Dear Doctor Column, November 4, 2002
Question:

I like the way I look with a tan and go to a tanning parlor about twice a week year-round. My mother is constantly harping at me that I'm ruining my skin, even though I've told her that tanning booths are safer than sitting in the sun. Isn't this true? Can you provide me with information showing that tanning booths are the best alternative? I think maintaining a tan makes my skin look great.

Answer:

The simple truth of the matter is that there's no such thing as a safe tan from the sun or a tanning bed. A tan is the skin's response to an injury and every time you tan you accumulate damage to the skin, as well as accelerate the aging process and increase your risk for skin cancer.

The sun emits three kinds of ultraviolet (UV) light — UVA, UVB, and UVC. UVA light (the major source of light emitted by tanning beds) causes some of the cancer-inducing effect of sunlight, which is primarily composed of UVB rays. In addition, UVA light penetrates deeper into the skin. Both UVA and UVB rays cause wrinkled skin, cataracts, and damage to the retina of the eye. UVC light is absorbed by the earth's protective ozone layer.

On an average day, more than 1 million Americans invest both time and money visiting tanning salons. What many don't realize is that the damage they receive from the indoor lamps is just as dangerous as outdoor sun exposure: A single 15- to 30-minute salon session exposes the body to the same harmful UV rays as at the beach.

Skin cancer is the most common form of cancer in the U.S. with an estimated 1.4 million new cases expected to be diagnosed this year; 87,900 individuals will be diagnosed with melanoma — the deadliest form of skin cancer. Melanoma is now the fastest growing cancer in the country, and dermatologists associate the rising popularity of tanning beds as one reason for this trend.

Regrettably, most Americans — including young people — are not heeding medical advice to stay out of the sun and to use sunscreen daily. According to a new study published in the October 15, 2002, issue of the Archives of Dermatology, a journal of the American Medical Association, university students continue to use artificial tanning equipment, such as lamps and beds, despite being aware of the health risks associated with these devices.

Medical researchers at the Indiana School of Medicine conducted a survey of 489 students. Of the students surveyed, 47% had used a tanning lamp during the previous 12 months (these students were labeled "current users"). Female students comprised 84% of current users and 70% of past users (had not used a tanning lamp in the past year). Most current users (93%) were between the ages of 17 and 22.

The researchers found that more than 90% of users of tanning lamps were aware that premature aging and skin cancers were associated with tanning lamp use. Additionally, 92% of current users reported that they used tanning lamps because they liked the appearance of a tan, 71% reported using tanning lamps because they could not find the time to tan with natural sunlight and 61% of users said they used tanning lamps to prepare for a vacation. Incredibly, students with a positive family history of skin cancer were 1.5 times more likely to use tanning lamps than those without a family history of skin cancer.

Despite significant evidence supporting the relationship between indoor tanning and skin cancer, regulation of the $2 billion tanning salon industry in the U.S. is limited. The Centers for Disease Control and Prevention reports an estimated 700 emergency department visits per year are related to problems from tanning salon exposure.

UAB dermatologists cite additional factors that make tanning in a salon as bad or worse than getting a tan the old-fashioned way:

• Tanning facilities sometimes fail to follow recommendations and regulations, such as ensuring that customers wear eye protection and that overexposure does not occur.
• Some tanning facilities do not calibrate the UVA output of their tanning bulbs, which can lead to too much exposure or not enough to get what you've paid for.
• Tanning facility patrons often try for a total-body tan. The buttocks and genitalia are particularly sensitive to UV radiation and are prone to develop skin cancer.

To help protect its citizens from the dangers of indoor tanning, the state of Texas passed House Bill 663 in 2001 that prohibits any person under age 13 from using indoor tanning salons, except under a doctor's supervision. Adolescents age 13 to 15 must be escorted by a parent, and 16- and 17-year-olds must have a note from their parent to use the indoor tanning equipment. House Bill 663 also mandates that the tanning salon keep a record of each customer, including information on the patient's eye color and skin type. The AAD hopes this bill will serve as a model for other states to draft and pass their own state regulations.

The good news is that the skin has a terrific capacity to recover, so it's never too late to get out of the sun (or the tanning bed) and start protecting your skin.

For more information, including ways to protect your skin from skin cancers and from further damage, visit the AAD Web site www.aad.org or the American Cancer Society site at www.cancer.org.