Highest-Quality, State-of-the-Art Equipment

Young people[edit]

Children and adolescents who use tanning beds are at greater risk because of biological vulnerability to UV radiation.^[24] Epidemiological studies have shown that exposure to artificial tanning increases the risk of malignant melanoma and that the longer the exposure, the greater the risk, particularly in individuals exposed before the age of 30 or who have been sunburned.^[24]

Melanoma is increasing faster in females 15–29 years old than males in the same age group. In females 15–29 years old, the torso is the most common location for developing melanoma, which may be the result of high-risk tanning behaviors.^[41]

One study conducted amongst a college student population found that awareness of the risks of tanning beds did not deter the students from using them.^[42] A study published in Pediatrics in 2002 identified the main psychosocial factors of children and adolescents who using tanning beds as: having friends who tan, the belief that it’s ok to get burned in order to achieve a good tan, and that having tanned skin is more attractive and healthier looking than pale skin.^[43]

Tanorexia describes the inability of an individual to stop artificially tanning, and has been indicated among teenagers who regularly tan indoors and admit to being unable to stop.^[44]

In a national sample of non-Hispanic white teenagers, 24% of respondents [or 2.9 million teens] between the ages of 13 to 19 reported using a tanning facility at least once in their lives. Nationally, more than 25% of teenage girls have used tanning salons three or more times in their lives. Ten percent of teens visit tanning salons weekly.^[45] Teenagers are frequent targets of the tanning industry’s highly visible marketing tactics, attracting teens through coupons and media outlets, and going as far as placing ads in high school newspapers. It is difficult for a teen to resist offers for free tanning trial periods, membership deals, steep discounts, or “unlimited tanning”.^[44]

For children and adolescents who use indoor tanning facilities for cosmetic reasons, the focus on perceived, immediate benefits overshadows the cumulative risks and consequences in the future.^[46] Parents, pediatricians, public health practitioners, and lawmakers are rallying support to provide more comprehensive information and support to young people who use tanning beds.^[45]

In May 2012 Northern Ireland banned the use, hire and sale of tanning beds for children and teenagers under 18. A similar law was announced in Ireland in June 2014, to be effective from July 2014.^[32]

Comparison to natural tanning[edit]

Most tanning beds have about the same amount of UVA as sunlight (as opposed to UVB), while the ‘warning signs’ of overexposure, such as sunburn, do not appear at the same rate indoors as out.^[80] Furthermore, the radiation levels are more intense, requiring individuals to limit their exposure to very brief periods. The carcinogenic mutations in some skin cancers have been linked to UVA radiation more than UVB, suggesting that beds have different risks than natural light.^[27] The UVA light is also more strongly associated with skin aging than UVB,^[21] and with genetic damage.^[80]

Natural sunlight exposure has made studies of artificial tanning difficult, since all people are exposed to the natural sun. There are indisputable values to moderate sunlight exposure. UVB light induces the body to synthesize Vitamin D. Vitamin D is required for calcium absorption, and improves development and reduces cancer risk.^[12] The amount of sunlight required per day is estimated to be approximately the same that a single tanning session provides (10 minutes of strong sunlight every day for many people).,^[12] however 10 minutes of sunlight produces far fewer of the negative side effects caused by the tanning bed’s UVA intensity.

Ultraviolet Radiation (UVR) from the sun and in tanning beds[edit]

The sun emits UVR in the form of A, B, and C waves. They are named according to the length of the wave and are associated with various health events. The ozone affects UVR from the sun and different amounts reach the earth’s surface depending on the wavelength. Sunbeds can have the same health effects as UVR from the sun.^[28]

UVA wavelengths (315-400 nm) are the longest wavelengths, and are only slightly affected by ozone levels. Most UVA radiation is able to reach Earth’s surface and can contribute to skin aging, eye damage, and can suppress the immune system.^[28]

• Most of the UV radiation in tanning beds is UVA, but may be 10 to 15 times more intense than midday sun.^[24]
• UVA penetrates the skin more deeply and does not cause a burn.
• UVA does not damage DNA directly like UVB and UVC, but it can generate highly reactive chemical intermediates, such as hydroxyl and oxygen radicals, which in turn damage DNA.

