Six stages
From the booking to the written plan
The booking
You pick a physician and a time from the calendar on /appointments.html, or you telephone and we do it for you. The calendar shows only hours that are genuinely free — it is reading the same schedule the physician keeps, so an hour on screen is an hour you can have. If something has changed on your skin, say the word changed when you telephone: that is triaged differently from a routine appointment.
The history, which is most of the diagnosis
When it started, where it started, what it looked like then, what makes it worse, what you have already put on it and what happened. Then the rest of you: your general health, your medicines, what runs in your family, your work and what you handle all day. A surprising number of rashes are solved by the question about work.
The examination, in good light, in a gown
For a new patient that means the whole skin unless you ask otherwise — scalp, behind the ears, the back, between the toes, the soles and the nails. Anything of interest is examined again through a dermatoscope, which is a magnifier with cross-polarised light that shows structures under the surface you cannot see with the naked eye. You are welcome to look through it too, and most people do.
A name, out loud and written down
You are told what we think it is and why. If there is genuine doubt you are told that, and told what would resolve it — usually a biopsy, sometimes a swab, occasionally simply waiting a fortnight and looking again. Uncertainty stated plainly is better medicine than a confident guess.
A sample, if a sample is what settles it
A biopsy is done in the same appointment where possible, under local anaesthetic, in the procedure room. It takes about fifteen minutes, it stings for ten seconds while the anaesthetic goes in and then it does not hurt, and the result takes roughly a week. You will be told how you get the result before you leave — we telephone every result, including the reassuring ones.
The plan, on paper, with a stopping point
What to use, where, how much, how often, and when to stop or come back. Anything with a real risk attached carries its review date on the same sheet. If the condition is one that relapses, the plan includes what to do at the start of the next flare, so that the next flare is handled in two days rather than in three weeks of waiting for an appointment.
Why the history takes so long
Patients frequently expect a dermatologist to glance and pronounce. The glancing is real and it is the smaller half.
A great many conditions look alike. What separates them is when it started, where it started first, what it looked like then, what makes it better or worse, whether it itches or hurts, what you have already applied and what happened, what else has changed about you, what you take, what runs in your family, and what you handle all day. A surprising number of rashes are solved by the question about work, and a surprising number of long-running ones are solved by reading the strength off a tube somebody brought in.
That is also why we ask you to come as you are, still using whatever you are using. Skin that has been left alone for a fortnight before an appointment tells us less, not more.
Questions
How it works — the questions we are asked most
How long is an appointment?
Thirty minutes for a new patient, forty-five for a full skin examination, an hour for patch testing and for a child. Follow-ups are shorter. If you have several separate problems, say so when you book so enough time is set aside — six problems in a thirty-minute slot means none of them gets a proper history.
Will I have to undress?
For a full skin examination, yes — into a gown, with the examination done in sections so you are never fully uncovered, and underwear stays on. For a single spot, no. A chaperone is available at any examination and you only have to ask.
Will I get treated at the first appointment?
Often, yes. Unlike some specialities this one frequently diagnoses and treats in the same visit, and where a biopsy is needed we would rather take it there and then than book you back. Some procedures are planned for a second visit because the technique has to be chosen deliberately.
What if you do not know what it is?
You will be told that, and told what would settle it — usually a biopsy, sometimes a swab or a scraping, occasionally simply waiting a fortnight and looking again. Uncertainty stated plainly is better medicine than a confident guess, and a cream handed over without a diagnosis attached is how people end up treating the wrong thing for years.
This page is not medical advice, and it is not a diagnosis. Nothing on this website is medical advice for you in particular, and it is not a diagnosis. These pages describe conditions in general terms so that you arrive knowing what the questions are — they cannot tell you which condition you have, because that requires somebody to look at your skin, feel it, ask you a hundred questions and frequently take a sample of it. Two conditions on this website can look identical in a photograph and need opposite treatments. If something on your skin is new, changing, painful or not healing, the useful next step is an appointment rather than more reading.
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.