2023-05-13 05:20:00
The skin is the largest organ of the human being and the letter of introduction of anyone, the first thing that is seen of a person. Whether for health or aesthetics, the population pays attention to it and is increasingly aware of its care, says Yolanda Gilaberte (Huesca, 57 years old), president of the Spanish Academy of Dermatology and Venereology. And although this citizen interest is initially for aesthetic reasons, the result can also have a positive impact on health. “It is difficult to have beautiful skin without it being healthy,” defends the specialist, who attends EL PAÍS between presentations, during a break at the National Dermatology Congress that is being held this week in Santiago de Compostela. Gilaberte qualifies, yes, that putting beauty before the health of the skin, “is a mistake” and she asks to banish, for example, the habit of tanning.
Ask. Do we pay enough attention to the skin?
Answer. Increasingly, precisely because of the value of the image. It is true that an older person may be more interested in how he has blood pressure or sugar because he is more concerned about having a disease. But a young man, who sees diseases from afar, focuses a lot on the skin. Right now we are in a moment in which, due to the weight of the image, the skin is given a lot of value, especially to give beauty.
P. Is there, then, a more aesthetic interest than health prevention?
R. Yes. In principle it is a more aesthetic interest, because everyone wants to have beautiful skin, without wrinkles or disfiguring spots. But it is true that this search for beautiful skin, most of the time, coincides with having healthy skin: hydrated skin will give you fewer diseases, less eczema… Probably, the two things go hand in hand: it is It’s hard to have beautiful skin without it being healthy.
P. Can this turn to aesthetics trivialize the aspect of health prevention?
R. Putting aesthetics before skin health is a mistake. For example, when exposed to the sun, which is what ages the most, the more we protect ourselves from solar radiation, we will have healthy skin, because we will also prevent skin cancer.
P. Is excess sun the main enemy of the skin?
R. The sun is necessary to live, it is essential and our whole body needs sun. What is not right is to use the sun to be tanned because it seems to us that [así] we are attractive That abuse of using the sun to brown the skin is what makes you spend more hours than you have to. You have to avoid excessive sun, those hours, especially at noon, in spring-summer, which have a lot of ultraviolet B, which is the one that induces the most skin cancer. You have to expose yourself to the sun in a healthy way.
P. What is the limit of sun exposure between good and excessive? Is getting tanned already dangerous?
R. When our skin turns brown it is a defense mechanism. Just as when one has an infection, raising body temperature, having a fever, is a defense mechanism to fight against this infection, our skin turns brown because it produces melanin, which is a very good defense against ultraviolet radiation. Seeking to be tanned doesn’t make much sense, it’s like looking for a fever all the time.
P. Where is the balance?
R. It depends on the kind of life we have. For example, people who work outdoors have to protect themselves because they will accumulate a lot of ultraviolet radiation on their skin and that will take its toll. With regard to the activities that each one does, it will also depend on individual risk: a person with very white skin, who burns easily and turns red, will have more damage and will have to restrict the time spent outdoors, not in the midday hours; On the other hand, a person who hardly burns, who turns brown easily, has more luck because his defenses are greater and he can still be exposed for longer. Everything will depend on each individual and lifestyle.
P. Does the public misunderstand what it means to be tanned? To what extent can this aspect that, aesthetically, is associated with something positive be harmful?
R. In principle it is estimated that, in average skin, with 20 minutes of social exposure in the spring-summer months, you have solar erythema, redness, which is already a sign of damage. The trigger for tanning is ultraviolet radiation damage to DNA, and if that damage isn’t repaired, it leads to skin cancer. I’m not going to say that we all have to be as white as a sheet of paper, but the thing is not to look for a tan. What you don’t have to do is use the tan as something I want, because that’s when I’m not going to protect myself well from the sun.
P. Has the public improved in terms of prevention? Is it more protected?
R. Yes. We recently did a study to see what the skin cancer exposome is, that is, all the external factors that influence skin cancer. Apart from diet, exercise, stress, where they live, if they smoke… we asked them about their photoprotection habits and we saw that all the groups, both those who had had cancer and those who had not, used protection with a factor above of 30. However, there was a difference 15 years ago: those who now have skin cancer, then had used less sunscreen and with less protection factor than the control group [participantes sin cáncer]. Now we are increasingly aware: those factors of 4 or 6 are hardly seen and that taste for tanning has diminished.
P. Are there still myths about sun protection? What doubts come to the consultation?
R. The biggest myth is seen when someone comes to the consultation, you tell them that they have skin cancer and they answer: “How can it be, if I wear protection 50?”. It must be borne in mind that using a photoresist is not the same as if one is under a shade or if one is putting on clothes. The protectors are excellent, but when they are applied, they are absorbed, they are rubbed off, and let alone if we sweat, we bathe… One can have a false sense of security and it is true, they are not going to turn red or go to have a burning sensation, but the skin is receiving a lot of radiation. So you have to reapply photoprotectors, wear clothes, hats…
P. Do you have to change lifestyle habits? Like going to the beach and spending several hours in the sun.
R. You have to enjoy all the good things that being outside means for your health, but, above all, you have to control the hours of noon, from 12 to 4, which is when we have the peak of ultraviolet B. And whenever possible, be under a shade and complement with clothes. It is not necessary to prohibit people from living outside, but to do it properly.
P. In Congress they have warned that skin tumors have grown by 40% in four years. What’s going on?
R. Keratinocyte or non-melanoma cancer, which is basal cell and squamous cell carcinoma, is much more common than melanoma. These tumors are more related to chronic exposure and in our country there are many people who work in agriculture or construction, who are exposure positions. In addition, basal cell carcinoma seems to be more related to intense and sporadic exposures, which are what we also do a lot in our country, on weekends or vacations, and it is a type of tumor that has increased a lot. Melanoma has also increased in incidence, but apart from immunotherapies, something that has benefited the prognosis is early diagnosis: due to the awareness of the population and the knowledge of primary care physicians, we are all very alert.
P. One of the issues raised in Congress is the influence of socioeconomic factors on the greater or lesser risk of cancer. What does this want?
R. It’s because of the type of radiation. I mean, squamous cell carcinoma is mostly associated with chronic exposure, and where do we see chronic exposure? Well, generally in people who work in the fields, photo-exposed professions that are not usually in the office and middle or lower middle class people. Basal cell or melanoma are tumors that are also seen in intense and sporadic sun exposure, which are the ones that are seen more at leisure or on vacation, and for this reason it is the type of tumor that is seen more in middle-high social classes . There are many studies that demonstrate this duality.
Dermatological diseases are seen and stigmatized a lot: they can itch, smell bad, stain clothes…”
P. In Congress they have also warned of the rise of fungal infections, such as ringworm, and other ailments, such as scabies. What’s going on?
R. In the case of ringworms, there has been a clear trigger: it is the result of a fashion. As the shaving trend set in [como corte de pelo], this shaving damages the epidermis and favors the entry of germs. With scabies, on the other hand, we do not know what has happened: we have seen it increase after confinement. We have also been wondering if perhaps these mites have become resistant to permethrin, which is what was used the most. He monkeypox It was a localized thing and now it seems that it is already controlled.
P. In the press conference in Congress, he said that dermatological diseases are not usually fatal, but the skin is a person’s letter of introduction. How much do they affect the quality of life?
R. Dermatological diseases are seen and stigmatized a lot: and although we are all very understanding and empathetic, right now, appearance is what prevails. In addition, some of these diseases itch, smell bad, stain clothes… and we are in a perfectionist society that does not tolerate anything. What patients ask us for is psychological support.
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