UVB wavelengths (280-315 nm) are strongly affected by ozone levels. Decreases in stratospheric ozone mean that more UVB radiation can reach Earth’s surface.^[28]

• UVB causes burns, snow blindness, immune system suppression, and a variety of skin problems including skin cancer and premature aging.^[28]
• Short-wavelength UVB has been recognized for some time as carcinogenic in experimental animals.^[81]

UVC wavelengths (180-280 nm) have the shortest wavelengths, and are very strongly affected by ozone levels. Virtually all UVC radiation is absorbed by ozone, water vapor, oxygen and carbon dioxide before reaching Earth’s surface.^[28]

• Tanning lamps do not emit UVC

Medical use[edit]

Some people with keratosis, psoriasis, and eczema are treated with UVB light therapy. This is typically in the 310 nm to 315 nm portion of the UVB spectrum. Virtually all fluorescent tanning lamps have one spectral peak within this region of the UVB spectrum, making them an effective tool in mild to moderate cases. In some circumstances, salon memberships have been prescribed and more rarely the purchase of home tanning beds have been prescribed by doctors and may be covered by insurance policies.

Tanning may temporarily help some forms of acne by drying out the skin, but it is not a solution that lasts for very long.^[82][83][84] Further, most prescription or over the counter acne medications (e.g. Accutane, Benzoyl Peroxide, Retin-A), when used in combination with ultraviolet exposure, may lead to burning or delayed healing due to photosensitivity that these drugs (and many others) can create.

UVA light therapy is also used in dermatology. This is often combined with either an oral or topical medication called Psoralen. This combined therapy is referred to as PUVA.

Melanin is produced by cells called melanocytes in a process called melanogenesis. Melanocytes produce two types of melanin: pheomelanin (red) and eumelanin(very dark brown). Melanin protects the body by absorbing solar radiation. With the production of the melanin, the skin color darkens, but the UV-B in sunlight can also cause sunburn. The tanning process can also be created by artificial UV radiation, which can be delivered in frequencies of UV-A, UV-B, or a combination of both.

There are two different mechanisms involved in production of a tan by UV exposure: Firstly, UV-A radiation creates oxidative stress, which in turn oxidises existing melanin and leads to rapid darkening of the melanin. UV-A may also cause melanin to be redistributed (released from melanocytes where it is already stored), but its total quantity is unchanged. Thus, the effect of UV-A leads to skin darkening, but this is only cosmetic since it does not lead to greatly increased production of melanin and therefore also to little increase in protection against UV-B, or protection against sunburn.^[1]

In the second process, triggered primarily by UV-B, there is an increase in production of melanin (melanogenesis),^[2] which is the body’s reaction to direct photodamage (formation of pyrimidine dimers) from UV radiation.^[3] Melanogenesis leads to delayed tanning, and first becomes visible about 72 hours after exposure.^[2] The tan that is created by an increased melanogenesis lasts much longer than the one that is caused by oxidation of existing melanin, and is also actually protective against UV skin damage and sunburn, rather than simply cosmetic. However, in order to cause true melanogenesis-tanning by means of UV exposure, some direct DNA photodamage must first be produced, and this requires UV-B exposure (as present in natural sunlight, or sunlamps that produce UV-B).

As noted above, the ultraviolet frequencies responsible for tanning are often divided into the UVA and UVB ranges, which will be discussed:

An artificial source tanning bed

UVA [edit]

Ultraviolet A (UVA) radiation is in the wavelength range 320 to 400 nm. It is present more uniformly throughout the day, and throughout the year, than UV-B. UV-A is not blocked by the ozone layer. UV-A causes the release of existing melanin from the melanocytes to combine with oxygen (oxidize) to create the actual tan color in the skin. It is blocked less than UV-B by many sunscreens, but is blocked to some degree by clothing. UV-A (see above) apparently induces a cosmetic tan but little extra melanin protection against sun damage, sun burn, or cancer.

