Indoor tanning: Unexpected dangers
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Tanning beds expose virtually all your skin to intense UV radiation. An automatic timer is supposed to limit the UV dose,
but there’s no assurance that parlors follow the recommended exposure schedules.
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Nearly 30 million Americans, including a growing number of teenage girls, are expected to visit a tanning salon in 2005.
Our nationwide survey found evidence of a public-health threat that goes beyond the familiar warnings that tanning may increase
the risk of developing wrinkles and skin cancer.
When we called 296 tanning facilities in 12 cities, many not only denied or downplayed the possible risks but also endorsed
unsafe practices. Here are the highlights of our investigation:
• Seventy-five percent of the surveyed employees said we could come every day or as often as we liked, even though we called
ourselves beginners.
• Nearly 35 percent denied that indoor tanning can cause skin cancer, claimed it doesn’t prematurely age the skin, or said
both.
• About 6 percent said they permit the dangerous practice of tanning without protective eyewear.
• More than 20 percent said minors, who may face the greatest long-term risks from such exposure to ultraviolet rays, could
come without adult consent.
• About half of states in the U.S. have no tanning-parlor regulations, and the existing rules are sometimes minimal and frequently
flouted by parlor employees.
• Overall in our six-question survey, the employees gave an average of three to four answers that we consider false, questionable,
or inadequate. Only 1 percent answered all questions appropriately. If those findings translate into actual practice, many
indoor tanners are being exposed to particularly high risk.
EARLY WARNINGS
Medical groups have long warned about the dangers of indoor tanning. The American Medical Association and the American Academy
of Dermatology unsuccessfully petitioned the Food and Drug Administration in 1994 to ban cosmetic-tanning equipment.
Three years later, the Federal Trade Commission warned the public to beware of advertised claims that “unlike the sun, indoor
tanning will not cause skin cancer or skin aging” or that you can “tan indoors with absolutely no harmful side effects.”
In February 1999, still under pressure from the medical community, the FDA announced that current recommendations “may allow
higher exposures” to UV radiation “than are necessary.” The agency proposed reducing recommended exposures and requiring simpler
wording on consumer warnings. But it hasn’t yet implemented either of those changes. An FDA spokeswoman told us that “the
agency decided to postpone amendment of its standard pending the results of ongoing research and discussions with other organizations.”
To make matters worse, only about half of states have any rules for tanning parlors. In some of those states, the regulation
is minimal and may not require licensing, inspections, training, record-keeping, or parental consent for minors.
truth, or your consequences
The FTC’s warning to the public about false claims on indoor tanning has apparently minimized such false advertising. But
potentially dangerous practices and incorrect or questionable ideas persist, many of them pushed by the tanning-facility employees
we surveyed.
Beginners can tan every day. Some 67 percent of the employees said we could come for tanning daily; 8 percent more said we could come as often as we want.
Virtually every facility offered tanning packages, which encourage frequent tanning. But the FDA recommends no more than three
visits during the first week; the frequency after that depends on the particular sun bed and skin type.
Why would anyone want daily tanning sessions? One possible answer: It may be habit-forming.
A small study from Wake Forest University in North Carolina reported in the July 2004 issue of the Journal of the American
Academy of Dermatology found that people felt significantly more relaxed after lying in a real tanning bed than in a fake
tanner that served as a comparison. Based on preliminary evidence that tanning might stimulate secretion of mood-boosting
endorphins, the authors of the study speculated that sun beds might have a druglike reinforcing effect.
You don’t need protective eyewear. Six percent of the employees gave that dangerous advice. Federal rules require indoor tanning facilities to provide protective
eyewear, such as goggles. Exposure to intense UV light can damage the cornea or retina or eventually cause cataracts. Closing
your eyes or wearing ordinary sunglasses is not sufficient.
Gentle tanning works for people with very fair skin. About two-thirds of the employees said that our extremely pale-skinned cousin, who burns but never tans outdoors, could come
in for tanning or evaluation. But even the National Tanning Training Institute, an industry group, omits people with such
vulnerable skin from its chart on skin types in its current training manual. Moreover, people with such skin face especially
high risk from UV radiation, research indicates. We don’t know how many employees actually meant the feasible alternative,
spray-on tanning, since only a small percentage volunteered that option.
Indoor tanning is safer than sunlight. Both UVA and UVB, the main types of ultraviolet radiation, can tan the skin. Some sun beds emit proportionately less of the
skin-burning UVB rays than sunlight does, and more UVA rays. But the radiation from other beds today mimics that of sunlight.
And whether the lower-UVB beds are any safer than outdoor light is questionable.
Both UVA and UVB rays contribute to skin aging. Further, each can cause potentially cancerous changes in the cells’ DNA,
both directly and by creating destructive free-radical molecules. Production of melanin, the tanning pigment, generates additional
free radicals. Moreover, the radiation from as few as 10 indoor-tanning sessions in 2 weeks can suppress your cancer-fighting
immune system, a 2000 study from the Johns Hopkins University School of Medicine found.
