Transcript The Darker Side of Indoor Tanning Author: Lauren Alderdice Advisor: Professor VanDyke

The Darker Side of Indoor
Tanning
Author: Lauren Alderdice
Advisor: Professor VanDyke
History of Indoor Tanning



1906: Medical company in Germany made the
worlds 1st indoor UV tanning bed used to treat
ricketts
1st generation of indoor tanning beds were
principally UVB emitting; plagued by many
safety problems
1970’s: Development of high intensity UVA light
sources for medical purposes; was quickly
followed by their use in commercial tanning
parlors
Indoor Tanning Statistics



30 Million Americans visit indoor tanning salons
each year
70% are Caucasian girls and women between the
ages of 16 and 49
2005 AAD survey: 92% of respondents
understood that getting a tan from the sun is
dangerous; Yet, 65% said they think they look
better when they are tan.
UV Sources in Tanning Beds

UVA: 95%, aging of
the skin with recent
studies proving
cancer and genetic
damage.

UVB: 5%, sunburns
and skin cancer
Reasons for tanning

Recurrent themes :to look good ,relaxation, and to
prepare for a special event. (Murray and Turner’s
qualitative study)

Prevacation Tan- SPF 3

Zeller et al. :more difficult to quit tanning at younger
ages and higher frequency of use due to the moodenhancing or relaxing effects.

Feldmen, et al. study :artificial UVR is a reinforcing
stimulus in frequent indoor tanners.
Adverse Effects of Sunbeds





Sunburn: most apparent acute adverse effect
Determinants: Thickness of skin, skin
pigmentation based on hereditary skin type &
exposure time
CDC :700 visits were made to ED in a single year
due to tanning bed burns
AAD reports in Italy: 25% of sunbed users
experience sunburns in devices, but only 60%
suspend sessions after burning.
Blistering sunburns (even only a few) 1st 18 yrs of
life significantly increase the risk for MM
Other Immediate Effects



Ocular disorders: corneal
burns, cataracts, &
permanent eye damage
CDC : 152 pts had been
treated for eye injuries in
a 12 month period related
to tanning devices
Phototoxic/ Photoallergic
Rxns include but are not
limited to: NSAIDS,
Diuretics, ABX, TCA’s
Chronic Adverse Effects



Photoaging
Common in middleaged, and elderly
whites
Coarse, roughened,
deeply wrinkled skin,
reductions in
elasticity and recoil
Indoor Tanning & Skin Cancer




UV exposure : most
important environmental
factor in development
Most common CA in U.S.
Increasing in prevalence
ACS : “ Exposure to
sunlight causes almost all
cases of basal and
squamous cell skin cancer
and is a major cause of
skin melanoma”
Skin CA Cont.





BCC: 80%; Cumulative sun
exposure is main risk factor
SCC: 2nd most common; Excess
UV exposure
MM: Most fatal; excessive sun
exposure (esp. sunburn) most
preventable cause
NCI: Women who use tanning
beds>1/mo are 55% more
likely to develop MM
IARC: 1st exposure to sunbeds
before 35 yoa significantly
increases the risk of MM
How Indoor Tanning Is Regulated

FDA

FTC

Operators of indoor
tanning: state level or
not at all
Pitfalls of Enforcement




FDA ONLY recommends maximum exposure dosages
Survey of tanning facilities in NC :95% of patrons
exceeded recommended limits, with 33% beginning at
maximum doses recommended for maintenance tanning
FDA DOES NOT regulate the proportion of UVA and
UVB emitted
FDA Center for Devices and Radiological Health 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 tanning lamps
and doses of 10 to 15 times that of the sun in newly
available high-pressure sunlamps.
Government Position


Contends with the strong
lobbying at federal and
state levels by the
multibillion-dollar
tanning industry.
2003: FDA developed
amendment proposals to
develop a safer tanning
protocol that have yet to
be put in place.
Bottom Line

Appearance is driving patrons to the readily
accessible artificial UVR devices

http://www.youtube.com/watch?v=b2oyYU
hl0UE
The Role of PA’s




Increase efforts to warn and educate the public
and government about the dangers of excessive
UV exposure
Incorporate patient education on artificial
tanning in our daily practices
Sports physical for adolescents: 5th Vital Sign
Evidence that prevention efforts can be effective
over time
References

































