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Dr Bryan Murphy
ST6 Dermatology Belfast HSC Trust

The BSMD Trainee Award provided me with a fantastic opportunity to enhance my experience of psoriasis, joint psoriasis and psoriatic arthritis clinics and male genital dermatology.

I am most grateful to the BSMD committee for granting me the award, but also to my supervisors; Professor Griffiths, Professor Warren and their colleagues at Salford Royal Hospital in Manchester, and Professor Bunker at University College Hospital London for their time and teaching.

Psoriasis is an exciting field in our speciality with its expanding biologic repertoire. This is something I found daunting to grasp and an area I wanted to learn more about. Our emphasis as clinicians should be treating the whole patient; inclusive of comorbidity, quality of life and acknowledgment of how treatments might affect a patient’s routine or lifestyle.

I enjoyed spending time with the team in Manchester where I attended the difficult psoriasis clinic, observed multidisciplinary discussions between the doctors and specialist nurses about tailoring biologics to individual patients, taking into consideration their comorbidity, lifestyle and past treatments; and shadowed the dermatopharmacology unit physician reviewing and recruiting patients to clinical trials.

Professor Warren also invited me attend his joint dermatology and rheumatology clinic alongside Dr Chenoy, where I learnt more about the choice of biologics taking psoriatic arthritis into consideration and observed complications and treatments dilemmas which benefited from the input of a joint specialty clinic.

My rotation in Belfast at the vulval dermatology clinic sparked intrigue about this difficult-to-treat and often missed area given patient, and occasionally clinician, anxiety in addressing it. I further identified a lack of experience for treating male patients with genital dermatoses, so used my award to gain an honorary contract to work at the male genital and HIV dermatology clinics alongside Professor Bunker in London.​

The importance of a multidisciplinary approach to patients was again emphasised here by attending the andrology MDT with dermatology and urology for pre-malignant and cancerous penile conditions. Furthermore, I have developed my experience in managing dermatoses such as male lichen sclerosus, penile dysesthesia, genital lymphedema and genital psoriasis at the clinic.

HIV diagnoses are rising in Northern Ireland so I found it interesting to work at a dedicated clinic for HIV-related dermatoses. With increased use of anti-retroviral therapies, many consults related to patients with immune reactivation inflammatory syndrome, but certainly severe inflammatory acne requiring long-term low dose isotretinoin, eruptive dermatofibromata and nodular prurigo secondary to HIV pruritus stand out in my head as poignant cases. I hope this experience will better inform me when reviewing male genital and HIV patients locally; and the networks built permit discussion of difficult cases in the future.

I am still to attend Professor Kirby’s difficult psoriasis clinic in Dublin and have recently attended the Anogenital and Oral Dermatology Course in May 2019 at the Royal College of Physicians. This offered a great overview of what I have learnt during my award visits and an opportunity to reflect back on how fruitful the award has been in developing areas I wished to improve on.

I have thoroughly enjoyed my experiences to date and encourage all trainees with an interest in medical dermatology to consider applying for this award. Many thanks again to the BSMD for the opportunity and best wishes to this year’s applicants!

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