Some things should not wait for the next free routine appointment. Some things should not wait for the next free routine appointment. Telephone the practice and say what is happening, or go to an emergency room, if you have a mole or a mark that has changed shape, colour or size, that has become raised or uneven, or that bleeds, itches or will not heal; a sore anywhere that has not healed in three weeks; a rash that is spreading quickly, especially with fever, blistering, or peeling skin; a painful rash in a band on one side of the body, particularly near an eye; redness that is hot, swollen, tender and spreading, which can be a deep skin infection; a new rash after starting a medicine, especially with mouth or eye involvement; or a child under three months with any widespread rash. If you have been treated here and something is worse rather than better after a procedure, telephone us rather than waiting for the review appointment. We would far rather field a call that turns out to be nothing.
In your words
Sixteen reasons people book, and what each usually turns out to be
None of this is a diagnosis. It is a map from a complaint to the page that describes what is usually behind it, so that you arrive knowing what the questions will be.
Something on my skin has changed
The single most important sentence anybody says in this building, and it is triaged differently from a routine appointment — telephone and use the word changed. A mark that is new after about thirty, that has changed shape, colour or size, that has become raised or uneven, or that bleeds, itches or will not heal, gets examined properly and, where there is any doubt at all, sampled rather than watched. See Mole & Lesion Evaluation and Skin Cancer Screening.
A sore that will not heal
Three weeks is the threshold worth remembering. A patch that scabs, comes off, bleeds a little and scabs again over months is one of the commonest presentations of the commonest skin cancer, and nearly everybody who arrives with a large one explains that they thought it was a scratch and that it kept nearly healing. Nearly healing is the characteristic behaviour rather than evidence against it. See Basal & Squamous Cell Cancer.
My skin itches and I am not sleeping
Itch is the symptom this speciality treats most and takes least seriously in public. Scratching through the night wrecks sleep, and wrecked sleep makes the itch worse — a loop worth breaking early rather than after two years. Usually eczema; occasionally something that is not a skin disease at all, which is why we ask about the rest of you. See Eczema & Dermatitis.
I have been treating this for years and it keeps coming back
Usually one of three things: the diagnosis was never confirmed, the treatment was right at the wrong strength or for the wrong duration, or the condition genuinely relapses and nobody said so. All three deserve an appointment that starts from the beginning rather than a fourth cream added to the shelf. Bring the actual tubes. See Eczema & Dermatitis and Psoriasis.
My face breaks out and then leaves marks
Two problems, two treatments, and treating the marks before the acne is controlled wastes your money and your time. The brown marks fade over many months; the dents are scars and do not, which is the whole argument for treating acne properly rather than waiting to grow out of it. See Acne and Marks After Inflammation.
My face is red and it stopped settling
Flushing that has become permanent, with visible small vessels and sometimes bumps that look like acne and are not — which is why acne treatment frequently makes it worse. Different components of it need different treatments, and matching them is most of the skill. See Rosacea.
My hair is coming out
Roughly twenty causes, several reversible, a few urgent. The question that governs everything is whether the scalp is scarred, because scarring is permanent once it happens and the treatable window is while it is still active. A scalp that itches, burns or is tender is the version that should not wait. See Hair Loss.
Brown patches on my face that get worse every summer
Usually melasma, which is driven by hormones and by light — including visible daylight, not only ultraviolet, which is why an ordinary clear sunscreen is frequently not enough. It is controlled rather than cured, and aggressive treatment reliably makes it worse. See Melasma.
Painful lumps that keep coming back in the same folds
If you have been given antibiotics repeatedly and told it is boils or a hygiene problem, this is worth a proper look. It is an inflammatory disease rather than an infection, it is badly under-diagnosed, and every year undiagnosed converts treatable inflammation into permanent scarring. See Hidradenitis Suppurativa.
A nail that has thickened or discoloured
About half of what is assumed to be fungus is not — psoriasis, repeated trauma from footwear, and inflammation around the nail fold all look similar and none responds to antifungals. Since treatment means months of tablets and blood tests, we test first. A single dark band down one nail is a different and more urgent matter. See Nail Disorders.