Albert MR, Ostheimer KG. The evolution of current medical and popular attitudes toward ultraviolet light exposure: part 3. J Am Acad Dermatol. 2003 Dec; 49(6):10961106.
American Academy of Dermatology (AAD). Skin Cancer. 2005. Available at http://www.aad.org/public/Publications/pamphlets/SkinCancer.htm
American Academy of Dermatology (AAD). 2006 Skin Cancer Fact Sheet. Available at
http://www.aad.org/aad/Newsroom/2005+Skin+Cancer+Fact+Sheet.htm
Amercian Cancer Society. Cancer Facts and Figures 2005. Available at http://www.cancer.org
Centers for Disease Control and Prevention (CDC). Epidemiologic Notes and Reports Injuries Associated with Ultraviolet Tanning Devices – Wisconsin. Morbidity and
Mortality Weekly Report. 1989 May; 38(19):333-335.
Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC. Use of indoor tanning facilities by white adolescents in the United States. Arch Pediatr Adolesc. 2003;
157: 854-860.
Feldman SR, Liguori A, Kucenic M, Rapp SR, Fleischer Jr. AB, Lang W, et al.
Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners. J Am Acad Dermatol. 2004; 51(1):45-51.
Ferguson, J. WHO says skin cancer incidence is rising. Journal Watch Dermatology. 2005;4 (4).
Gambichler T, Breukmann F, Boms S, Altmeyer P, Kreuter A. Narrowband UVB
phototherapy in skin conditions beyond psoriasis. J Am Acad Dermatol. 2005; 52(4):660-70.
Gorgos D. Popularity of indoor tanning contributes to increased incidence of skin cancer. Dermatology Nursing. 2006 June; 18(3):281.
Hillhouse JJ, Turrisi R. Examination of the efficacy of an appearance-focused intervention to reduce UV exposure. Journal of Behavioral Medicine August 2002; 25(4):
395-409.
Hornung RL, Magee KH, Lee WJ, Hansen LA, Hsieh Y. Tanning facility use: Are we exceeding Food and Drug Administation limits? J Am Acad Dermatol. October 2003;
49(4): 655-660.
IARC Working Group. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. Int. J. Cancer. 2006;
120:1116-1122.
Isaacs G, Stainer DS, Sensky TE, Moor S, Thiompson C. Phototherapy and its
mechanisms of action in seasonal affective disorder. J Affective Disorder. 1988; 14:13-19.
Knight JM, Kirincivh AN, Farmer E, Hood AF. Awareness of the risks of tanning lamps does not influence behavior among college students. Arch Dermatol. October
2002; 138(10):1311-11315.
Lee T, Chen E, Chan C, Paterson J, Janzen H, Blashko C. Seasonal affective disorder. Clinical Psychology: Science and Practice. 1998; 5(3):275-90.
Levine JA, Sorace M, Spencer J, Siegel D. The indoor UV tanning industry: A review of
skin cancer risk, health benefit claims, and regulation. J Am Acad Dermatol.
2005; 53(6):1038-44.
Lim HW, Cyr WH, DeFabo E, Robinson J, Weinstock MA, Beer JZ, et al. Scientific and regulatory issues related to indoor tanning. J Am Acad Dermatol. 2004; 51(5):7814.
Lim HW, Gilchrest BA, Cooper KD, Bischoff-Ferrari HA, Rigel DS, Cyr WH, et al. Sunlight, tanning booths, and vitamin D. J Am Acad Dermatol. 2005; 52(5):868-76.
MacKie R M. Long-term health risk to the skin of ultraviolet light. Progress in Biophysics and Molecular Biology. 2006; 92:92-96.
Morbidity and Mortality Weekly Report (MMWR). Quickstats: percentage of teens aged 14-17 years who used indoor tanning devices during the preceeding12 months, by
sex and age---United States, 2005. October 13, 2006; 55(40):1101.
Murray CD, Turner E. Health, risk and sunbed use: A qualitative study. Health, Risk and Society. March 2004; 6(1): 67-80.
National Cancer Institute (NCI). Artificial Tanning Booths and Cancer. 2004. Available at http://www.cancer.gov
Neale, RE, Davis M, Pandeya N, Whiteman DC, Green AC. Basal cell carcinoma on the trunk is associated with excessive sun exposure. J Am Acad Dermatol. In press,
Corrected proof, Available online 13 October 2006.
Palmer RC, Mayer JA, Woodruff SI, Eckhardt L, Sallis JF. Indoor tanning facility density in eighty U.S. cities. J. of Community Health. 2002; 27(3):191-202.
Rhainds M, De Guire L, Claveau J. A population based survey on the use of artificial tanning devices in the Province of Quebec, Canada. J Am Acad Dermatol. 1999 Apr;
40(4): 572-6.
Sinclair, C. Risks and benefits of sun exposure: implications for public health practice based on the Australian experience. Progress in Biophysica and Molecular Biology.
2006;92: 173-178.
Questions?