Tanning salon exposure and molecular alterations

doi:10.1067/mjd.2001.112581

Journal of the American Academy of Dermatology

Volume 44, Issue 5, May 2001, Pages 775-780

https://doi.org/10.1067/mjd.2001.112581 Get rights and content

Abstract

Background: Human studies of the short-term cellular effects of tanning salon exposures are lacking. Findings of such studies may prove extremely helpful in educating consumers considering or currently attending tanning salons. Objective: Our purpose was to determine whether tanning salon exposure causes DNA alterations and p53 protein expression in epidermal keratinocytes and/or circulating peripheral lymphocytes. Methods: Eleven subjects received 10 full-body tanning salon exposures over a 2-week period. UV-induced DNA cyclobutane pyrimidine dimers and p53 protein expression were examined, comparing pretreatment peripheral blood lymphocytes and epidermal biopsy specimens with analogous specimens obtained after the 10 tanning salon exposures. Results: Cyclobutane pyrimidine dimers in DNA and p53 protein expression were detected in epidermal keratinocytes, but were absent in lymphocytes. Conclusion: Similar to outdoor sun exposure, short-term recreational tanning salon exposure causes molecular alterations believed essential in the development of skin cancer. (J Am Acad Dermatol 2001;44:775-80.)

Section snippets

Material and methods

To avoid the potential confounding effects of casual outdoor sunlight exposure, this investigation was performed in the spring. Subject inclusion criteria included age between 18 and 50 years, good general health, Fitzpatrick skin type II or III, nongravid and non-breast-feeding state, and willingness to use contraception throughout the study. Exclusion criteria included dysplastic nevi, history of malignancy, connective tissue disease or any type of photosensitivity, use of systemic or topical

Results

Eleven subjects were recruited and completed the study as planned. The average age of subjects was 38 years (standard deviation [SD], 8.2 years); 4 were males; 10 had Fitzpatrick skin type II and one had skin type III. As outlined in the Methods section, the UV dose was increased by 20% per treatment to a maximum of 2 times the initial dose. Although no subjects had erythema in the 24 hours after the first exposure, on the subsequent 9 exposures all subjects had at least one episode of mild

Discussion

Epidemiologic studies and case reports have cited an increased risk of potentially fatal melanoma in persons frequenting tanning salons.8, 9, 10, 11, 12, 13, 14, 15, 16 Experimental animal studies have supported the role of tanning salon—type radiation sources in cutaneous carcinogenesis.17, 18, 19 Despite these studies and concerns regarding other tanning salon—associated morbidities, regulation of this $2 billion industry in the United States is spotty, with only 21 states having regulatory

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Cited by (72)

