The Case Against Indoor Tanning

Is It Healthy?
Over the last year, the indoor tanning industry has taken an aggressive stand, claiming that not only is indoor tanning harmless, but that it is actually healthy.

Tanning is an acquired darkening of the skin in response to ultraviolet radiation. Not all people are capable of developing a tan in response to UV radiation exposure: Very fair-skinned people simply burn and freckle. In those who can tan, the brown pigment melanin is produced and distributed in the superficial portion of the skin (the epidermis) in the days following exposure. The development of this pigment minimally protects the skin against further damage from UV radiation.

This rather minor protection is cited to support the suggestion that a tan is healthy; that is not the case. In fact, the important point is that damage to the skin must have been produced to create a tan in the first place.

The wisdom of indoor tanning for cosmetic purposes has been repeatedly questioned by organized medicine. This criticism reached a peak in December, 1994, when the American Medical Association (AMA) adopted a resolution calling for a ban on the sale and use of tanning equipment for non-medical purposes, i.e., cosmetic. However, the United States Federal Trade Commission (FTC), which regulates the sale and marketing (but not the use) of indoor tanning equipment, declined to institute such a ban. The FTC did not accept the AMA's position, and in fact moved in the other direction, prohibiting the industry from marketing indoor tanning for any purpose other than cosmetic. It cannot make health claims. The tanning industry has requested a change in this regulation and is actively seeking the ability to market the "health benefits" of indoor tanning. The case for such benefits is very weak, while the case for the risks of indoor tanning is very strong.

The Rise of Indoor Tanning
The social desirability of a tan is a modern phenomenon, beginning in the 1920s when the French designer Coco Chanel decreed it as a fashion look. The concept of obtaining a tan without going outdoors became increasingly attractive. However, early indoor tanning units emitted the most damaging portions of the ultraviolet spectrum, UVC and UVB, and were plagued by safety problems. In the 1970s, medical devices that emit principally UVA were developed and quickly adopted for modern indoor tanning. The biological effects of UVA were less obvious than those of UVB, which is responsible for skin reddening, or UVC and these devices were touted as offering a "safe" tan.

It soon became apparent that UVA exposure could cause the same problems as UVB, namely sunburns, wrinkles (photoaging), and skin cancer. The UVA-emitting devices also were not very effective at inducing a tan. And so, the idea of a "safe" UVA tan, so highly promoted by the indoor tanning industry just a few years ago, is now gone. It was not abandoned for scientific reasons, but purely out of the market-driven desire for darker and faster tanning than UVA could induce.

The next step was the development of indoor tanning devices that contain a mixture of UVA and UVB, simulating the mixture found in the sun. These are the ones in use today.

Indoor Tanning and Skin Cancer
What then is the evidence that associates indoor tanning with skin cancer? Tanning Trends magazine, a trade publication, writes: "Moderate tanning has never been linked scientifically to skin cancer. In fact, by helping people tan with a reduced incidence of sunburn, indoor tanning may reduce your risk of ever contracting skin cancer." Indeed, quite the reverse is true: By increasing exposure to carcinogenic UV rays, the risk of skin cancer is increased.

UV radiation seems to be the cause of all three common skin cancers -- basal cell carcinoma, squamous cell carcinoma, and melanoma. It is thought to induce skin cancers by three mechanisms: First, ultraviolet light directly damages DNA leading to mutations; second, it produces activated oxygen molecules that in turn damage DNA and other cellular structures; and third, it leads to a localized immunosuppression, thus blocking the body's natural anti-cancer defenses.

Public Policy on Tanning
Physicians and medical groups around the world have undertaken extensive campaigns to decrease excessive exposure to ultraviolet light in order to reduce the current epidemic of skin cancer. These efforts have been successful at educating the public. Surveys show there is increasing awareness that ultraviolet light causes skin cancer. Despite this knowledge, tanning indoors and outdoors is more popular than ever. Most studies suggest young women are the most frequent patrons of tanning salons. The development of photoaging and skin cancer will take years to become apparent in these young tanners, while the perceived social value of a tan is apparent immediately. It seems likely the indoor tanning industry will continue to actively market its services, including the rather dubious claim that indoor tanning is not only harmless but is healthy. Regulation of the tanning industry at the state and national level is important, especially to prevent false health claims from being made. Physicians and those concerned about preventing skin cancer can and should continue to play a major role in educating the public about the dangers of tanning, especially directing efforts towards young tanners.

Developed from the Skin Cancer Foundation website statement on Indoor Tanning. For more details on this and the risk of skin cancer associated with indoor tanning visit www.skincancer.org.