Pre-Cancer Meets a Skin Picker
I've had acne-prone skin for as long as I can remember. Even though I'm in my 6th decade, I still get spots. About 10 years ago I decided to see a dermatologist to try and get my flare-ups under control. There are many treatments available for acne that have good results, and I was hopeful.
Early on, the provider called out my skin picking, pointing out that it's a bad thing and I needed to get it under control. I say 'a bad thing,' because this translated for me into I'm a bad person. His attitude was so unconcerned and blaming that I began to feel anxiety about myself as a person and that I was causing my own skin problems.
Each visit he'd enter the room briskly, take a look at my face and shoulders, peering out over the top of his glasses, and proclaim, "You been pickin'?" to which I'd immediately feel shame and say," I guess I was." He'd then go on about the picking, but not the diagnosis. Were they not cysts, or something he could remove? I think we tried a few creams, with a bit of healing but then scabbing over again, which perpetrated the itch-scratch cycle for my skin picking. I felt like I was caught in a terrible loop.
Seeing a PA
For years we went on like this, with me trying any over the counter creams that were available, using bandaids when they oozed, in-between visits to the clinic. At a certain point, there was a physician's assistant that joined the practice, and I changed to seeing her. Now I was hopeful! She thought I might have skin lupus, and sent me to a rheumatologist.
After a workup and a trial of hydroxychloroquine, my frustration was growing, and this new drug was not having any positive effects but had added possible long term eye damage to the possible side effects. This meant getting many more eye exams, and the worry that this was not the right drug, anyway. After a year I decided I was done with the drug, and talked with the rheumatologist, who was in agreement with me and released me from her care. The itching and oozing continued though, along with the shame that as diagnoses were ruled out, it was looking like I was my own culprit.
The new derm told me again that she was not sure what these spots were, so she would send me to a larger skin clinic a few hours away. All the while in the back of my mind, was the nagging thought, these are probably skin cancer and why doesn't she just biopsy them? The shame of the skin picking kept me in silence, and I told myself, She's the expert. I'm sure she knows what she's doing. They must not have looked like skin cancer to her, but then again, maybe she's never met a skin picker.
A visit to a larger skin clinic
The visit to the larger skin clinic with an exam on these spots revealed....that I needed to increase my dose of Paxil and try Sarna lotion for the itching! Yes, that's right. I guess it was anxiety that fed my need to pick my skin. Their diagnosis was sent to my derm, I stayed in my shame, but I tried both those things for a number of months, trying to keep away from touching my skin.
Fast forward to three months ago. I finally drummed up the courage to speak up. I asked the derm if she could just REMOVE the spots from my chin. Why this was so hard, and why she never OFFERED it before is beyond me. I am still unpacking all of it. Her answer, in the traditionally dismissive way, was, "Well, if I myself do it, you're going to have a big scar." And then silence. I sat there waiting and giving her a chance to actually suggest some other plan for removal, and she said...nothing. I then replied, "Well, how can I get them removed then without a big scar?" and she said, "Well... I could send you to plastic surgery."
Why didn't you suggest this in the first place?!
Finally a diagnosis and an action plan
The plastic surgeon enters the room, greets me, speaks to me, and then takes one look at them and says, "That one's for sure a pre-cancer, and the rest we're going to remove and biopsy. I don't want them on you." Wow! Here's a guy who is concerned with a skin picker's spots being skin cancer. I've been looking for him for a decade.
I've since had five areas wide-excised and biopsied, and these pre-cancers will no longer be able to morph into cancer. And guess what, I don't scratch and pick them because they don't itch anymore. They're gone! I'll be breaking up with my derm soon, but this plastics guy will be working with my new derm to keep things under control. He's saved my skin and my sanity.
Do you check the UV index before leaving the house?