Dangers of indoor tanning

Indoor tanning use 

  • On an average day in the United States, more than 1 million people tan in tanning salons.1
    • Thirty-five percent of American adults, 59 percent of college students, and 17 percent of teens have reported using a tanning bed in their lifetime.2
  • Nearly 30 million people tan indoors in the United States annually. Of these, 2.3 million are teens.3,4
  • More than 70 percent of tanning salon patrons are Caucasian girls and women, primarily aged 16 to 29 years.5
  • The indoor tanning industry’s revenue was estimated to be $2.6 billion in 2010.6

Risks of indoor tanning

  • The United States Department of Health and Human Services and the World Health Organization's (WHO) International Agency of Research on Cancer panel has declared ultraviolet (UV) radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known carcinogen (cancer-causing substance).7
  • Indoor tanning equipment, which includes all artificial light sources, including beds, lamps, bulbs, booths, etc., emits UVA and UVB radiation. The amount of the radiation produced during indoor tanning is similar to the sun, and in some cases might be stronger.8,9 
  • Evidence from several studies has shown that exposure to UV radiation from indoor tanning devices is associated with an increased risk of melanoma and nonmelanoma skin cancer (NMSC), including squamous cell carcinoma and basal cell carcinoma.1,5,11,14
    • Each year, more than 419,000 cases of skin cancer, including both melanoma and NMSC, in the U.S. are linked to indoor tanning.2
  • Studies have found a 59 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning, and the risk increases with each use.10-13
    • Research demonstrates that even people who do not burn after indoor tanning or sun exposure are at an increased risk of melanoma if they tan indoors.15
  • Even one indoor tanning session can increase users’ risk of developing squamous cell carcinoma by 67 percent and basal cell carcinoma by 29 percent.16
    • Indoor tanning before age 24 increases one’s risk of developing basal cell carcinoma by age 50.17
  • Studies have demonstrated that exposure to UV radiation during indoor tanning damages the DNA in the skin cells. Excessive exposure to UV radiation during indoor tanning can lead to premature skin aging, immune suppression, and eye damage, including cataracts and ocular melanoma. 1,18-21
    • A recent investigation estimated that 3,234 injuries related to indoor tanning — including burns, loss of consciousness and eye injuries — were treated in U.S. hospital emergency departments every year from 2003 to 2012.22 
  • In addition to the above-mentioned risks, frequent, intentional exposure to UV light may lead to tanning addiction.23
  • Indoor tanning beds/lamps should be avoided and should not be used to obtain vitamin D because UV radiation from indoor tanning is a risk factor for skin cancer. Vitamin D can be obtained by a eating a healthy diet and by taking oral supplements.

Legislation and regulations

  • The U.S. Food and Drug Administration has issued a final order that strengthens regulations on indoor tanning devices through:
    • A strong recommendation against the use of tanning beds by minors under 18.
    • The reclassification of indoor tanning devices from a Class I to a Class II medical device.
    • Labeling that clearly communicates the risk of skin cancer to all users.
  • California, Delaware, Hawaii, Illinois, Louisiana, Minnesota, Nevada, Texas and Vermont have passed laws that prohibit minors under the age of 18 from indoor tanning.
  • Oregon and Washington have passed laws prohibiting minors under the age of 18 years old from using indoor tanning devices, unless a prescription is provided.
  • Connecticut, New Jersey and New York have passed legislation banning minors under the age of 17 from using tanning devices.

Academy position statement about indoor tanning

  • The American Academy of Dermatology Association (AADA) opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for nonmedical purposes.
  • The American Academy of Dermatology supports the WHO recommendation that minors should not use indoor tanning equipment because indoor tanning devices emit UVA and UVB radiation, and because overexposure to UV radiation can lead to the development of skin cancer.
  • Unless and until the FDA bans the sale and use of indoor tanning equipment for nonmedical purposes, the Academy supports restrictions for indoor tanning facilities, including:
    • No person or facility should advertise the use of any UVA or UVB tanning device using wording such as “safe,” “safe tanning,” “no harmful rays,” “no adverse effect,” or similar wording or concepts.

