The Darker Side of Indoor Tanning

Author: Lauren AlderdiceAdvisor: Professor VanDyke

History of Indoor TanningHistory of Indoor Tanning

1906: Medical company in Germany made 1906: Medical company in Germany made the worlds 1the worlds 1stst indoor UV tanning bed used indoor UV tanning bed used to treat rickettsto treat ricketts

11stst generation of indoor tanning beds were generation of indoor tanning beds were principally UVB emitting; plagued by many principally UVB emitting; plagued by many safety problemssafety problems

1970’s: Development of high intensity UVA 1970’s: Development of high intensity UVA light sources for medical purposes; was light sources for medical purposes; was quickly followed by their use in quickly followed by their use in commercial tanning parlorscommercial tanning parlors

Indoor Tanning StatisticsIndoor Tanning Statistics

30 Million Americans visit indoor tanning 30 Million Americans visit indoor tanning salons each year salons each year

70% are Caucasian girls and women 70% are Caucasian girls and women between the ages of 16 and 49between the ages of 16 and 49

2005 AAD survey: 92% of respondents 2005 AAD survey: 92% of respondents understood that getting a tan from the sun understood that getting a tan from the sun is dangerous; Yet, 65% said they think is dangerous; Yet, 65% said they think they look better when they are tan.they look better when they are tan.

UV Sources in Tanning BedsUV Sources in Tanning Beds

UVA: 95%, aging of UVA: 95%, aging of the skin with the skin with recent studies recent studies proving cancer and proving cancer and genetic damage.genetic damage.

UVB: 5%, UVB: 5%, sunburns and skin sunburns and skin cancercancer

Reasons for tanningReasons for tanning

Recurrent themes :to look good ,relaxation, and Recurrent themes :to look good ,relaxation, and to prepare for a special event. (Murray and to prepare for a special event. (Murray and Turner’s qualitative study)Turner’s qualitative study)

Prevacation Tan- SPF 3Prevacation Tan- SPF 3

Zeller et al. :more difficult to quit tanning at Zeller et al. :more difficult to quit tanning at younger ages and higher frequency of use due to younger ages and higher frequency of use due to the mood-enhancing or relaxing effects.the mood-enhancing or relaxing effects.

Feldmen, et al. study :artificial UVR is a Feldmen, et al. study :artificial UVR is a reinforcing stimulus in frequent indoor tanners. reinforcing stimulus in frequent indoor tanners.

Adverse Effects of SunbedsAdverse Effects of Sunbeds Sunburn: most apparent acute adverse effectSunburn: most apparent acute adverse effect Determinants: Thickness of skin, skin Determinants: Thickness of skin, skin

pigmentation based on hereditary skin type & pigmentation based on hereditary skin type & exposure time exposure time

CDC :700 visits were made to ED in a single CDC :700 visits were made to ED in a single year due to tanning bed burnsyear due to tanning bed burns

AAD reports in Italy: 25% of sunbed users AAD reports in Italy: 25% of sunbed users experience sunburns in devices, but only 60% experience sunburns in devices, but only 60% suspend sessions after burning.suspend sessions after burning.

Blistering sunburns (even only a few) 1Blistering sunburns (even only a few) 1stst 18 yrs 18 yrs of life significantly increase the risk for MMof life significantly increase the risk for MM

Other Immediate EffectsOther Immediate Effects Ocular disorders: corneal Ocular disorders: corneal

burns, cataracts, & burns, cataracts, & permanent eye damagepermanent eye damage

CDC : 152 pts had been CDC : 152 pts had been treated for eye injuries in treated for eye injuries in a 12 month period a 12 month period related to tanning related to tanning devicesdevices

Phototoxic/ Photoallergic Phototoxic/ Photoallergic Rxns include but are not Rxns include but are not limited to: NSAIDS, limited to: NSAIDS, Diuretics, ABX, TCA’sDiuretics, ABX, TCA’s

Chronic Adverse EffectsChronic Adverse Effects

PhotoagingPhotoaging Common in middle-Common in middle-

aged, and elderly aged, and elderly whiteswhites

Coarse, roughened, Coarse, roughened, deeply wrinkled deeply wrinkled skin, reductions in skin, reductions in elasticity and recoilelasticity and recoil

Indoor Tanning & Skin CancerIndoor Tanning & Skin Cancer

UV exposure : most UV exposure : most important important environmental factor environmental factor in developmentin development

Most common CA in Most common CA in U.S.U.S.

