Depressing Hospital dermatology visit today

Depressing hospital today visit here in the UK. So I'm 39 and had this since I was a young child, can't remember when it exactly started but I would guess between 4-7. Only treatment I have ever had is vaseline, daktarin, Antibiotics , antifungals, allergy checks, every kind of lotion and potion prescribed or tried on here with no discernable difference including steroids, swabs showed bacteria but even a healthy mouth has bacteria. Last time I saw specialist was 18 months ago, real old white haired guy, I was asking about Imuran - probably a bit heavy treatment but he really didn't like my contribution. Prescribed vaseline, nizoral shampoo, loctiderm and other steroid and gave instructions for use - as previous experience it just kept my mouth long term raw over a period of many months, the application of all of does that for me, skin just gets no chance to adhere to the lips and always peels with application every second day. He also mentioned I might have actinic (sun related) damage and he would refer me. He also said I had exczema on my face, forehead, on my knees and on my elbows, nobody has ever noticed that, I'll post pictures for your thoughts.

I never heard any referral and got despondent, so I made a new appointment and saw dermatoligist today to ask to follow up on that referral for possible sun damage related cause and treatment (I didn't mention that I'd be interested in trying flourouracil as read here that has helped some).She didn't like my referral request although stated on notes, said it was caused by lip licking, perhaps that is the origin in early childhood but there there is nobody licks less than me, cause I know moisture causes the skin to fall off, especially in public. Both she and the original old guy said while in the meeting with them talking to them that at that very time I was licking my lips before them! I would never ever under any circumstances allow my mouth to get wet in public! My take is they have this dogma, "we don't know what it is so it must be your fault, therefore I am looking for that causation, therefore as you speak and I see your tongue move within your mouth as is necessary for human speech I am going to go 'aha lip licker!'", any dogma is self fulfilling it's human psychology and after all they are a qualified expert right?!. Also I sit with mouth open to prevent getting wet so they see my tongue more than normal. However I know I have several small mucous membrane present around the very inner edge of my lips out of which comes sticky saliva, so at any time I talk by touching my lips together, which is necessary for human speech, this saliva is transmitted to the surface of my lips, any clinician must know that so why the need to demonise the patient with in my view 'imagined' behaviour because they have a self fulfilling ideology. At what point does medicine become to blame rather than try new ways to help the patient, at what point when a patient tries to take an interest in possible treatment and engage with their clinician does that become an unreasonable offence that must be thrown out as delusional and no! we must re-administer the exact same treatment which has yielded no improvement in a 35 year period? Here's the thing, I was only asking for the actual referral for possible actinic damage which the previous consultant recommended?

She wasn't happy with that and said, trying to intimidate, that such a consultation or treatment would require a biopsy and would leave a scar (which I hadn't considered but I have little to lose). Therefore she recommended I return on Thursday to sit in their group 'problem case' consultation with several specialists to debate the best treatment, I mentioned that is 4 days away and from that time she should be aware the current crust on my lips may well have fallen off and might not be so clear to see extremity of the condition. She asked 'so then the skin underneath is normal?'. Erm huh ? Wha? Its umm raw pretty bright red very thin skin that will slowly grow into this, peeling form day 1 and perhaps 3 layers becoming a very apparent yellowing crust after 5 daysish, other than that it's ablsolutely fine yeah. So for that reason she sent me to the photograph dept. and they took pictures ahead of Thursday, should be interesting. I told her this wasn't supposed to be adversarial and trying to find a medical solution for a long term persistent problem which treatment had not helped.

Sorry if this appears a but of a rant, so demoralising, little wonder I lose hope on visiting any dermatologist. My local doctors are fantastic they will try anything to help, but I just can't understand why a clinician is so precious about a condition they openly say is no easy fix. Perhaps it didn't help when I replied to her licking diagnosis 'Isn't that akin to you telling someone with extreme facial Psoriasis 'you really need to stop scratching your face pal?'". Engagement between patient and clinician over treatment is not a reason for hostility or ego. I would so love to be able to video my mouth when I speak on Thursday in the 'group' and also have a video of the 'group' comments so you could observe my clear obsessive licking (as in nil, sometimes when you speak, your tongue visibly moves iside the mouth. a precursor for human speech!). I'm contemplating wearing a boxer's mouthguard and only communicating with postcards a la Bob Dylan Subterranean Home Sick Blues' video. To paraphrase Bob in the very tune:

Look out kid
It’s somethin’ you did
God knows when
But you’re doin’ it again....
Get sick, get well
Hang around an ink well
Try hard, get barred
Get back, write braille
Look out kid
They keep it all hid
Better jump down a manhole
Light yourself a candle

Oh and here to follow are pics of lips today, and those shocking knees and elbows

My EC today:
//www.curezone.org/ig/i.asp?i=76824
Me excema elbows today per dermatology:
//www.curezone.org/ig/i.asp?i=76825
My excema knees today per dermatology
//www.curezone.org/ig/i.asp?i=76826