My job: Understand the skin you're in

Diana Purvis' area of interest is now paediatric dermatology. Photo / Ted Baghurst

Name: Diana Purvis
Occupation: Dermatologist
Employer: Starship Children's Hospital and private practice at Auckland Dermatology, 17 Gilgit Rd, Epsom www.dermatology.co.nz
Age: Late 30s
Working hours: 30-40 hours per week
Pay scale: Greater than $100,000 per annum full time
Qualifications: MBChB Otago University, Diploma of Paediatrics and Child Health (University of Auckland), MRCPCH (Member of the Royal College of Paediatrics and Child Health, London), FRACP (Fellow of the Royal Australasian College of Physicians) Paediatrics and Dermatology

Describe your job

A dermatologist specialises in the health and diseases of the skin. I work as a paediatric dermatologist at Starship Children's Hospital and also as a general dermatologist in private practice at Auckland Dermatology in Epsom.

Skin diseases disrupt the normal function of the skin and can result in pain, infections, fluid loss and, in some case, even death. Research has shown that severe skin diseases, such as eczema, can have a greater impact on everyday quality of life than some life-limiting conditions such as kidney failure and cystic fibrosis.

What is your background?

After six years at Otago Medical School and four years as a junior doctor, I sat specialty exams in paediatrics. After this, I undertook four years' advanced training in child and youth health to become a specialist paediatrician. During this time, I became interested in dermatology. I was offered a place in the paediatric dermatology department at Great Ormond Street Hospital in London - the leading children's hospital in the United Kingdom.

I cared for children with rare and severe diseases from all over the UK and Europe, and I was able to gain experience in the diagnosis and management of children with a wide range of skin conditions.

After two years in London, I returned to New Zealand and worked in the dermatology department at Auckland Hospital, seeing adult patients as well as children, and completed a second specialist qualification as a dermatologist.

My area of special interest now is paediatric dermatology, skin problems affecting children and young people.

However I also enjoy the variety that comes with seeing older patients and performing skin surgery.

It takes a long time to qualify as a specialist dermatologist (a minimum of 13 years) and training is ongoing.

What are the most common skin conditions?

Common problems in adults include skin cancers, sun damage, eczema, acne, rosacea and psoriasis. Many patients are referred because their family doctor has not been able to diagnose their skin condition.

In children, I also see a lot of eczema, acne and psoriasis, but also skin infections, birthmarks, and genetic disorders of the skin.

At Starship, I often see children who are in hospital with other problems, but who develop skin conditions either as part of their disease or its treatment. An important part of my role is to support paediatricians from around New Zealand with the management of children with skin disease.

Do New Zealand's skin conditions vary to those of other countries?

One of the remarkable differences between practising dermatology in New Zealand and the UK is the amount of sun damage and the high rates of skin cancers in New Zealanders, particularly squamous and basal cell carcinoma and, of course, melanoma. Treatment of these can benefit from early detection.

I would encourage anyone with a suspicious new lump or spot to get it checked.

The job's main challenges?

I am the only person in New Zealand to hold qualifications in both paediatrics and dermatology, and so I have a special role in advising paediatricians on aspects of dermatology, and dermatologists on aspects of paediatrics.

I work closely with other paediatric specialists, in fields such as allergy, oncology and rheumatology. I am involved with teaching fellow specialists, general practitioners, nurses and students about dermatology, and with research.

People who live away from major centres can have difficulties in accessing specialised advice.

The New Zealand Paediatric Society is working to set up clinical networks, so that paediatric sub-specialists, such as myself, can work more closely with local teams to provide better care closer to where children live.

And, as with all working parents, I face the challenge of balancing career and family life.

The best part of your job?

It is rewarding to help people and I get immense satisfaction from successfully treating distressing conditions such as eczema and psoriasis.

There are a lot of strange and unusual conditions that can affect the skin and I enjoy the challenge of piecing together the patient's story, the examination and the results of tests to reach a diagnosis.

Any negatives?

Well, I do see a few people with scabies but I haven't caught it ... yet.

What are your strengths?

My training in paediatrics has given me a holistic approach, where I am able to see a problem in the broader context of the child, their development and their family. This is equally relevant to adults, whose health has an impact on their relationships, family and work.

Advice to those interested in a similar role?

The great thing about training in medicine is that almost anyone can find a specialty area that suits them and their lifestyle.

You have to be prepared to work hard, but the work is almost always interesting and rewarding.