah.

They do look a little bit inflamed.

To be honest um there’s a couple of quite inflamed ones that you don’t pick them at all do you I know it’s tempting but try not to cuz it can really just spread the infection you’ll end up with a wider area of of these sorts or spots that is actually acne that’s on your chest yeah it’s quite um a small area but they are quite quite bumpy art may look a little bit cystic in a couple of.

Areas so but we can get you something for that okay um have you had any acne treatment before I can’t.

Have no okay do you have any on your back at all no okay that’s fine so it’s just the chest okay do you tend to sweat quite a bit yeah I guess it could be.

To see where the heat makes it worse a little bit as well but we’ll we’ll give you something for that okay it’s bad with mix.

I’m just gonna make a few notes no GPS and the right.

Thing by referring you because you know we can look at everything related to your skin here in dermatology that’s what we’re here for and there are even some medications that.

Your GP couldn’t describe anyway not that you’ll be needing those today but they can only come from consultant dermatologist right okay so as i’ve said this top area is a fungal infection it’s a brownish fungal patch i have sampled it as you know so that will get confirmed but I can tell by its appearance and the.

Way it’s played that it’s it’s a fungal patch and we can we can sort that for you and I’ll.

Prescribe you something called ketoconazole cream for that and you’ll probably need to use that once a day use it.

For up to four weeks okay I will get you back anyway for another appointment and to check that so we can do that for you okay and I’m moving on to the nose area and across your face here and I know this is a tiny bit on your forehead as well and that certainly does look like um acne rosacea rosacea do you get any sensations before it tends to flare yeah so it feels like it’s itchy and tingly and sometimes a little bit like.

Some burn yeah she kind of look round the side a little bit yeah I’m not gonna touch it yeah yeah you it typically does spread across the face I should Bloods are really good I’m not concerned that there’s any other inflammatory I’m illness going on there which could cause a similar rash across the face so I’m not worried about that at all do you get the little papules yeah you do get the bumps okay yes I can prescribe you a cream for that as well I’ll I’ll give.

You some metronidazole cream to pop on Matt twice a day unfortunately.

We don’t really know what causes rosacea it’s still a bit of a mystery to us and there isn’t really a cure that we know of it’s.

More a case of trying to keep it at bay trying.

To keep the flare down and avoiding things that can trigger the flare yeah have you noticed anything in particular okay yeah um sunlight may trigger it.

Okay and alcohol it’s quite well documented that alcohol can actually trigger the redness the flower and also and believe it or not.

Eating spicy food can do it as well so try to avoid I’m obviously we can’t avoid the sunshine all the time but try and avoid drinking alcohol or spicy foods and see if it does help it’s I mean they’re not the only things that can.

Trigger it even changes in weather can can trigger.

It but I can certainly see that’s what that is there and we’ll get you on some cream for that and we’ll have another look at it when I ask you back in about four weeks okay now moving on to the chest area because you haven’t got a widespread area of acne I.

Don’t really want to put you on an oral treatment like antibiotic just yet and I’d be more inclined to give you a topical topical solution for that I think.

What I’ll try you on first rather than an antibiotic I will try you on some benzoyl peroxide on a milder one something like a 5% I don’t want to burn your skin and put you on a stronger and strength straightaway because that you know it can be uncomfortable so just.

Apply it at night time in the area but do be mindful that it can bleach fabrics so and when you pop it on just wear an old t-shirt or something try not to get it on your bedding because it actually can bleach and you you may find that should calm down within a couple of weeks it may go a little bit dry but we’ll monitor that again when you come back it’s not okay do you have any more questions for me right okay that’s.

Fine if you’re happy I’ll write you a prescription and I’ll get in touch with reception now on the computer and they’ll be able.

To book you an appointment for four weeks time okay so I’ll do.

That now you can come to this clinic here cut you in four weeks again yeah that’s fine we.

Do have another clinic but it’s a little bit further away so I thought you’d be better off coming here right bear with me I’m just gonna write out your description yes you can get this from the hospital pharmacy yeah that’s fine they’ve got the three items on there it will tell you on the packets what they’re for so don’t worry you.

Won’t get confused okay I notice all the dosages are on there and how many times to apply okay so there’s your prescription okay okay so if you have no more questions for me I will see you again in four weeks in the meantime if you do have any.

Problems or anything else seems to pop up on your skin or you’re having any.

Reactionists the to the creams that I’ve given you then please do call the secretary and the number is on your appointment card and then she will pass a message on to me okay and I can give you a call if needs be but hopefully you’ll be fine and I’ll be able to see you again in four weeks and back in this clinic.

Okay bye so good to see you take care.