UVB[edit]

Ultraviolet B (UV-B or UVB) radiation is in the wavelength range 280 to 320 nm. Much of this band is blocked by the Earth’s ozone layer, but some penetrates. UV-B does the following:

• produces Vitamin D in human skin
• reduced by virtually all sunscreens in accordance with their SPF
• is thought, but not proven, to cause the formation of moles and some types of skin cancer
• stimulates the production of new melanin, which leads to an increase in the dark-coloured pigment within a few days.^[5]

Tanning behavior of different skin colors[edit]

A person’s natural skin color has an impact on their reaction to exposure to the sun. An individual’s natural skin color can vary from a dark brown to a nearly colorless pigmentation, which may appear reddish due to the blood in the skin. In 1975, Harvard dermatologist Thomas B. Fitzpatrick devised the Fitzpatrick scale which described the common tanning behavior of various skin types, as follows:^{[6][7] [8][9][10]}

Sunless tanning[edit]

To avoid exposure to UVB and UVA rays, or in sunless seasons, some people take steps to appear with darkened skin. They may use sunless tanning (also known as self-tanners); stainers which are based on dihydroxyacetone (DHA); bronzers, which are simply dyes; tan accelerators, based on tyrosine and psoralens. Some people use make-up to create a tanned appearance^[12] while others may get a tanned appearance by wearing tan colored stockings or pantyhose.

Many sunless tanning products are available in the form of creams, gels, lotions, and sprays that are self-applied on the skin. Another option is the use of bronzers which are cosmetics that provide temporary effects. There is also a professional spray-on tanning option or “tanning booths” that is offered by spas, salons, and tanning businesses.^[13]

Spray tanning does not mean that a color is sprayed on the body. What is used in the spray tanning process is a colorless chemical which reacts with proteins in the top layer of the skin, resulting in a brown color. The two main active ingredients used in most of the sunless tanners are dihydroxyacetone and erythrulose.^{[citation needed]}

The U.S. Food and Drug Administration (FDA) has not approved the use of DHA spray tanning booths because it has not received safety data to support this specific use. DHA is a permitted color additive for cosmetic use restricted to external application. When used in a commercial spray tanning booth, areas such as the eyes, lips or mucous membrane are exposed to the DHA which is a non-permitted use of the product.^[14]

Several tanning activators use different forms of psoralen, which are known to be photocarcinogenic.^[21][22][23] Health authorities have banned psoralen since July 1996.^[24]

Sunless tanning (also known as UV-free tanning, self tanning, spray tanning (when applied topically), or fake tanning) refers to the application of chemicals to the skin to produce an effect similar in appearance to a suntan. The popularity of sunless tanning has risen since the 1960s after links were made by health authorities between exposure to the sun and other sun tanning methods, such as sunbeds or tanning beds, and the incidence of skin cancer.

Carotenoids[edit]

Artificial sunscreen absorbs ultraviolet light and prevents it from reaching the skin. It has been reported that sunscreen with a sun protection factor (SPF) of 8 based on the UVB spectrum can decrease vitamin D synthetic capacity by 95 percent, whereas sunscreen with an SPF of 15 can reduce synthetic capacity by 98 percent.^[1]

A safe and effective method of sunless tanning is consumption of certain carotenoids^[2][3][4] — antioxidants found in some fruits and vegetables such as carrots and tomatoes — which can result in changes to skin color when ingested chronically and/or in high amounts. Carotenoids are long-lasting. In addition, carotenoids have been linked to more attractive skin tone than suntan.^[5] Carotenes also fulfil the function of melanin in absorbing the UV radiation and protecting the skin.^[6] For example, they are concentrated in the macula of the eye to protect the retina from damage. They are used in plants both to protect chlorophyll from light damage and harvest light directly.^[7]

Carotenaemia (xanthaemia) is the presence in blood of the yellow pigment carotene from excessive intake of carrots or other vegetables containing the pigment resulting in increased serum carotenoids. It can lead to subsequent yellow-orange discoloration (xanthoderma or carotenoderma) and their subsequent deposition in the outermost layer of skin. Carotenemia and carotenoderma is in itself harmless, and does not require treatment. In primaary carotenoderma, when the use of high quantities of carotene is discontinued the skin color will return to normal. It may take up to several months, however, for this to happen.

