Susana Puig: "We have to be happy to sweat!"

Susana Puig is the head of dermatology at Clínic, a specialty that is usually the most sought-after by those who achieve the highest scores on the MIR exams. "This was already happening when I was a student," she says. And she recalls that several studies have concluded that dermatologists are the happiest doctors.

What is skin?

— The largest organ in the body, it allows us to communicate with the outside world and also identify ourselves as individuals. And it does a lot!

Like which ones?

— Maintains morphology, acts as a thermal regulator...

But do we agree that sweating is uncomfortable?

— Sweating is essential. Our sweat glands detect when we're too hot, and they make us sweat to lower our core temperature. Did you know that some children are born without sweat glands?

And what happens to them?

— They can die from hyperthermia when they have a fever or if they are in a room that is too hot.

But then… can't they travel to the desert, for example?

— They can't play in the yard. We take cases like this to the Clinic, and it's a complicated life. We should be happy to sweat!

Yes, and how well organized the whole body is…

— And clever: the skin is also a blood reservoir. When someone suffers an accident, the skin becomes completely cold so that all the blood can be used to maintain circulation in the brain and vital organs.

Skin seems to be in fashion. If you go on Instagram everyone is doing skin care routines.

— Society places a lot of importance on appearance.

I admit that I don't like having wrinkles.

— I'm sorry to tell you that your cells aren't immortal, and age shows on your skin. But more than age, it shows what we've done. We can also do things to stay young.

Which is it?

— A good diet, good sleep, and sun protection. The important thing is sun protection. This doesn't mean applying sunscreen every day, but rather avoiding the sun.

But I have the impression that we are adding products, needs.

— There's a huge market, maybe we're overthinking it. Every day we see more pathologies in 18-year-olds due to putting six things on their skin.

AND Instagrammers advertising treatments. Do any of them work?

— There are substances that we do know have an effect. Retinoic acid derivatives and some treatments that help re-produce collagen. Also, some vitamins and antioxidants.

What happens to the skin when we diet?

— There's a 1939 study I discovered years ago that shocked me. They used ultraviolet radiation to cause skin cancer in mice, and then gave them two different diets: one with 40% calorie intake and the other with 20%.

Result?

— If you cut your calorie intake in half, there were fewer skin cancers. But there's a lot of controversy surrounding this.

And will we have synthetic fur?

— We already have it, and we use it, for example, to treat children with butterfly skin.

It's a beautiful name for a terrible disease.

— Yes, they're like severe burns. The slightest touch can cause the skin to peel off, so they can't wear anything with seams. These children can be treated with artificial skin. Not all over their body, but in some areas.

What worries you?

— Sexually transmitted diseases are on the rise. And, sadly, congenital syphilis. Babies are infected while still in the womb.

An amazing fact.

— Skin microbes: The skin microbiota contains a trillion microorganisms. Without them, we would be completely unprotected.

A case you will always remember.

— A patient with melanoma, who had already metastasized, decided after trying many things that she'd had enough. She went home with palliative care, just waiting to die. But she mounted an immune response, and the melanoma disappeared. It was 2005, and I still visit her today.

How can this be?

— Melanoma can sometimes induce this spontaneous immune response. Previously, these were rare cases; now, thanks to new immunotherapies, we're able to do so in half of patients with metastatic melanoma. We continue to research to increase this percentage.