Learn more about the dangers of indoor tanning:

1 Whitmore SE, Morison, WL, Potten CS, Chadwick C. Tanning salon exposure and molecular alterations. J Am Acad Dermatol 2001;44:775-80.
2 Wehner MR, Chren M, Nameth D, et al. International Prevalence of Indoor Tanning: A Systematic Review and Meta-analysis.JAMA Dermatol. 2014;():. doi:10.1001/jamadermatol.2013.6896.
3 Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE. Promotion of frequent tanning sessions by indoor tanning facilities: two studies. J Am Acad Dermatol 2002;46:700-5.
4 Dellavalle RP, Parker ER, Ceronsky N, Hester EJ, Hemme B, Burkhardt DL, et al. Youth access laws: in the dark at the tanning parlor? Arch Dermatol 2003;139:443-8.
5 Swerdlow AJ, Weinstock MA. Do tanning lamps cause melanoma? An epidemiologic assessment. J Am Acad Dermatol 1998;38:89-98.
6 ”Tanning Salons in the US: 81219c.” IBISWorld Industry Report. 2009 August 7.
7 U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on carcinogens, 11th ed: Exposure to sunlamps or sunbeds.
8 Hornung RL, Magee KH, Lee WJ, Hansen LA, Hsieh YC. Tanning facility use: are we exceeding the Food and Drug Administration limits? J AM Acad Dermatol. 2003 Oct;49(4):655-61.
9 Miller, SA, Hamilton, SL, Wester, UG, Cyr, WH. An analysis of UVA emissions from sunlamps and the potential importance for melanoma.Photochem Photobiol 68(1998), 63-70.
10 Lazovich, D, et al. "Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population." Cancer Epidemiol Biomarkers Prev. 2010 June;19(6):1557-1568.
11 The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer "The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review.” International Journal of Cancer. 2007 March 1;120:111-1122.
12 Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. British Medical Journal 2012;345:e4757.
13 Corrections: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. British Medical Journal 2012;345:e8503.
14 Karagas M, et al. "Use of tanning devices and risk of basal cell and squamous cell skin cancers.” Journal of the National Cancer Institute. 2002 February 6;94(3):224-6.
15 Vogel RI, Ahmed RL, Nelson HH, Berwick M, Weinstock MA, Lazovich D. Exposure to indoor tanning without burning and melanoma risk by sunburn history. J Natl Cancer Inst. 2014 Jul 16;106(7). pii: dju219. doi: 10.1093/jnci/dju219.
16 Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and
non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct
2;345:e5909.
17 Karagas MR, et al. Early-onset basal cell carcinoma and indoor tanning: a population-based study. Pediatrics. 2014 Jul;134(1):e4-12. doi: 10.1542/peds.2013-3559.
18 Piepkorn M. Melanoma genetics: an update with focus on the CDKN2A(p16)/ARF tumor suppressors. J Am Acad Dermatol. 2000 May;42(5 Pt 1):705-22; quiz 723-6.
19 Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken JF, Giles GG, Armstrong BK. Artificial ultraviolet radiation and ocular melanoma in Australia. Int J Cancer. 2004 Dec 10;112(5):896-900.
20 Walters BL, Kelly TM. Commercial tanning facilities:a new source of eye injury. Am J Emerg Med 1987;120:767-77.
21 Clingen PH, Berneburg M, Petit-Frere C, Woollons A, Lowe JE, Arlett CF, Green MH. Contrasting effects of an ultraviolet B and an ultraviolet A tanning lamp on interleukin-6, tumour necrosis factor-alpha and intercellular adhesion molecule-1 expression. Br J Dermatol. 2001 Jul;145(1):54-62.
22 Guy G, Watson M, Haileyesus T, Annest J. Indoor tanning-related injuries in a national sample of US hospital emergency departments. JAMA Intern Med. Published online December 15, 2014.
23 Fisher DE , James WD. Indoor tanning--science, behavior, and policy. N Engl J Med 2010;363:901-3.

 

 

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