Some research suggests that UVA might be somewhat less likely than UVB to cause the direct DNA damage. But the experts we
consulted said that any such difference doesn’t justify claims about sun-bed safety. In addition, the tanning industry argues
that proper use of sun beds doesn’t cause sunburns, a potential risk factor for skin cancer. But several epidemiological studies--including
at least one that controlled for sunburn history--have tentatively linked indoor tanning with increased risk of melanoma,
the deadliest type of skin cancer.
There’s less evidence on other skin cancers. But a study from Dartmouth Medical School and elsewhere, published in 2002 in
the Journal of the National Cancer Institute, found that indoor tanners had substantially increased risks of basal- and squamous-cell
carcinoma, the two most common types of skin cancer.
Our consultants say the overall evidence plus ordinary prudence warrants a presumption of probable risk, particularly for
people with lighter complexions.
Indoor tanning is carefully controlled. The total UV intensity of tanning units is about 2 to 6 times greater than in standard sunshine, according to Jeff Nedelman,
a spokesman for the Indoor Tanning Association, a trade organization. But length and frequency of exposure, he says, are the
key controls in slowly building a tan without burning. That lets customers receive a moderate amount of ultraviolet light
based on their skin type and tanning history, he adds.
However, new tanning bulbs emit considerably more radiation than older bulbs, a change that may not be taken into account.
Indeed, our survey and other research indicate that sun-bed operators often fail to appropriately control the length and frequency
of exposure. A 2003 study from the University of Washington School of Medicine and elsewhere, involving 50 North Carolina
tanning facilities and published in the Journal of the American Academy of Dermatology, found that 95 percent of novice tanners
were exposed to UV radiation for a longer time than the federally recommended levels. One-third of them started at or above
the maximum exposure limits for already-tanned people.
A study published in 2001 in the same journal by researchers at San Diego State University and elsewhere found that none
of 54 facilities in the San Diego area complied with all seven FDA rules and recommendations on length and frequency of indoor
tanning; 94 percent allowed more-frequent sessions than the FDA recommends. Both North Carolina and California regulate tanning
parlors.
Moderate tanning won’t age your skin. Nearly half of the tanning-facility employees made that claim. (About 18 percent denied that any tanning would cause aging.)
It’s true that the potential damage rises with increasing exposure to UV radiation. But any tan indicates that your skin has
undergone some cellular damage, which is what triggers the melanin production. No one knows how many times you can tan before
the damage becomes visible, but it’s cumulative and largely irreversible.
Lotions can reduce the aging effects of indoor tanning. Preliminary research suggests that topical lotions containing antioxidant vitamins might possibly reduce skin damage if applied
before tanning. But any such protection would be quite minimal, says photobiology expert Vincent DeLeo, M.D., chairman of
the dermatology department at St. Luke’s-Roosevelt Medical Center and Beth Israel Medical Center in New York. Indeed, Nedelman,
spokesman for the tanning association, says the vast majority of products are moisturizers. In 1997 the FTC ordered California
SunCare of Los Angeles to stop saying its California Tan Heliotherapy tanning lotions, oils, and gels prevent or minimize
skin cancer and premature skin aging. The company complied without admitting any wrongdoing, according to the FTC.
Indoor tanning may help prevent disease. It’s true that UVB stimulates the skin to synthesize vitamin D. And some research suggests that adequate vitamin D may help
ward off not only osteoporosis but several other diseases as well, including certain common cancers. But there are safer ways
to get enough D.
People under age 60 or so can get a year’s supply in most parts of the U.S. by going outdoors for several minutes between
midmorning and midafternoon a few times a week during the spring, summer, and fall in the North or any three seasons in the
South. Those who are older or heavier, have darker skin, or live farther north need somewhat more exposure. Alternatively,
you could regularly eat foods high in vitamin D, notably fortified milk and fatty fish, or take a multivitamin or other pill
containing the vitamin.
WHAT YOU CAN DO
Consumers Union, the publisher of Consumer Reports, believes the FDA should promptly implement and publicize its 1999 proposal to reduce UV exposure limits and require additional
consumer warnings. Meanwhile, all states should have licensing regulations; require sun-bed operators to pass a comprehensive,
state-recognized training course; and require parental consent for minors.
County and state health officials should inspect the facilities regularly to ensure compliance with regulations. For a periodically
updated list of states that regulate tanning parlors, go to
wwww.tanningtraining.com/state.html.
• We don’t recommend indoor tanning for anyone, just as we discourage more than brief exposure to strong sunlight without
sunscreen protection. Some people must avoid UV tanning entirely: those who have certain diseases, such as eczema or lupus,
or take certain drugs, such as some antibiotics, thiazide diuretics, or oral contraceptives. So check with your physician
or pharmacist before tanning. Individuals who want to get bronzed without the potential risks of UV rays could consider spray-on
tanning.
• If you or your children can’t resist sun beds, be sure to get no more than the minimum tanning exposure for your skin type.
Raise the questions that we asked, and be wary of any facility that provides improper answers.
• People who’ve already tanned frequently should be especially cautious about further UV exposure, since damage is cumulative
and tends to thin the skin, increasing susceptibility to further harm. They should be sure to wear sunscreen, sun-protective
clothing, or both outdoors. And both they and a dermatologist should periodically check their skin for suspicious moles or
other lesions: those that change, bleed, or don’t heal; are asymmetric or ulcerated; or have a blurred or notched border or
a mixture of colors.
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