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Rash mum is the one who's flaky, not her itchy son

As a fellow sufferer, Copperfield has every sympathy with those with skin conditions. Just not this particular over-sensitive Mum whose dragged her itchy infant in.

As a fellow sufferer, Copperfield has every sympathy with those with skin conditions. Just not this particular over-sensitive Mum whose dragged her itchy infant in.

This is a picture of my dominant thumb, just to show that I have a good deal of sympathy for people with painful skin conditions. Now and again, usually in the middle of signing a pile of repeat prescriptions it bleeds from one of its recurring fissures.

So you'd think I had a good working knowledge of the local PCT's guidelines on referrals to dermatology out patients. You'd think, but actually I haven't. But I will hazard one guess, somewhere within the small print there'll be a requirement that the skin condition under consideration should be visible to the naked eye.

Using a powerful electron microscope it might just have been possible to see the patches of "severe and untreatable" eczema that's just been presented to me by Anxious Mum. Under normal binocular vision in ambient sunlight, augmented by a dollop of halogen exam light there was, frankly, very little to see.

"There," Anxious Mum pointed, "is where he scratches every night." I didn't show her where I scratch every night, things were going badly enough as it was. If you turned the kid's leg so that the incoming photons from the office window caught the skin at exactly the correct oblique angle you could just about make out bit of flaking.

Even if the kid's skin wasn't flaky, his Mum was. You can tell by the time a kid with an invisible rash is on to his third steroid and fourth moisturiser that the problem is, as the diagnostic codings have it, external to the patient.

So, no, I wasn't about to send the kid off to dermatology out-patients so that the consultant could have a laugh at my expense and send me another copy of his referral guidelines in case the original had been misplaced.

And no, I wasn't going to prescribe a different moisturiser or a different steroid. I did suggest, mainly for sport, that Mum left a small patch of her child's surface untreated for a day or so - in case a perceptible eruption developed. You'd have thought I'd suggested cutting one of his fingers off so I could watch it rot overnight.

So she's off to see someone privately, who will inevitably drop me a line about my charming young patient and his equally delightful Mother suggesting that I hand over a hundred pounds worth of topical tacrolimus for his appalling skin problem.

Well I'm not buying it – and neither will the PCT. That's one private prescription I'm looking forward to signing.

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