Dear Doctor Column, June 22, 2009

Question:

I think I look so much better with a tan. Is using a tanning bed safer than sitting in the sun?

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. Every time you tan you damage your skin. You also accelerate the aging process and increase your risk for skin cancer.

Indoor tanning can be addictive. The American Academy of Dermatology (AAD) says that exposure to ultraviolet (UV) light produces endorphins, or “feel-good” hormones. Teenaged girls who can’t seem to get enough of indoor tanning call it “tanner-rexia.”

Indoor tanning before the age of 35 has been shown to significantly increase risk of melanoma, the deadliest form of skin cancer. One American dies from melanoma every hour. 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.

Evidence from several studies has shown that exposure to UV radiation from indoor tanning devices is associated with an increased risk of melanoma and nonmelanoma skin cancer such as squamous cell carcinoma and basal cell carcinoma. People exposed to UV radiation from indoor tanning before the age of 35 have a significant increase in their risk of melanoma. Exposure to UV radiation during indoor tanning damages the DNA in skin cells and can lead to skin aging, immune suppression, and eye damage, including cataracts and ocular melanoma.

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.

The sun emits three kinds of 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 (UVB rays are the primary cancer-causing light). In addition, UVA light penetrates deeper into the skin than UVB light. 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.

Regrettably, most Americans — including young people — are not heeding medical advice to stay out of the sun and to use sunscreen daily.

The World Health Organization recommends prohibiting minors from indoor tanning because of the danger of skin cancer. Despite significant evidence supporting the relationship between indoor tanning and skin cancer, regulation of the $5 billion US tanning salon industry is left up to each state. While 26 states regulate tanning salon operators, the legislation varies in severity and enforcement is limited. Texas, California, and Tennessee have enacted legislation restricting indoor tanning facilities, particularly with regard to use by minors. Some states require parental permission for minors to use tanning beds, some require warning signs, and others set educational and training standards for tanning salon operators. The Centers for Disease Control and Prevention reports an estimated 700 emergency department visits per year are related to problems from tanning salon exposure.

In September 2007 the Tanning Accountability and Notification Act became law. The law requires the FDA to determine whether the current labeling of indoor tanning beds provides enough information about the risks associated with indoor tanning and whether to modify the warning label required on the beds to read “Ultraviolet radiation can cause skin cancer.” The AAD opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for nonmedical purposes. It recommends

• No minor should be permitted to use tanning devices
• A Surgeon General’s warning should be placed on all tanning devices
• No person or facility should advertise the use of any UVA or UVB tanning device using wording such as “safe,” “safe tanning,” “no harmful rays,” “no adverse effect,” or similar concepts.

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.

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 or the American Cancer Society site.