Susana Puig, dermatologist: ‘A tan is the body’s response to skin damage — there’s not much sense in seeking it out’

Dermatologist Susana Puig is in mourning. It was brought on by a positive change, at least, but she is still mourning. The doctor, 60, head of dermatology at Barcelona’s Hospital Clínic, was just named director of the August Pi i Sunyer Biomedical Research Institute (IDIBAPS), the scientific institution affiliated with her hospital. She is happy and eager to take on the challenge, but the new position will take up most of her time going forward, and in addition to stepping down from her current role, she will have to reduce the amount of time she spends with her patients. She admits that this will be difficult. “For me, the doctor-patient relationship is fundamental. I treat families with familial melanoma, including the first patient I included in my doctoral thesis in the 1990s. One of the positive things about this profession is the relationship with people and being able to help them, the bond with patients,” she says.

Puig is the first woman to head IDIBAPS, a leading biomedical research facility with 30 years of history. The scientist, who is also the leader of the institution’s Melanoma: Image, Genetics and Immunology group, is a professor at the University of Barcelona. She receives EL PAÍS in her office, which is already empty in preparation for her upcoming move. Her new job is a stone’s throw away from the hospital, a location that fits perfectly with her obsession for advancing translational research. Science leaves the clinic, and then returns, she insists.

Question. The rise of the extreme right, Trump’s cuts to research centers, the leadership of the U.S. National Institutes of Health in the hands of a person who promotes anti-vaccine messaging… Is science being questioned more than ever?

Answer. It is being questioned, but at the same time, these same people have always used pseudoscientific vocabulary. They’re against it, but they use it for their own benefit. We are in a complicated time in which science has arrived to places that we couldn’t have imagined, and done so very quickly. And that deep knowledge in all aspects, even in human behavior, I think, can scare some leaders and that’s why they’re trying, in some way, to avoid the process of learning.

Q. Do you fear that there will be a halt to the advancement of scientific knowledge?

A. It would be hard for it to stop. Right now we are generating more knowledge, much more rapidly. Artificial intelligence tools allow us to analyze data at a stratospheric rate and all these new technologies that are being designed allow us to question things that until now, were unthinkable. Because of that, I find it hard to think that there will be a massive destruction of science. There could be a slowdown and of course, science requires investment. And one of the big problems is that in many institutions, we are pushing for open science, for sharing. And there is a danger that science could be swallowed up by industry that is darker than it claims to be, that seeks to keep science closed off and to the benefit of a few special interests. That is where the battle will be fought.

Q. Are Trump’s cuts to science taking their toll on IDIBAPS?

A. We have collaborators in the United States, of course. And more than anything, there is a lot of uneasiness. Even an article and study or two of ours have suffered from some delay. But we have to analyze what all this could mean. I don’t want to be alarmist, but we should be alert, because we are in a globalized world and decisions made in the United States on a scientific level can have repercussions for us. But there could also be positive aspects, like looking for collaborators in other places, or researchers being more inclined to come back [from the United States] or not leaving to go there in the first place. It is an opportunity that we should understand, but we will have to create the positions, spaces, and funding for it to happen.

Q. What could the long-term implications of the shake-up of science be?

A. Among humans, we always have a bit of the pendulum effect. There comes a time in which science seems like it can fix anything, and then we return to more of a Dark Age, in which we stop believing in objective and scientific facts and begin to have more subjective beliefs. It’s possible that could happen. My impression is that right now, in a world this globalized in which information is so accessible, it’s possible for there to be different trends on different parts of the planet.

Q. How can pseudoscience be combated?

A. One would like to think that scientific data should be enough to counteract all the pseudoscience, but in reality, these are emotional positions, like supporting a football team. Perhaps, we should try to understand what fuels them. Often it is fear, and maybe if we could understand why that fear exists, where it comes from, we could change the whole concept.

Q. Your area of study is melanoma; 15 years ago, a revolutionary immunotherapy for this skin cancer was developed. How have things changed?

A. So much. At that time, average life expectancy for a metastatic patient with melanoma was six months, and now it’s five years. That’s a very significant change. Although of course, when we say that, it means 50% of patients are no longer alive after five years. So there’s still a lot of work to be done.

Q. How are melonomas impacted by lifestyle habits? Is exposure to the sun the key element?

A. Exposure to ultraviolet radiation in some sensitive people — which would be the majority of our population, especially if we suffered burns in childhood or after accumulated radiation — may be implicated. But there are other factors that also play an interesting role, including, for example, diet. It should be noted that coffee has been found to protect against melanoma and also non-melanoma skin cancer. Other interesting factors are stress, which in some way causes a certain amount of immunosuppression, and sleep disorders, which we have also seen may be involved in the development of melanoma and in the rapid progression of cancer.

Q. It’s summer, the beaches are crowded. Is this the dangerous time for skin, or is it at risk year-round?

A. Seasons are important. In May [in Barcelona], we have rates of ultraviolet radiation similar to those of August. The ultraviolet radiation that we are receiving today is incredibly high and the days get much longer. The longest days of the year are in June and that is when we accumulate the highest amount of ultraviolet radiation. But right now, there’s the question of whether ultraviolet radiation paired with heat can do more damage to our skin and DNA. There’s an entire line of research that is analyzing how the effects of ultraviolet radiation depend on temperature and what accumulative, additive, and even synergistic damage can look like when we combine ultraviolet radiation with higher temperatures.

I say this because being in the sun for five or 10 minutes and then going inside is not the same as being exposed for a longer period of time to ultraviolet radiation and high temperatures. When people are doing a thing that I’d rather not witness, which is tanning, their skin receives ultraviolet radiation at a very high temperature. And current scientific evidence tells us that is much more harmful.

Q. Dermatologist Yolanda Gilaberte said in an interview with EL PAÍS that trying to get a tan is like trying to get a fever.

A. Tanning is the body’s response to skin damage. Without damage, you don’t get darker. The body is wise and when damage is done to our DNA, our cells, the keratinocytes, produce a hormone that interacts with the neighboring melanocytes and triggers a series of intracellular responses to produce more melanin. This melanin is then transmitted back to the keratinocytes to try to protect the skin from further damage. So without damage, there is no tan. That’s why there’s not much sense in seeking it out.

Q. Do you see more social consciousness about the risks of the sun? Using sunscreen seems to be deeply ingrained in us.

A. Yes, there’s so much more consciousness, particularly among children. It’s uncommon these days to see a kid getting sunburned. And our society has done better at accepting sunscreen than wearing clothes and a hat [at the beach or pool]. We should change school schedules and insist on having awnings [over playgrounds] at schools during the summer months. During summer camps, swimming should not take place between 1 and 2 p.m. — which I understand is when it is the hottest, but it is also when ultraviolet radiation is strongest.

Q. There are thousands of skincare products and routines. What does one really need to protect and care for our skin?

A. The tendency is to apply a lot of products, and some of them aren’t necessary, and can even be damaging at certain ages. Young skin doesn’t need much more than hygiene and sunscreen when it is exposed to the sun. But one of the things that we are seeing is that, thanks to influencers, we have adolescents with routines of eight or nine products that, aside from being a huge cost for their family, are leading to significant adverse impacts, like comedogenic acne, contact dermatitis. I call that a red flag.

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