Indoor tanning for skin care

Tanning Trends and Regulation

In 1988, as few as 1% of American adults reported using indoor tanning facilities; by 2007, that number had increased to 27% [27**]. Other reports have found even higher levels of tanning among younger adults, particularly young white women [28]. At the same time that tanning rates are increasing, many tanning devices are employing more powerful UV lamps: a recent study from England found that 83% of tanning beds evaluated exceeded European standards for UV-B radiation levels, and similar findings of increased UV intensity have been reported in Norway [29*, 30]. Combined, these results portend a potential looming public health crisis, with tens of millions of individuals putting themselves at increased risk of developing BCC, SCC, and melanoma in the years ahead.

Future prospects

How can this information be utilized optimally relative to the escalating incidence of skin cancers? First, education of the general public regarding the risks of UV exposure, including from indoor tanning devices, is necessary. The ability of UV to induce cutaneous vitamin D production is not a persuasive argument supporting UV-tanning, because of non-UV means to obtain identical (if not more accurate) maintenance of healthy blood vitamin D levels. In one study, 67% of subjects surveyed in 2007 were aware that limiting tanning decreases the risk of developing skin cancer, but that proportion was down from 77% in 1994 [27**]. In light of the indoor tanning industry's current public relations campaign to dissociate tanning from melanoma risk, knowledge of the dangers posed by intentional UV exposure is likely only to decrease unless an effective counter-message is offered by the biomedical community.

Second, physician counseling of patients who engage in intentional tanning should be considered. Several recent studies have found that 12-26% of frequent tanners, particularly adolescents and young adults, show signs of addiction to tanning, which may be related to endogenous opioids that are released as a byproduct of the tanning pathway [31, 32*, 33*, 8**]. Physicians may therefore need to view tanning similarly to cigarette smoking or alcohol use: as a potentially addictive behavior that can increase the risk of future malignancies.

Third, political action may be required to expand and enforce regulation of the tanning industry. Twenty states currently have laws regarding indoor tanning, most of which regulate access by minors to tanning facilities [34, 35]. However, mechanisms to enforce these regulations are not currently sufficient. In one study conducted in Minnesota and Massachusetts, 15 year-old girls were sent to 200 indoor tanning facilities and attempted to purchase tanning sessions without parental consent, in violation of state law; the girls succeeded in purchasing sessions at 81% of facilities [36]. Given that early exposure to indoor tanning is associated with the greatest increase in risk of developing melanoma, improved regulation of the tanning industry, especially as it concerns youth access, is of vital public health concern. It may also be cost-effective: in a recent analysis in Austraila, strict regulation of tanning access was estimated to save $AU 256,054 in eventual healthcare costs per 100,000 persons [37**]. Importantly “Tanning Salons” sometimes offer customers non-UV tanning options, which represent cosmetic alternatives that are likely to be profoundly safer (many of these cosmetic darkening products may contain sunblocks). The switch to such marketing strategies may profoundly alter the skin cancer risk for clients.