Everything we do, and what it costs.

We start by working out which kind of acne you have, because the treatment is different for each. Topical retinoids and antimicrobials for inflammatory disease; hormonal treatment where the pattern and history point that way; oral isotretinoin for scarring or treatment-resistant nodulocystic acne, with the monitoring that requires.

Scarring is treated separately and later, once the acne is quiet. Depending on scar type that means fractional resurfacing, subcision or focal excision — often a combination.

Rosacea is treated on two tracks at once: the inflammatory component with topical or oral treatment, and the fixed redness and visible vessels with vascular laser, which medication cannot shift.

We photograph at baseline under standardised lighting so that progress is measurable rather than remembered. Trigger and barrier advice is written down, not recited.

Most eczema that has not settled is being under-treated rather than wrongly treated. We set out a written step-up and step-down plan with quantities, so you know how much to apply, where, and when to stop.

For moderate to severe disease that has failed topical treatment we assess suitability for narrowband UVB phototherapy, systemic immunomodulators or biologic therapy, and we manage the monitoring.

If a rash keeps coming back in the same place, something is touching it. Patch testing finds out what. Patches go on the back on a Monday, come off on Wednesday, and are read again on Friday, because some reactions only appear late.

You leave with a named list of what to avoid and where those substances hide — including in products you would not suspect.

Treatment is matched to how much skin is involved, where it is, and how much it affects your life — not to severity scores alone. Topical treatment for limited disease; narrowband UVB for widespread plaques; systemic or biologic treatment where those are not enough.

We screen for joint involvement at every visit, because psoriatic arthritis is easier to treat before joints are damaged.

Hidradenitis is frequently mistaken for recurrent boils for years before it is named. Getting the diagnosis and Hurley stage right is what unlocks effective treatment.

We combine medical treatment with surgical options for established tunnels — deroofing under local anesthetic for limited disease, wider excision where scarring is extensive.

Scarring and non-scarring hair loss look similar to the naked eye and are treated completely differently. Trichoscopy usually separates them in the first visit; where it does not, a 4 mm scalp biopsy settles it.

Scarring alopecias are urgent — hair follicles that have been replaced by scar do not come back, so the aim is to stop progression quickly.

Chronic hives are rarely an allergy, which is why allergy testing so often comes back clear and changes nothing. Treatment is antihistamine up-titration first, then targeted therapy for the minority who do not respond.

We check for the physical triggers that are worth knowing about — pressure, cold, delayed pressure — and screen for the conditions urticaria travels with.

Stepwise: prescription antiperspirants, then iontophoresis for hands and feet, then intradermal injection treatment for underarms, which typically gives six to nine months of relief per treatment.

We exclude the secondary causes first, since sweating that starts suddenly in adulthood or occurs on one side only needs a different investigation.

The lesion is removed with a margin and the wound closed in layers along the natural skin tension lines, which is what decides how the scar eventually looks. Everything removed goes to histology, without exception.

We show you where the scar will sit and how long it will be before you consent. A scar shorter than three times the width of the lesion is usually not achievable, and we would rather say so first.

Tissue is removed in stages and examined under the microscope between each stage, so the surgeon knows the margin is clear before closing. It spares the most normal tissue, which matters on a nose, eyelid or lip.

Set aside half a day. Most of it is waiting while sections are processed. Reconstruction happens the same day once margins are clear.

A cyst comes back if any of the wall is left behind, so the aim is to remove it intact. That is considerably easier when it is not currently inflamed — if yours is, we settle it first and book the removal for later.

A single dark band in one nail needs a definite answer rather than watchful waiting, because subungual melanoma is missed for years when it is treated as a bruise. Nail matrix biopsy gives that answer.

Expect the nail to grow back with a permanent line in it after a matrix biopsy. We would rather you knew that in advance and accepted it.

Quick treatments for lesions that do not need cutting out. Curettage and cautery leaves a flat pale mark rather than a line; cryotherapy blisters then crusts over about ten days.

We do not freeze anything we have not first identified with certainty. A pigmented lesion is examined dermoscopically before any destructive treatment, so a melanoma is never treated as a wart.