I sweat far more than seems normal
Enough to soak through clothing, drip from your hands or determine what you wear. It is a recognised medical condition with a ladder of treatments, it is not caused by anxiety, and most people have spent years assuming it was simply how they are. See Excessive Sweating.
My child's skin is red and raw and nothing is working
Usually eczema, usually being treated with something too weak for too short a time because everybody involved is frightened of steroids, and usually improvable within a fortnight once somebody writes the plan down. A child scratching every night is a reason to be seen sooner rather than to persevere. See Childhood Eczema.
My child has bumps or warts and I do not know whether to treat them
Most of them need nothing. Molluscum and the majority of warts resolve on their own, and treatment is uncomfortable and frequently unnecessary — the honest default is to leave them alone, with a clear list of what would change that. See Warts & Molluscum.
I burn easily and I have had a lot of sun
Sun damage arrives decades later as rough scaly patches, brown marks and skin that repairs badly. A small proportion of those patches progress, which makes treating them one of the few genuinely preventive things in this building. See Sun Damage & Precancers.
The marks bother me more than the condition does
That is the commonest thing said in this room, it is entirely reasonable, and it changes the plan rather than being redirected. It is also frequently medical rather than cosmetic, since the marks are a consequence of an inflammatory disease. See Marks After Inflammation and Skin of Color Dermatology.
I was told it was nothing and I am not reassured
A second opinion is an ordinary appointment and it offends nobody. Bring what you were told, what you were given and any biopsy report. If we agree it is nothing you will get the reasoning rather than the verdict — which is usually the part that was missing — plus what change would make it worth coming back.
The one distinction worth making before you book
Almost everything on this website can wait for an ordinary appointment. A small number of things should not, and telling those apart is the only triage we ask you to do yourself.
If something on your skin has changed — a mark that is new, growing, darkening, becoming raised or uneven, bleeding, itching or refusing to heal — telephone and say that word. It is booked differently. The same applies to a rash that is spreading quickly, a rash with fever, blistering or peeling skin, redness that is hot and spreading, a painful band of rash on one side of the body near an eye, or any widespread rash in a baby under three months.
Everything else — the itch you have had for two years, the acne, the psoriasis, the nail, the hair — is an ordinary appointment, and the fact that it has waited two years is not a reason to make it wait longer.
Questions
Where to start — the questions we are asked most
I do not know which of these I have. Which appointment do I book?
Book a new patient consultation and describe the problem in a sentence when you book. Working out which condition it is happens in the room and is the largest part of what we do — you are not expected to arrive with a diagnosis. The only distinction worth making yourself is whether something has changed, because that is triaged differently.
Do I need a referral?
Not to book here. Some insurance plans require one from a primary care physician before they will pay, which is a rule about your coverage rather than about our door — check the number on your card if you are relying on a plan.
Can I be seen for more than one thing in an appointment?
Yes, and please say so when you book so that enough time is set aside. What does not work well is a list of six problems in a thirty-minute slot, because each of them then gets five minutes and none of them gets a proper history.
Should I stop my treatment before coming?
No — come as you are, still using whatever you are using, and bring the actual containers. Seeing skin part-treated is more informative than seeing it after a fortnight of nothing, and the strength on the label is usually the key to why something has not worked. The one exception is patch testing, which has its own preparation.
Nothing is diagnosed from a photograph. We do not diagnose skin from photographs, and we do not answer "what is this?" by email, by message or through a form. This is not caution for its own sake. A photograph has no history attached to it, cannot be felt, cannot be stretched or pressed to see whether the colour blanches, cannot be examined under a dermatoscope, and misreports colour badly — which matters enormously on skin that is not pale. The examination that actually distinguishes a harmless growth from an early cancer involves magnification, cross-polarised light and, when there is any doubt at all, a biopsy. An application that offers to tell you whether a mole is dangerous from a picture taken on a telephone is selling reassurance, and reassurance is the one product in this field that is dangerous when it is wrong. Bring the mark to a room where somebody can look at it.
A named diagnosis and a written plan you leave holding
Book an appointment
Pick a physician and a time from the calendar — it shows only the hours each of them genuinely has free. A new patient appointment is thirty minutes, a full skin examination forty-five, and you leave with a named diagnosis written down. If something on your skin has changed, telephone instead and say that word: it is triaged differently.