Meet Ruth Cammish
Name: Ruth Cammish
Occupation: General Practitioner
Location: Manchester, UK
Skin Condition: Eczema
I feel like people with skin conditions often have a one-line explanation that they use to explain their skin to others. Tell us yours.
I’ve had eczema since I was a baby, it’s had its ups and downs but has been more severe over the last 5 years, leading me to question my conventional treatment.
What are you up to in life right now?
I love being a GP in a deprived area in a city, it can be challenging but so rewarding and as a practice we’ve been looking at ‘lifestyle medicine’ and how helping people with their diet, exercise and connection with others, is centre to feeling well. I’ve always been interested in holistic health and how viewing the patient as a whole is key. ‘Physician heal thyself’ came into full effect about 2 years ago when my eczema flared terribly, topical steroids stopped working and my skin was getting progressively worse. It was the kick I needed to question the traditional approach to my chronic skin condition. A year ago I went through months of topical steroid withdrawal* and time off work before making the decision to start ciclosporin (an immunosuppressant) to bridge the TSW symptoms. At this time, I also became vegan as eggs have always been a massive trigger for me since I was little. Alongside the usual – stress and allergens like pollen. I am fascinated by the role of gut health in chronic conditions so I’ve become a gut health enthusiast over the past 12 months, fermenting, brewing kombucha and generally making my diet as diverse and colourful as possible.
You're a GP, and you went through topical steroid withdrawal, which is not widely recognized by healthcare professionals. Tell me about that experience. What was it like when you'd tell other doctors about what was going on with your skin? Did they take you seriously?
This has been really tough and frustrating! My only source of information, at the start, has been online communities which gave me so much support, encouragement and information. Social media can get such a bashing but it was a lifeline when I needed it most. Seeing that in countries like the USA and Australia there were doctors diagnosing TSW, whereas it’s not acknowledged in my own country, still baffles me. As a doctor, the timeline to a patients condition is key and important in TSW, what we do when a condition isn’t responding to the accepted treatment pathway. Yes, not all red skin is TSW, but there seemed to be a lack of awareness at all in the UK. As a doctor, my conversations with my dermatologist have felt easier, he has accepted I don’t want to use steroids and has been interested in the science behind steroid addiction. However, he also does not recognise it as a diagnosis. He is treating me as severe eczema with ciclosporin whereas I am using it to bridge steroid withdrawal. Find a doctor who is supportive and listens.
There's so much pseudoscience out there online, and when doctors don't take patients seriously, we often turn to the internet for advice on care and treatment. Sometimes that's benign, but sometimes it's dangerous. As a GP with an interest in holistic care, how do you help patients navigate all the wellness information (and misinformation) they're bombarded with everyday?
This is so true! Desperation lead me to trying all sorts for me skin. I massively worry about people rejecting support from their doctors and putting their health at risk. For example, if you actually have a contact dermatitis and think you have TSW, you could delay the right treatment. I feel strongly that the next step needs to be a recognition of the diagnosis, to set out the diagnostic criteria and research into management options. I’m working with ITSAN who are passionate about this approach. Watch this space!
My advice about online information is it can never be a substitute for professional advice. Look at the credentials of your online sources, question, question and question some more. Miracle before and after photos are a red flag for me. In reality, TSW takes time. I believe the science behind allergy and gut health is very relevant for eczema sufferers.
You're a vegan, and you always seem to be whipping up delicious-looking food, or brewing kvass or kombucha or just generally fermenting the shit out of the things. Why do you make these food choices? What do we know - and what don't we know - about the connection between skin health and gut health?
Aaaaw that’s so kind, I do love to cook! It’s meditation for me. My major triggers for my skin are stress and sleep so I encourage anyone to take a multi pronged attack to their skin. Eczema is a complex beast so the solutions will be too! Gut health is one of those approaches for me. The science is still in its infancy, the skin and gut microbiome are less diverse in eczema sufferers. There is one study which has shown that giving probotics to pregnant women with babies at risk of eczema, can reduce the chance of them developing it in childhood. However, there’s no such data with established eczema. 70% of our immunity lives in our gut but it’s also where the majority of our serotonin (happy hormone) and melatonin (sleep hormone) is made, so looking after your gut makes sense to general wellbeing. I encourage people to eat colourfully, diversely (30 plant based foods weekly) and plenty of fibre. Sleep, stress, not being overly clean, getting outside into nature and regular exercise are known to affect our gut bacteria too. I’m really excited where the research is headed, but at present we can’t be cut and dry when it comes to skin and gut health. I’ve written a blog post which some may find helpful: https://rhitrition.com/does-a-happy-gut-mean-happy-skin/
Where can we keep up with you?
Instagram is where I hang out - @drruthskinjourney
As a doctor, I cannot give advice online, but I hope through sharing my story of what has helped for me and my curiosity around the science, will be helpful for those struggling x
*Editor’s note: Topical steroid withdrawal is not well understood by the medical community, and many dermatologists do not believe that it is a real condition. To see the the National Eczema Association’s scientific paper on topical steroid withdrawal, click here.