Lycopene[edit]

Lycopene is a key intermediate in the biosynthesis of beta-carotene and xanthophylls.

Lycopene may be the most powerful carotenoid quencher of singlet oxygen.^{[8][full citation needed]}

Due to its strong color and non-toxicity, lycopene is a useful food coloring (registered as E160d) and is approved for usage in the USA,^[9] Australia and New Zealand (registered as 160d)^[10] and the EU.^[11]

Beta-carotene[edit]

A sunless-tanning product is tanning pills which contain beta-carotene.

However, chronic, high doses of synthetic β-carotene supplements have been associated with increased rate of lung cancer among those who smoke.^[12]

Canthaxanthin[edit]

Canthaxanthin is most commonly used as a color additive in certain foods. Although the FDA has approved the use of canthaxanthin in food, it does not approve its use as a tanning agent. When used as a color additive, only very small amounts of canthaxanthin are necessary. As a tanning agent, however, much larger quantities are used. After canthaxanthin is consumed, it is deposited throughout the body, including in the layer of fat below the skin, which turns an orange-brown color. These types of tanning pills have been linked to various side effects, including hepatitis and canthaxanthin retinopathy, a condition in which yellow deposits form in the retina of the eye. Other side effects including damage to the digestive system and skin surface have also been noted.^{[citation needed]} The FDA withdrew approval for use of canthaxanthin as a tanning agent, and has issued warnings concerning its use.^[13]

Other products[edit]

DHA-based products[edit]

DHA is not a dye, stain or paint, but causes a chemical reaction with the amino acids in the dead layer on the skin surface. One of the pathways is a free radical-mediated Maillard reaction.^[14][15] The other pathway is the conventional Maillard reaction, a process well known to food chemists that causes the browning that occurs during food manufacturing and storage. It does not involve the underlying skin pigmentation nor does it require exposure to ultraviolet light to initiate the color change. However, for the 24 hours after self-tanner is applied, the skin is especially susceptible to ultraviolet, according to a 2007 study led by Katinka Jung of the Gematria Test Lab in Berlin.^[16] Forty minutes after the researchers treated skin samples with high levels of DHA they found that more than 180 percent additional free radicals formed during sun exposure compared with untreated skin. Another self-tanner ingredient, erythrulose, produced a similar response at high levels. For a day after self-tanner application, excessive sun exposure should be avoided and sunscreen should be worn outdoors, they say; an antioxidant cream could also minimize free radical production. Although some self-tanners contain sunscreen, its effect will not last long after application, and a fake tan itself will not protect the skin from UV exposure. The study by Jung et al. further confirms earlier results demonstrating that dihydroxyacetone in combination with dimethylisosorbide enhances the process of (sun-based) tanning. This earlier study also found that dihydroxyacetone also has an effect on the amino acids and nucleic acids which is bad for the skin.^[17]

The free radicals are due to the action of UV light on AGE (Advanced Glycation End-products) as a result of the reaction of DHA with the skin, and the intermediates, such as Amadori products (a type of AGE), that lead to them. AGEs are behind the damage to the skin that occurs with high blood sugar in diabetes where similar glycation occurs.^[18] AGEs absorb and provide a little protection against some of the damaging factors of UV (up to SPF 3),^[19][20] However, they do not have melanin’s extended electronic structure that dissipates the energy, so part of it goes towards starting free radical chain reactions instead, in which other AGEs participate readily. Overall tanner enhances free radical injury.^[21] Although some self-tanners contain sunscreen, its effect will not last as long as the tan. The stated SPF is only applicable for a few hours after application. Despite darkening of the skin, an individual is still susceptible to UV rays, therefore an overall sun protection is still very necessary.^[22] There may also be some inhibition of vitamin D production in DHA-treated skin.^[23]

The color effect is temporary and fades gradually over 3 to 10 days. Some of these products also use erythrulose which works identically to DHA, but develops more slowly. Both DHA and erythrulose have been known to cause contact dermatitis.