Indoor tanning and skin cancer in Canada: A meta-analysis and attributable burden estimation
2019, Cancer Epidemiology
Citation Excerpt :
Indoor tanning is similar to sun exposure for ultraviolet B (UVB) radiation exposure, but is 10–15 times stronger than sun exposure for ultraviolet A (UVA) radiation [6]. With longer wavelengths than UVB radiation, UVA rays penetrate more deeply into the skin than UVB, and can cause mutations in tumor suppressor genes or other oncogenes, both directly through DNA damage and indirectly through oxidative stress [7]. Moreover, UVA has been shown to be relatively ineffective at inducing pigmentation changes that can attenuate the potentially damaging effects of future exposure to UVR, as UVB does [8].
Consistent epidemiologic and experimental studies have demonstrated that UV-emitting tanning devices cause melanoma and non-melanoma skin cancer. The purpose of this study was to estimate the relative risk of skin cancer associated with the use of indoor tanning devices relevant to Canada, to estimate the proportion and number of skin cancers in Canada in 2015 that were attributable to indoor tanning, and to explore differences by age and sex.
Skin cancer cases attributable to the use of an indoor tanning devices were estimated using Levin’s population attributable risk (PAR) formula. Relative risks for skin cancer subtypes that were relevant to Canada were estimated through meta-analyses and prevalence of indoor tanning was estimated from the 2006 National Sun Survey. Age- and sex-specific melanoma data for 2015 were obtained from the Canadian Cancer Registry, while estimated NMSC incidence data were obtained from the 2015 Canadian Cancer Statistics report.
Ever use of indoor tanning devices was associated with relative risks of 1.38 (95% CI 1.22–1.58) for melanoma, 1.39 (1.10–1.76) for basal cell carcinoma (BCC), and 1.49 (1.23–1.80) for squamous cell carcinoma (SCC). Overall, 7.0% of melanomas, 5.2% of BCCs, and 7.5% of SCCs in 2015 were attributable to ever of indoor tanning devices. PARs were higher for women and decreased with age.
Indoor tanning contributes to a considerable burden of skin cancer in Canada. Strategies aimed at reducing use should be increased and a total ban or restrictions on use and UV-intensity should be considered by health regulators.
Tanning bed use and melanoma: Establishing risk and improving prevention interventions
2016, Preventive Medicine Reports
Citation Excerpt :
Exposure to UVR from indoor tanning devices has been shown to cause DNA damage in skin cells, and is associated with an increased risk of developing melanoma, and squamous and basal cell carcinomas (Whitmore et al., 2001; The International Agency for Research on Cancer Working Group on Artificial Ultraviolet I SC, 2006; Karagas et al., 2002). Indoor tanning has also been associated with accelerated skin aging, ocular melanoma, immune suppression, and skin burns (Whitmore et al., 2001; Piepkorn, 2000; Vajdic et al., 2004; Walters and Kelley, 1987; Clingen et al., 2001; Cokkinides et al., 2009). Due to variation in the intensity and UV wavelength emitted by indoor tanning devices, consistent regulation of their use is paramount.
Exposure to ultraviolet radiation (UVR) from indoor tanning devices is thought to cause melanoma and other negative health consequences. Despite these findings, the practice of indoor tanning in the United States remains prevalent. In this paper we aim to present a clear discussion of the relationship between indoor tanning and melanoma risk, and to identify potential strategies for effective melanoma prevention by addressing indoor tanning device use.
We reviewed relevant literature on the risks of indoor tanning, current indoor tanning legislation, and trends in indoor tanning and melanoma incidence. Study was conducted at the University of Southern California, Los Angeles, CA between the years of 2014 and 2015.
Our findings reaffirm the relationship between indoor tanning and melanoma risk, and suggest a widespread public misunderstanding of the negative effects of indoor tanning.
This review argues for an aggressive initiative to reduce indoor tanning in the United States, to design prevention efforts tailored towards specific high risk groups, and the need to better inform the public of the risks of indoor tanning.
Ultra-violet indoor tanning addiction: A reinforcer pathology interpretation
2015, Addictive Behaviors
Citation Excerpt :
More than 1,000,000 Americans will expose their skin to dangerous levels of ultra-violet radiation via ultra-violet indoor tanning (UVIT) in the next 24 h (Whitmore, Morison, Potten, & Chadwick, 2001), with nearly 30,000,000 Americans engaging in UVIT over the course of the year (Kwon et al., 2002).
Ultra-violet indoor tanning (UVIT) is a pervasive issue that is increasing at record rates, despite obvious and well-publicized links to skin cancer. Recent studies on UVIT have found that frequent users face difficulty quitting and report symptomatology similar to substance-related disorders, causing the medical field to begin classifying excessive UVIT use as an addicting behavior. Despite calls for research, relatively little behavioral research has been aimed at determining the psychology of UVIT. This mini-review reinterprets the existing dermatology literature in light of the reinforcer pathology model of addiction. The relevancy of this model, in conjunction with the similarities between UVIT addiction and other substance-related addiction, suggests that behavioral economic research on UVIT is overdue. This mini-review concludes with directions for future research in this area.
Tanning accelerators: Prevalence, predictors of use, and adverse effects
2015, Journal of the American Academy of Dermatology
Tanning accelerators are topical products used by indoor tanners to augment and hasten the tanning process. These products contain tyrosine, psoralens, and/or other chemicals.
We sought to better define the population using accelerators, identify predictors of their use, and describe any related adverse effects.
This cross-sectional study surveyed 200 indoor tanners about their tanning practices and accelerator use. Primary analysis compared accelerator users with nonusers with respect to questionnaire variables. Descriptive statistics and χ² contingency tables were applied to identify statistically significant variables.
Of respondents, 53% used accelerators; 97% were female and 3% were male with a median age of 22 years (range: 19-67). Users were more likely to spray tan, tan frequently, and be addicted to tanning. Acne and rashes were more common in accelerator users. Adverse reactions to accelerators prevented their further use 31% of the time.
A limited adult population was evaluated; exact accelerator ingredients were not examined.
Tanning accelerator users are high-risk indoor tanners who tan more frequently and who are more likely addicted to tanning. Acne and rashes are more common with these products and act as only mild deterrents to continued use. Additional research should investigate accelerators' longer-term health effects.
Tanning lamps: Health effects and reclassification by the Food and Drug Administration
2015, Journal of the American Academy of Dermatology
Tanning lamps have long been considered a class I medical device under regulation by the Food and Drug Administration (FDA). A growing body of research has repeatedly documented the association between elective indoor tanning and several negative health consequences. These accepted findings have prompted action by the FDA to officially reclassify tanning lamps as a class II medical device. The main purpose of this review is to update practitioners on the current state of tanning lamp classification and highlight the practical implications of this recent change. This information can be used by clinicians to easily reference this important action, and empower patients with a better understanding of the risks associated with indoor tanning.
Tanning beds: Impact on health, and recent regulations
2016, Clinics in Dermatology
As the use of indoor tanning beds gained popularity in the decades after their appearance in the market in the early 1970s, concerns arose regarding their use. Clinical research has revealed an association between indoor tanning and several health risks, including the subsequent occurrence of melanoma and nonmelanoma skin cancers, the development of psychologic dependence, and a tendency toward other high-risk health behaviors. In the face of mounting evidence, legislation has been passed, which includes the restriction of access to tanning beds by minors in 42 states and the District of Columbia, and the recent reclassification by the Food and Drug Administration, which now categorizes tanning beds as class II devices and worthy of restrictions and oversight. Early evidence suggests that these labors are resulting in cultural change, although continued efforts are necessary to limit further exposure and better inform the public of the dangers associated with indoor tanning use.