Increasing in Increasing in prevalence prevalence

ACS : “ Exposure to ACS : “ Exposure to sunlight causes almost sunlight causes almost all cases of basal and all cases of basal and squamous cell skin squamous cell skin cancer and is a major cancer and is a major cause of skin cause of skin melanoma”melanoma”

Skin CA Cont.Skin CA Cont. BCC: 80%; Cumulative sun BCC: 80%; Cumulative sun

exposure is main risk factorexposure is main risk factor SCC: 2SCC: 2ndnd most common; most common;

Excess UV exposureExcess UV exposure MM: Most fatal; excessive MM: Most fatal; excessive

sun exposure (esp. sunburn) sun exposure (esp. sunburn) most preventable causemost preventable cause

NCI: Women who use NCI: Women who use tanning beds>1/mo are 55% tanning beds>1/mo are 55% more likely to develop MMmore likely to develop MM

IARC: 1IARC: 1stst exposure to exposure to sunbeds before 35 yoa sunbeds before 35 yoa significantly increases the significantly increases the risk of MMrisk of MM

How Indoor Tanning Is How Indoor Tanning Is RegulatedRegulated

FDAFDA

FTCFTC

Operators of indoor Operators of indoor tanning: state level tanning: state level or not at allor not at all

Pitfalls of EnforcementPitfalls of Enforcement FDA ONLY recommends maximum exposure FDA ONLY recommends maximum exposure

dosages dosages Survey of tanning facilities in NC :95% of patrons Survey of tanning facilities in NC :95% of patrons

exceeded recommended limits, with 33% exceeded recommended limits, with 33% beginning at maximum doses recommended for beginning at maximum doses recommended for maintenance tanningmaintenance tanning

FDA DOES NOT regulate the proportion of UVA and FDA DOES NOT regulate the proportion of UVA and UVB emitted UVB emitted

FDA Center for Devices and Radiological Health FDA Center for Devices and Radiological Health has shown that on a per-MED basis: UVA doses of has shown that on a per-MED basis: UVA doses of 1.1 to 4.1 times that of the sun are used in regular 1.1 to 4.1 times that of the sun are used in regular tanning lamps and doses of 10 to 15 times that of tanning lamps and doses of 10 to 15 times that of the sun in newly available high-pressure sunlamps.the sun in newly available high-pressure sunlamps.

Government PositionGovernment Position Contends with the Contends with the

strong lobbying at strong lobbying at federal and state federal and state levels by the levels by the multibillion-dollar multibillion-dollar tanning industry.tanning industry.

2003: FDA developed 2003: FDA developed amendment proposals amendment proposals to develop a safer to develop a safer tanning protocol that tanning protocol that have yet to be put in have yet to be put in place.place.

Bottom LineBottom Line

Appearance is driving patrons to the Appearance is driving patrons to the readily accessible artificial UVR devicesreadily accessible artificial UVR devices

http://www.youtube.com/watch?v=b2oyYUhttp://www.youtube.com/watch?v=b2oyYUhl0UEhl0UE

The Role of PA’sThe Role of PA’s

Increase efforts to warn and educate the Increase efforts to warn and educate the public and government about the dangers public and government about the dangers of excessive UV exposureof excessive UV exposure

Incorporate patient education on Incorporate patient education on artificial tanning in our daily practicesartificial tanning in our daily practices

Sports physical for adolescents: 5Sports physical for adolescents: 5thth Vital Vital SignSign

Evidence that prevention efforts can be Evidence that prevention efforts can be effective over timeeffective over time

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Questions?Questions?