Out of the Frying Pan and Into the Fire: Indoor Tanning

Abstract

Sources: (1) Hornung RL, Magee KH, Lee WJ, et al. Tanning facility use: are we exceeding Food and Drug Administration limits? J Am Acad Dermatol. 2003;49:655–661. (2) Demko CA, Borawski EA, Debanne SM, et al. Use of indoor tanning facilities by white adolescents in the United States. Arch Pediatr Adolesc Med. 2003;157:854–860.Tanning facilities represent a fast-growing, multi-billion-dollar industry in the United States, attracting an increasing number of younger customers.1 Some states limit or prohibit indoor tanning by minors, and the Food and Drug Administration (FDA) has established recommended limits for ultraviolet light exposure at indoor tanning salons;2 however, few studies have evaluated compliance in these areas.The first study, by investigators from the University of Washington, Seattle, Northwestern University, Evanston, Ill., and Oregon Health and Science University, surveyed a convenience sample of tanning facilities in North Carolina to ascertain facility characteristics, patron exposure data, availability of FDA-recommended exposure schedules, and ultraviolet emissions from tanning lamps at each site. The majority of sites were combination hair and tanning salons (58%), 16% were primary tanning salons, 8% were health and fitness centers, and 18% were a variety of miscellaneous institutions including grocery and clothing stores. All sites provided recommended exposure schedules; however, patron records indicated that 95% of patrons exceeded recommended ultraviolet exposure limits. Tanning is typically initiated at a lower dose for the first week and a higher dose for maintenance during subsequent weeks. However, as many as one-third of patients started their first tanning visit at or above the maximum recommended exposure limit for maintenance tanning. Customers at dedicated tanning facilities had significantly lower overall weekly exposure times than those at mixed-use facilities (34.8 minutes versus 50.33 minutes, P<.05). Even so, all sites exceeded recommended weekly maintenance limits of 20.51 average minutes set by the FDA.2In the second study, researchers from Case Western Reserve University, Cleveland, Ohio, analyzed data from the National Longitudinal Study of Adolescent Health Study to determine the frequency of indoor tanning among adolescents within a national sample of 6,903 white adolescents between 13–19 years of age. Twenty-four percent of those surveyed had participated in indoor tanning at least once. Among female adolescents who had reported prior indoor tanning use, 76% reported tanning 3 or more times while 51% tanned 10 or more times. Statistically significant factors that predicted frequent users included being female, frequent sunbathers, polysubstance use (at least 2 of the following: alcohol, tobacco, or marijuana), residence in the South or Midwest, attendance at a rural high school, having a personal allowance or income, and active dieters. Factors that predicted lower odds of indoor tanning use included having greater cognitive ability, poor tanning ability, and a mother with a college degree.Despite widespread education about the risks of ultraviolet light in the pathogenesis of skin cancer and the recent classification of ultraviolet light produced by tanning lamps as a known carcinogen by the Department of Health and Human Services,3 tanning facilities continue to gain in popularity. Several recent studies have indicated that a sizable proportion (18–34%) of teenagers have used tanning beds at least once,4–6 and that many teens subsequently become frequent users. As documented in the first article, customers of indoor tanning facilities regularly exceed recommended federal guidelines for ultraviolet light exposure. Since ultraviolet light damage appears to be cumulative, early and frequent users of indoor tanning facilities should be especially worrisome since they are at the greatest risk for the development of actinic damage and skin cancer. A variety of measures have been proposed that may help limit the risk such as: increased education; minimum legal age limits for indoor tanning; parental supervision; use of new and improving topical self-tanning products; and taxes to increase the cost of indoor tanning, which could also provide funds to support education and enforcement of these measures.7 (See also AAP Grand Rounds, 2003;8:13).8As noted in the editorial accompanying the second report,6 skin cancer is the most commonly diagnosed cancer, and melanoma is the cancer most rapidly increasing in frequency. Yet, we continue to permit marketing of a known carcinogen, UV radiation, to teenagers and do not enforce FDA safety standards. Do we have to repeat the costly mistakes we made with regulating tobacco? It is beyond the pale that FDA standards are merely guidelines, not regulations.