Nothing deeper than our skin | Ricardo Ruiz | TEDxValladolid

The skin, the largest organ in our body, is often telling us a deeper story about what is happening and who we are, physically and emotionally. Ricardo offers a new vision of this medical specialty, and how dermatology is capable of changing lives.

This talk was given at a local TEDx event, produced independently of the TED Conferences.

When I chose to become a dermatologist,

it was a big disappointment
for my parents.

My mother from Valladolid,

from Ureña,

told me,

"My son, with your CV

you should have chosen
a medical specialty to save lives;

instead, you'll be looking
at warts and lumps your whole life".

I'd like to show you three things:

First, my mother was mistaken,

and second,

dermatology is a great help

changing people's lives
through the skin.

And third,

a doctor who only knows about medicine

doesn't know anything in fact.

Why did I choose dermatology?

When I was a medical student

at the hospital, we went
to see a patient at the ICU.

The patient was in a bad state,

with injuries all over the body;
the prognostic was bad.

and he had also ulcers on his legs.

The reason why
a dermatologist was called.

The dermatologist explored
the patient and said,

"The patient is allergic to one
of the creams that you are using."

Two days later, the team at the hospital
stopped the cream and he got better.

I though that was incredible.

A specialization, that within seconds,
allows you to make a diagnosis,

to start a treatment
and to help a patient.

Let see, for example, Ines.

Ines came to our practice

because she had a redness
over their eyelids, and was very tired.

She was diagnosed with dermatomyositis,

a sort of illness associated

with some cancers.

It turned to be true;
Inés had breast cancer.

She was treated and saved, because
the cancer was in the early stages.

It was possible to help Ines,
thanks to her skin.

Another example, Beatriz,
came with these spots.

These white spots are known as vitiligo.

Beatriz was diagnosed
with an illness of thyroid,

sometimes associated with vitiligo.

Lucia: Lucia came to our practice because
she had these coffee milk spots

and they were caused
by a neurofibromatocis,

an illness associated with brain tumours.

Lucía had a little cerebral tumor,
which was treated and cured.

Dermatologists, we can

diagnose many illnesses through skin.

But it is possible not only through
the skin, but also through hair and nails.

Dermatology is the external face
of the internal medicine.

In fact, dermatologists are
the managers of the imperfections,

some of them medical,
and some others aesthetics.

Skin cancer is one of worst imperfections.

Did you know that here,

four in ten people
will be affected by skin cancer?

The statistics are harsh.

In the United States, every minute,

a melanoma case is diagnosed.

And every hour a patient dies
due to a melanoma

because it is one
of the most aggressive cancers.

Here is the case of Mateo
who came to our practice

because of one melanoma on his back.

The melanoma was extirpated,
but the injury was very deep

and the tumour has already spread

to the brain and other organs.

Later, came his brother,

who was very anxious about that,

and his own back

which was full of freckles.

One of them was a melanoma.

Which?

It is difficult to know at first glance;

this was the one.

Then, with a machine

known as a digital dermascope,

we can see the freckles inside.

And know which will be bad or not.

In other words, skin talks us.

What happens is that sometimes
we need a higher technology

to understand its language.

This was the melanoma,

and in the case of melanomas

around 100% of the cases
are cured if diagnosed on time.

Let's look at Julian.

He came due to light acne.

He had gone two years
without leaving home.

He had no friends, no studies,

and he was deeply affected.

Acne affects 90% teens, and for them,

whose personality is not structured yet,

this illness affect them greatly.

In this case,

Julian was treated with a drug,
and he was cured in 6 months.

His life changed thanks to his skin.

Or in the case of Jose Ignacio

who had a hemangioma.

An hemangioma is a dilated
blood vessel problem.

Let's see with a drug

known as Propanolol,

a drug which was known to be useful
for hemangiomas 3 years ago.

Let's see before and after.

It was possible to help him,
and to change life of the whole family,

through the improvements
with the modern dermatology

Maria came to our practice

because she looked like
she was suffering from tonsillitis.

She started developing some illness
on the back, legs, arms and hair.

Maria had psoriasis,

which affects 5% Spanish population.

Maria started changing
her way of dressing,

going out less often,

and avoiding the swimming
pool or the beach.

She even started to look for miraculous
treatments on the internet.

Finally she came to our practice
and received a treatment

known as "light therapy",
which is just taking sun.

Only with sun, the psoriasis disappeared.

Now, Maria has a normal life

and the psoriasis is under control.

Before I carry on, I'd like to tell you
something that happened this morning.

I was running because I had not been
in Valladolid since I was a child,

so, I went running to river shore,

and I found a beautiful landscape.

You realize how, like the changing skin
of the banks of the river,

you are also changing people's lives here.

People are practising paddle surf,

canoeing, volley, practising sports.

It's similar to Albania,
capital of Tirana,

which was a grey,
and sad city three years ago;

typical post-communism city,

with lots of delinquency

and the Mayor decided to paint
all houses in brilliant colours.

A month later,

delinquency had fallen by a 90%.

So, if we change the skin of things

and that affects our behaviours,

changing our skin will affect us greatly.

I am going to tell you
the story of Adriana.