Professional spraytan applications are available from spas, salons and gymnasiums by both hand-held sprayers and in the form of sunless or UV-Free spray booths.^[24] The enclosed booth, which resembles an enclosed shower stall, sprays the tanning solution over the entire body. The U.S. Food and Drug Administration(FDA) states when using DHA-containing products as an all-over spray or mist in a commercial spray “tanning” booth, it may be difficult to avoid exposure in a manner for which DHA is not approved, including the area of the eyes, lips, or mucous membrane, or even internally. DHA is not approved by the FDA for inhalation.^[24]

Many self tanners use chemical fragrances which may cause skin allergies or may trigger asthma. Furthermore, some of them contain parabens. Parabens are preservatives that can affect the endocrine system.^[25]

An opinion^[26] issued by the European Commission’s Scientific Committee on Consumer Safety, concluding spray tanning with DHA did not pose risk, has been heavily criticized by specialists.^[27] This is because the cosmetics industry in Europe chose the evidence to review, according to the commission itself. Thus, nearly every report the commission’s eventual opinion referenced came from studies that were never published or peer-reviewed and, in the majority of cases, were performed by companies or industry groups linked to the manufacturing of DHA. The industry left out nearly all of the peer-reviewed studies published in publicly available scientific journals that identified DHA as a potential mutagen. A study by scientists from the Department of Dermatology, Bispebjerg Hospital, published in Mutation Research has concluded DHA ‘induces DNA damage, cell-cycle block and apoptosis’ in cultured cells.^[28]

Tyrosine-based products[edit]

Tanning accelerators—lotions or pills^[13] that usually contain the amino acid tyrosine—claim that they stimulate and increase melanin formation, thereby accelerating the tanning process. These are used in conjunction with UV exposure. At this time, there is no scientific data available to support these claims.

Melanotan hormone[edit]

Afamelanotide, a synthetic melanocyte-stimulating hormone analog, which induces melanogenesis through activation of the melanocortin 1 receptor, is another alternative on the horizon. A 1991 clinical Investigational new drug trial conducted at the Department of Internal Medicine, University of Arizona Health Sciences Center with afamelanotide (then known by its amino acid formula [Nle⁴, D-Phe⁷] (NDP)-alpha-melanocyte-stimulating hormone) with 28, “healthy white men” who used a, “high-potency sunscreen during the trial” and concluded, “Human skin darkens as a response to a synthetic melanotropin given by subcutaneous injection. Skin tanning appears possible without potentially harmful exposure to ultraviolet radiation.” ^[29]

Afamelanotide in a subcutaneous implant form is currently undergoing clinical trials and being developed by a company in Australia.

Other melanogenesis stimulants[edit]

Vitamin D metabolites, retinoids, melanocyte-stimulating hormone, forskolin, isobutylmethylxanthine, diacylglycerol analogues, and even cholera toxin, all stimulate the production of melanin. 9-cis retinoic acid is a potential treatment for vitiligo.^[30]

Forskolin is a natural compound that has been shown to create a natural tan by stimulating melanin production in mice. It is derived from the root of the Indian Coleus, from the foothils of the Himalaya.^[31][32]

Temporary bronzers[edit]

Bronzers are a temporary sunless tanning or bronzing option. These come in powders, sprays, mousse, gels, lotions and moisturizers. Once applied, they create a tan that can easily be removed with soap and water. Like make-up, these products tint or stain a person’s skin only until they are washed off.

They are often used for “one-day” only tans, or to complement a DHA-based sunless tan. Many formulations are available, and some have limited sweat or light water resistance. If applied under clothing, or where fabric and skin edges meet, most will create some light but visible rub-off. Dark clothing prevents the rub-off from being noticeable. While these products are much safer than tanning beds, the color produced can sometimes look orangey and splotchy if applied incorrectly.

A recent trend is that of lotions or moisturizers containing a gradual tanning agent. A slight increase in color is usually observable after the first use, but color will continue to darken the more the product is used.

Air brush tanning is a spray on tan performed by a professional. An air brush tan can last five to ten days and will fade when the skin is washed. It is used for special occasions or to get a quick dark tan. At-home airbrush tanning kits and aerosol mists are also available.