View all citing articles on Scopus

^☆: Supported by the Dermatology Foundation Clinical Career Development Award sponsored by Ortho Dermatological and by the American Cancer Society Institutional Research Grant, #1RG11-35.

^☆☆: Reprint requests: S. Elizabeth Whitmore, MD, Department of Dermatology, 550 N Broadway, Suite 1002, Baltimore, MD 21205.

^★: J Am Acad Dermatol 2001;44:775-80.

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ReportsTanning salon exposure and molecular alterations☆,☆☆,★

Abstract

Section snippets

Material and methods

Results

Discussion

J Am Acad Dermatol

J Photochem Photobiol

J Invest Dermatol

J Invest Dermatol

Lancet

Population UV-dose and skin area—do sunbeds rival the sun?

Health Phys

The 0.8% ultraviolet B content of an ultraviolet A sunlamp induces 75% of cyclobutane pyrimidine dimers in human keratinocytes in vitro

Br J Dermatol

Sunlight and sunburn in human skin cancer: p53, apoptosis, and tumor promotion

J Invest Dermatol Symp Proc

DNA damage in UV-irradiated human skin in vivo: automated direct measurement by image analysis (thymine dimers) compared with indirect measurement (unscheduled DNA synthesis) and protection by 5-methoxy-psoralen

Int J Radiat Biol

Isolation of mononuclear cells and granulocytes from human blood

Scan J Clin Lab Invest

Cutaneous malignant melanoma and exposure to sunlamps or sunbeds: an EORTC multicenter case-control study in Belgium, France, and Germany

Int J Can

Cutaneous malignant melanoma and exposure to sunlamps and sunbeds: a descriptive study in Belgium

Melanoma Res

Malignant melanoma caused by UV-A suntan bed?

Acta Derm Venereol (Stockh)

UVA induced melanocytic lesions

Br J Dermatol

Reports
Tanning salon exposure and molecular alterations☆,☆☆,★