Adriana came to our practice
because as she said,

"Doctor, I do not recognise myself

when I am watching myself in the mirror.

What can I do?"

The battle against aging
is a lost battle since we're born.

But it is also true
that modern dermatology

has some techniques

that can help our patients

to become old with elegance
and discretion.

We made a combination of treatments.

She sent me an email
some months ago, telling me,

"My self-esteem is much better,

my relationships have improved,

and I have just been promoted at work."

And the most important,

"When watching myself in the mirror,
how I look matches how I feel."

It means that aesthetic dermatology,
as frivolous as it can sound,

can help people.

It is true that if we're only looking
for an ideal of beauty, the final results

can be grotesque.

And when looking around us,

we can see very attractive people

who have asymmetric eyebrows,

big noses and prominent mouths;

their faces are imperfect,

however, they are very attractive.

It is known that a smile

is the best first impression,

rather than what clothing
or surgery can do.

Even if the smile is squint.

As happens with the smile
of my wife and my daughter Adriana.

Dermatologist has the duty

to tell people when less is more,

and that we have to live
with our physical imperfections.

Picasso said,

"We have to look for beauty
within imperfection."

We should not be obsessed
with removing the wrinkles of life

but to put more life in our wrinkles.

Did you know that many of the techniques
used in aesthetic dermatology

are also used in medical dermatology?

An example is facial paralysis;

There are many patients
with facial paralysis,

and thanks to Botox, which relax muscles,

they can improve their condition,

and he quality of their lives.

Patients have more symmetrical faces.

Or in the case of María José

who came to our practice

because she was suffering
from Hyperhidrosis.

Hyperdrosis is sweating
too much, by armpits or hands.

She destroyed the keyboard
on her computer,

her clothes, and she was very worried
about her wedding day.

Finally, she was injected with Botox

and she could enjoy her happy wedding.

What will the future of dermatology be?

The future is fascinating.

New and personalised drugs
are being developed,

according to patient's genetic code,

or a tumor's genetic code.

It is possible to make
a diagnosis via distance

thanks to teledermatology.

We are collaborating
with some African organizations

and they send us pictures to make
a diagnosis, or start treatment.

Mother cells.

Did you know that the biggest store
of mother cells is in our skin?

In the fat of the skin.

But now, I'd like to ponder,

because we are talking
about advances, the Internet,

mother cells, high technology.

And we cannot forget
something very important:

the patient.

Sometimes, doctors treat the illness
very well, but not the patient.

When talking about health systems,

either public, or private,
concerted, or all of them,

the best health system

should be based on the patient.

The real personalized medicine

is to be sitting down with the patient

listening to them, touching them
and being involved in their problems.

I remember a boss who always told me,

"Every time a patient is coming
with a very wide psoriasis

or some sort of skin illness,

you must sit down with the patient
and touch them without gloves

to show them
that you're not rejecting them.

Because in medicine,
as in many other fields

there is much information

but little wisdom.

It's time to come back
to the roots of medicine.

Which means,

what the Mayo brothers said
when they set up the Mayo Clinic,

"Necessities of patients are the first".

As you can see, there is a fascinating
relationship between skin and mind.

Many skin patients

suffer from depression
or anxiety due to illness,

but it also can happen vice versa.

There are many changes,

for example, our skin gets red
when we are nervous,

our hair falls out often
when we are anxious,

or dermatitis is worsening.

Or psoriasis.

Did you know that brain cells
and skin cells

came from the same embrionary cells?

This is something very important.

because our skin is not just
a cover on our body, but an organ.

The biggest organ that we have.

It is an active organ
in contact with all our being,

and it is an organ which speaks to us,

telling us what is happening inside
physically and mentally.

One of the most difficult talks

was a few months ago, when I had to talk
at my four-year old daughter's school.

The talk was about being a doctor,
and being a dermatologist.

I started by asking them a question,

"What is most cool about being a doctor?"

A boy quickly got up and said,
"You can see people naked"

(Laughter)

And then a girl said,
"You can help lots of people."

And it's true, the best thing
about being a doctor

is that you can help lots of people

because although a cure
is not always possible,

at least we can mitigate pain

and as Nietzche said,

"The doctor who cannot understand a soul

wil never understand a body."

So, two messages
for everybody to take home

from today's talk:

First,

We can change people's lives
throughh their skin

and second,

the doctor who only knows about medicine

doesn't know anything.

I would like to finish with this case:

my mother.

Here she is with my
six month old daughter.

It was 4 years ago.

She was diagnosed with lung cancer,

and breast cancer, a year later.

So she has received during this time

chemotherapy, radiotherapy, etc.

You might not believe it,

but the biggest concern
for my mother was losing her hair;

a secondary effect of the treatment.

It can sound frivolous
but around 90% cancer patients

are very worried about
losing hair and eyebrows.

Modern dermatology
can help these patients a lot;

controlling the secondary effects
from chemo and radio,

over hair, skin and nails.

So, I would like to finish
saying that finally my mother

is not bothered anymore by the fact
that her son became a dermatologist,

because she has learned
that there is nothing deeper,

than our own skin.

Thanks.

(Applause)