It was in 1995, at a lunchtime presentation about the internet, that Dr Amanda Oakley embarked on the project she would come to describe as her “life”.

Oakley is the founder, chief editor and main force behind DermNet NZ, the world’s most frequented medical website for skin diseases.

During the presentation, a mock-up of a dermatology website was used to demonstrate the potential of the internet, which had been invented two years earlier. Oakley then approached the developer to make the website, which she thought of as a ‘public library’, into a reality.

“I knew exactly what I wanted to put on it because we already had handouts with our department, which were pieces of paper we gave to patients. That in itself was quite unusual in those days, that you’d actually give something to the patient,” Oakley says.

“It seemed to me ,why should we just give it to the people we see; why shouldn’t other people have access to this as well?”

Today DermNet NZ hosts about 2,500 pages of dermatological information and is accessed by doctors, students, librarians, pharmacists, pharmacologists, drug companies and, of course, patients and their families.

Oakley believes the wider availability of dermatological information has changed perceptions of both the field and the professionals within it.

“It’s a bit frustrating that we don’t have many effective treatments yet, but we certainly can make a difference to people by saying, ‘well, it isn’t such and such so there’s no point in taking that medicine because it’s not going to work’,” she says.

“Patients I used to see in the early nineties would come and they’d look at you with great suspicion. We’d give them a long-lettered name and send them away saying, ‘sorry there’s nothing that can be done’. They didn’t believe us so they’d go to another doctor and try this medication and that medication, which were never going to work, but there was less trust in their doctors.

“Now they can look it up, they can have a trustworthy source of information, and we can manage the conditions so much better because we can share ownership of the condition and its treatment with the patient.”

Oakley managed the website by herself for a number of years, alongside her regular role as a dermatologist. In addition to creating content, a few years after DermNet NZ’s launch she took it upon herself to learn how to code.

“If you’ve got to make something work, you’ve got to learn how to do it yourself,” she says.

“I found it frustrating having to go through a developer when all I wanted to do was change a spelling mistake, so I learnt how to programme.” (A content management system has now been developed, making access to the site much easier.)

Oakley is passionate about dermatology, which she says is tremendously rewarding because of its mysterious nature.

“Dermatology is fantastic because there’s never a dull moment. Every patient is different; we have so many ways in which skin conditions can present. There are more than 3,000 named conditions, but everybody has their own version of them.”

When she is not working as a dermatologist in the public and private sectors, her time (or, as she puts it, “every waking hour”) is spent on DermNet NZ. Oakley would like to be able to concentrate on the website full-time, but says she feels torn as New Zealand is desperately short of dermatologists.

“Everybody has a skin condition; they’re terribly prevalent and our general practitioners look after most skin conditions, but they’re not trained to do so,” she says.

“I can see one patient at a time or I can see 1.3 million in a month, so where should I be spending my time – on the 1.3 million or the one that’s in front of me? That’s the dilemma.”

DermNet NZ has grown significantly since those early years and is now supported by a select team, though Oakley is still heavily involved. The next phase for the website is about consolidating and updating the content, she says.

“I’ve got about 50 pages of new stuff that I haven’t had time to upload and about 50 pages of updates to existing pages over the next six months.”

Oakley envisions a future in which artificial intelligence will support dermatology worldwide. With this in mind, DermNet NZ is working on launching a diagnostic algorithm for patients to enter their symptoms and receive a list of potential diagnoses, a shop for other entities to access their wide array of medical images, and an artificial intelligence research database to develop tools to diagnose skin lesions better.

DermNet’s skin disease image recognition tool was the Active Project winner of the 2017 Ministry of Health Clinicians’ Challenge at the November HiNZ conference.

Oakley herself was awarded the Companion of the New Zealand Order of Merit for her services to dermatology in the 2018 Queen’s Birthday Honours.

For her, it’s just about doing the work that needs to be done to make dermatological information accessible to everyone.

“It’s my life. There’s always another job, and it’s exciting.”

Dr Amanda Oakley has been a specialist dermatologist in Hamilton since 1986. She qualified from Bristol in 1979 and undertook postgraduate training in dermatology in New Zealand and the UK. She was clinical director of the Department of Dermatology at Health Waikato from 1998 to 2010 and is an Adjunct Associate Professor at Waikato Clinical School (Auckland University School of Medicine).

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