The Risks of Tanning

At this year's Oscars actress Anne Hathaway stood out not just because of her gorgeous red Marchesa gown but because of the creamy pale skin she wore under it. If her decision to appear sans tan was an attempt to send a signal that tanning is losing its glamorous glow, her timing couldn't be better, dermatologists say.

This is just the time of year when the temptation to hit a tanning salon is highest, particularly for women, who make up an estimated 70 percent of tanning customers. With prom and wedding season around the corner, and beach weekends not far off, a lot of women think they need some "healthy color" to look their best. But dermatologists say that there is no such thing as a healthy "real" tan. "A tan is essentially an injury to the skin," says Dr. Henry Lim, chairman of the department of dermatology at the Henry Ford Hospital in Detroit. "Tanning is just a reaction by the skin to try and protect itself."

While most people know they have to slather on sunscreen (SPF15 or above) whenever they're in the sun for more than a few minutes, there's a lot of confusion about the relative merits and risks of tanning salons. Promoters say tanning machines are healthy because they emit mostly ultraviolet A (UVA) rays and just 5 percent UVB rays, which cause most sunburns. But dermatologists say there's a growing stack of research that UVA rays are more damaging than originally thought. The UVA rays generated by tanning beds penetrate much deeper into the skin than the sun does, says Lim. For people concerned about their skin's appearance, that's a big problem, since most prematurely wrinkled, spotted and leathery skin can be blamed on exposure to ultraviolet radiation.

More worrisome is the increased risk of skin cancer associated with UV rays. Sunburns have long been associated with skin cancer, and Dr. Scott Fosko, chairman of dermatology at St. Louis University School of Medicine, says people can get burned in tanning salons as well as from the sun. "The tanning industry says tanning beds are a safe way to get a tan, but I see a lot of people who use tanning beds who get burned," he says. "They are not foolproof." Those with the lightest skin need to be the most careful.

But even if you don't get burned, skin experts say UVA rays' deep penetration into the skin causes genetic damage and increases the risk of squamous-cell, basal-cell and malignant melanoma, the most serious type of skin cancer. Dermatologists are particularly distressed at the growing number of younger people developing melanoma and other skin cancers. A recent review of skin cancer studies, conducted by the International Agency for Research on Cancer, concluded that people under 35 who use tanning beds increase their risk of developing melanoma by 75 percent. Meanwhile, the Indoor Tanning Association countered this unfavorable news by launching a media blitz in March accusing dermatologists of fearmongering and stressing the positive benefits of sun exposure, including the natural production of vitamin D. Their new Web site, also launched in March, goes as far as to say "there is no compelling evidence that UV exposure causes melanoma."

Many people start using tanning beds when they're teenagers, researchers say. A 2003 study done at Case Western Reserve University found that nearly 40 percent of white American teens have used a tanning bed at least once, and 47 percent of 18- and 19-year-olds say they've used them repeatedly. "A lot of these places set up shop close to schools and place ads in the school newspapers," Fosko says. That's one reason most states have instituted age restrictions and some now require parental permission or presence on site. This type of regulation has limited effect, however. Not only is enforcement spotty, Fosko says research indicates that many kids get hooked on tanning because their parents are regular customers.

More government restrictions may be coming soon. While tanning equipment is currently required to have warning labels, Congress last year passed the TAN Act, which directed the Food and Drug Administration to determine what changes, if any, need to be made to sunbeds' warning labels to make them more noticeable, accurate and understandable to consumers. The report is due in this September.

For those who want the look without the risk, dermatologists recommend self-tanning products containing dihydroxyacetone (DHA) as a safer alternative to real tans. These products simply stain the top layer of skin; there's no real change at the cellular level. While the first generation of these products made the skin look more orange than tan, the quality of the cosmetic effect has improved in recent years, and now the difference is harder to detect. "These products are not dangerous, but they do give you that tan glow," says Dr. Diane Berson, a dermatologist who practices in New York City. She says if you do a good job of exfoliating your skin before applying these products, you'll "get a natural look without any streaking." Some manufacturers combine a moisturizer with a self-tanner so you can accomplish two things at once. While the resulting "tan" will eventually wash or flake off, you can maintain the look by reapplying the cream every couple of days, as directed on the container.

It's important to understand, however, that these bottle tans are only cosmetic. That means you don't have the kind of "base tan" that offers a little protection against sunburn. Those whose skin is naturally pale are as vulnerable to burns as they were before their skin turned artificially darker. You'll need to regularly apply sunscreen (15 SPF or higher) every couple of hours, anytime you go out in the sun.

What remains unclear, adds Lim, is whether spray-on tans (which are also offered by many tanning bed salons) are themselves completely safe. "We don't have data that says whether aerosol sprays, if inhaled, would cause any harm," he said. "The presumption is that they are safe, but we have no data at this point." Doctors also warn against so-called tanning pills, which are illegal for sale in the U.S. but can often be found on the Internet.

Dermatologists are hoping that those who prefer a tan will at least try to achieve the look without doing long-term damage to their skin. "If you look at the older movie stars," Berson says, "you'll see that the ones who still look great are the ones who stayed out of the sun and didn't allow their skin to get tan, dry and wrinkled." So if you want to look like a movie star, why not try to look like one of the smart ones.