Risks[edit]

Since the coloration that forms does not provide much protection against UV, and the effect only lasts for a few hours,^[33] tanners usually contain a sunscreen. The ingredients known to offer appropriate protection are titanium dioxide, zinc oxide, or avobenzone.^[34] However, when avobenzone is irradiated with UVA light, it generates a triplet excited state in the keto form which can either cause the avobenzone to degrade or transfer energy to biological targets and cause deleterious effects.^[35] It has been shown to degrade significantly in light, resulting in less protection over time.^[36][37][38] The UV-A light in a day of sunlight in a temperate climate is sufficient to break down most of the compound. Data presented to the Food and Drug Administration by the Cosmetic, Toiletry and Fragrance Association indicates a -36% change in avobenzone’s UV absorbance following one hour of exposure to sunlight.^[39]

If avobenzone-containing sunscreen is applied on top of tanner, the photosensitizer effect magnifies the free-radical damage promoted by DHA, as DHA may make the skin especially susceptible to free-radical damage from sunlight, according to a 2007 study led by Katinka Jung of the Gematria Test Lab in Berlin.^[16] Forty minutes after the researchers treated skin samples with 20% DHA they found that more than 180 percent additional free radicals formed during sun exposure compared with untreated skin.

September 2012 also saw a surge in debate within the United Kingdom regarding the inhalation of DHA through spray tanning. While the quantities inhaled would have to be considerably higher than an average consumer or even spray tan technician would be exposed to,^{[citation needed]} press coverage on the issue has resulted in increased consumer diligence with regard to the level of DHA and other ingredients in their spray tanning products, and a move toward more naturally-derived spray tan solutions. An EU Directive published by the Scientific Committee of Consumer Safety to eventually limit DHA content of spray tan products to 14% has also been cited within this discussion. Risks of inhaling or ingesting DHA are not known. People are advised to close their eyes or protect them with goggles and to hold their breath or wear nose plugs while they have a spray-on tanning applied.

In the report released to ABC News, FDA scientists concluded that DHA does not stop at the outer dead layers of skin. They wrote: “The fate of DHA remaining in skin is an important issue, since high DHA skin levels were found.” They added that tests they performed revealed that much of the DHA applied to skin actually ended up in the living layers of skin. They concluded: “This leaves about 11 percent of the applied DHA dose absorbed remaining in the [living] epidermis and dermis.” Any absorption into the living areas of the skin could be pose a potential risk, even if none of it made it into the bloodstream, said Dr. Darrell Rigel, an NYU professor of dermatology. The fact that some does potentially get into the bloodstream raised additional red flags for him that he said needed to be further explored. Rigel was especially concerned for repeated users of the product and those in higher-risk groups such as pregnant women or young children. “What you showed me certainly leads me to say I have to rethink what I’m doing and what I’m saying because there’s … a real potential problem there,” he said. “I feel that I must give my patients the information that you’ve given to me, because I think it is valid.” Before he read all of the papers, Rigel said, he would “tell my patients what every other dermatologist tells them: ‘If you want to be tanned, [tanning with DHA] is effective, it’s not being absorbed and there’s no long-term problems.’ After reading these papers, I’m not sure that’s true anymore.”^[40] [41]

A toxicologist and lung specialist at the University of Pennsylvania’s Perelman School of Medicine (Dr. Rey Panettieri) has commented, “The reason I’m concerned is the deposition of the tanning agents into the lungs could really facilitate or aid systemic absorption — that is, getting into the bloodstream. These compounds in some cells could actually promote the development of cancers or malignancies, and if that’s the case then we need to be wary of them.”^[42] A study by scientists from the Department of Dermatology, Bispebjerg Hospital, published in Mutation Research has concluded DHA ‘induces DNA damage, cell-cycle block and apoptosis’ in cultured cells.^[28]

Many self tanners use chemical fragrances which may cause skin allergies or may trigger asthma. Furthermore, some of them contain parabens. Parabens are preservatives that can affect the endocrine system.^[25]

Tanners can stain clothes. It is therefore important to look for fast drying formulas and wait around 10 to 15 minutes for the product to dry before dressing.