The Ugly – and Deadly – Side of Tanning

Every day, an estimated 1 million Americans seek out tanning salons nationwide unaware that a mere 20 minutes spent in their favorite booth is equivalent to spending an entire day at the beach. And despite the popular notion that tanning beds offer a "safe" alternative to getting a tan, nothing could be further from the truth.

Posted on | Audrey Kunin, MD | Comments ()

Every day, an estimated 1 million Americans seek out tanning salons nationwide unaware that a mere 20 minutes spent in their favorite booth is equivalent to spending an entire day at the beach. And despite the popular notion that tanning beds offer a "safe" alternative to getting a tan, nothing could be further from the truth.

While everyone seems to know the dangers related to outdoor tanning, few seem to realize that exposure to a sunlamp or use of a tanning bed or booth is now listed by the World Health Organization as a "known human carcinogen.” This declaration was also made in the U.S. Department of Health and Human Services.

Truth in Advertising?

 

Claims made by tanning salons that tanning beds are safe would seem to have been convincing as evidenced by the large number of loyal followers. But these purveyors have been proven wrong.

Why aren't tanning beds safe? Primarily, exposure to ultraviolet light alters cellular DNA and other skin proteins that drastically increase one's risk of developing skin cancer. In Sweden, researchers found that young people under the age of 30 were more likely to develop melanoma (a potentially fatal form of skin cancer) at a rate of 7 times that of the rest of the population.

Also, it is well documented that the earlier in life one experiences UV skin damage, the more likely melanoma will develop. Most tanning bed users tend to be under the age of 30 (70%), which makes them highly vulnerable.

Worldwide studies ranging from Baylor University in Texas to Italy and Sweden have repeatedly shown that the vast majority of teenagers surveyed were unaware of the potential dangers associated with the use of tanning beds. And while a significant number of those teens had already experienced significant damage to their skin, at least those under the age of 16 were more willing to modify their behavior when educated about these risks.

Yet far too many teens are finding their way into tanning beds on a routine basis, partly because as a group they equate being tan as being "cool" and partly because they are often times the direct target of intentional marketing.  A tanning salon not far from my home puts out a sign offering $5.00 tanning sessions to students who show their I.D.

The last 3 melanoma patients I have had were all young women in their early 20s with fair complexions and avid tanning bed users. Fortunately for them, it appears all 3 melanomas were discovered early.

All Rays Are Not Created Equal

Sure, the tanning parlor may claim their tanning beds are safe, free of those "burning" UVB rays. But what are these rays and how do they affect the skin?

There are 2 forms of damaging ultraviolet wavelengths of light transmitted by the sun. UVB (the burning rays) are relatively short. These tend to cause more superficial epidermal burns and sun damage. UVB exposure contributes to the formation of blotchy skin discoloration.

Then there are the UVA rays. These rays are much longer and can penetrate down into the dermis. These rays can cause damage to cellular DNA, collagen and elastin fibers (think wrinkles!), dermal blood vessels and other deeply situated structures.

While the early forms of tanning bed lights used UVB bulbs, the concern that customers would get burned by these short wavelengths caused the manufacturers to switch to the UVA bulbs; more damaging but far more subtle. So while it's true you may be less vulnerable to receiving a bad burn in the booth, your skin receives far worse UV damage. And it has been proven that at least 5% of the rays given off by UVA bulbs are in fact UVB anyway.

Before and After

Have you ever seen a poster in a tanning salon that showed a pale perky 18-year-old girl on one side (before) and a weathered wrinkled 65-year-old woman on the other? Of course not, but that's exactly how a sun worshipper's appearance can age. And let's not forget another scenario ... a lengthy scar from the excision of a skin cancer. Before you're seduced by the sunkissed goddess looking at you from that sales brochure, think ahead to what other "after" consequences you may have to look forward to.

The Ugly Side of Tanning

Here are some of the risks one takes by getting as tan as they can:

Skin Cancer

You're looking at a 75% increased risk in skin cancer, including malignant melanoma, from frequenting tanning beds. All of my melanoma patients in their 20s have been young women who frequented tanning parlors.

Wrinkles

Your skin will prematurely age, and wrinkles become more exaggerated if you go to a tanning bed. Why hasten the onset of wrinkles by working on your tan?

Decreased Immunity

Ultraviolet light, particularly UVA, diminishes the ability of the T cell to function appropriately. That's one of the reasons medical UVA is used in the treatment of such severe skin diseases as T cell lymphoma and generalized psoriasis. But do you really want to decrease your body's ability to fight infection or early forming cancer? It may seem strange but skin cancer is caused by two events caused by UVA light. The cellular DNA damage and the reduced immune system ability to destroy these early cancer cells. 

Leathery Skin Texture

If you want your skin to be weathered, lined and leathery later in life, the tanning bed is the way to go. There's a reason our great grandmothers tried to avoid the sun, wore their bonnets and took milk baths. They were trying to keep their skin soft and youthful.

 

Formation of Superficial Blood Vessels

Years of sun damage are often the reason baby boomers notice those fine "broken" blood vessels (really telangiectasias). Many may blame rosacea but the truth is that sun damage is a far more likely culprit.

Skin Discoloration

You may be on hormones, you may be pregnant, but you're not going to develop melasma and freckles without the main component: sunlight. Increase the intensity and voilà, you've got blotchy skin.

Base Tan – Basically a Myth

What of your concerns, you say, about the need to get a "base" tan before heading to the tropics this winter? What's spring break without the ritual of hitting the tanning parlor? Well, the truth is, you're likely doing more damage in the tanning bed since you probably apply sunscreen at the beach. And UV exposure in a tanning bed can make the skin even more vulnerable to outdoor sunburns following use of a tanning bed. So, there really is no such thing as helping protect your skin by getting a base tan.

Nationwide Controversy

Now you'd think that, just like cigarettes, there would be a warning label associated with a known carcinogen and a significant degree of monitoring. However, a study in the Journal of the American Academy of Dermatology (JAAD) published in January of 2001 profiled an investigation of tanning salons located in San Diego. Amazingly enough, none of them complied with all 13 required regulations and recommendations. Failure to obtain parental consent was quite low, just 43%. The conclusion: Mandatory comprehensive training of facility operators and establishment of enforceable penalties was needed to help protect the consumer.

Perhaps enforcement is made more difficult by the split responsibilities of the FDA and FTC. The FTC goes after false claims as to the effectiveness or safety of tanning beds. And while the FDA is on record as discouraging the use of tanning beds, they are strictly responsible for supervising label claims on the machines themselves. This dichotomy makes it twice as difficult to monitor what goes on within the tanning industry.

Congress established a 10-percent tax on tanning bed use in 2008 in order to discourage use.  Unfortunately, due to heavy lobbying by the tanning industry, legislation was recently introduced to repeal the 10-percent tax on indoor tanning services.

This bill would remove the only federal law designating indoor tanning as a carcinogen, and would send the wrong message to young women about the dangers of tanning.

Ideally, nationwide consumer education, mandatory regulations and protection of minors will reduce the use of tanning beds and reduce the incidence of skin cancer and melanoma in the United States.

Blog written by Audrey Kunin, MD
Dr. Audrey Kunin is a board-certified dermatologist, author, clinician, educator and President of DERMAdoctor, Inc. Dr. Kunin...