Question: Is there such a thing as a healthy tan?
Fashion and Fiction…
Decades of research and hundreds of thousands of skin cancer-related deaths have shown that there is no such thing as a “healthy tan.” Followers of the fashion trends of the past endured bleeding themselves into anemia and poisoning from lead-based cosmetics and arsenic ingestion in order to obtain the palest skin possible; in the 20th century as the tan was redefined to represent health and a life of leisure rather than day labor outdoors, the same devotees began enduring blistering sunburns and dying of cancer in their twenties.
As a medical student helping out with a research study, I spent a few weeks in the waiting rooms of some tanning salons, surveying patrons about their tanning habits and why they liked to tan. The tanning salon staff who had allowed me to survey their patrons also offered me their “educational materials” about the benefits of tanning and explained to me how doctors overly exaggerated the dangers of UV exposure, how there was no risk associated with having a “healthy tan,” and that tanning was actually the cure for many health problems. Years later, I remember that experience when my patients ask how much UV exposure is healthy amount, and am not surprised that it could be confusing and hard to find accurate answers outside the doctor’s office, especially when faced with advertising and claims in the media sponsored by the indoor tanning industry, which in the United States alone is a 5 billion dollar per year industry. (Please refer to U. S. HOUSE OF REPRESENTATIVES Investigative Report: False and Misleading Health Information Provided to Teens by the Indoor Tanning Industry: http://democrats.energycommerce.house.gov/sites/default/files/documents/False-Health-Info-by-Indoor-Tanning-Industry-2012-2-1.pdf).
In fact “health tan” is actually an oxymoron as a tan itself is a sign of DNA damage. Dr. David Fisher, Chairman of the MGH Department of Dermatology, and his research team have shown that tanning is a protective response in the skin that is turned on when a person’s DNA is being damaged by ultraviolet (UV) radiation, and that having tan is sign that DNA in skin cells has already been damaged. The body has systems in place that can repair DNA damage to a certain extent. However, when skin is continually exposed to UV radiation, the DNA of skin cells eventually build up enough damage that pre-cancers and skin cancers are formed. It is for this reason that the FDA, the American Cancer Society, the World Health Organization (WHO), and the International Agency for Research on Cancer (IARC) have all classified UV radiation as a known cause of cancer in humans (http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-039643-pdf.pdf).
According to the American Academy of Dermatology, the risk of melanoma, the deadliest type of skin cancer, increases by 75% for those who have been exposed to UV radiation from a tanning bed and the risk increases with each use. Last year the FDA proposed to require that tanning beds display a warning label designed to warn young people about their dangers (http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm350864.htm).
Tannorexia the Addiction…
In recent years scientific evidence has also been found that tanning can improve a person’s mood and even become addictive. Dr. Fisher’s research team has also shown that the tanning process in the skin releases a type of endorphin, signaling molecules in the body that also rise when people exercise, listen to music or eat chocolate. These molecules bind to nerves in the skin and the brain and have the effect of relieving pain and promoting a sensation of happiness and wellbeing.
This could explain why many people who frequently tan have reported in research studies the same answer given on the news by the infamous “tanning mom” who repeatedly sunburned her skin in tanning salons – that they “need to do it” in order “to feel good.”
Related Media Coverage on these findings of the addictive nature of UV radiation/tanning:
Why is sunning like addiction? Study could explain – Today Show: http://www.today.com/video/today/55461718#55461718
MGH Researchers Discover UV Radiation May Be Addictive – CBS Boston, WBZ-4 HealthWatch: http://boston.cbslocal.com/2014/07/09/mgh-researchers-discover-uv-radiation-may-be-addictive/
The Evolution of Sun-seeking – No Longer a Fit Trait…
One theory is that at an earlier stage in human civilization, when people on average did not live long enough to develop skin cancer and when malnutrition and vitamin deficiencies were a bigger problem for most, sun-seeking behavior helped people ensure that they got enough vitamin D, which can be obtained from sun exposure and is necessary for the normal growth and development of bones among other processes in the body.
Nowadays a person can get vitamin D from various dietary sources including: fish, eggs, diary products, fortified cereals, and vitamin D supplements (600 – 800 International Units per day for adults and 400 IU/day for children is recommended by the National Institutes of Health – http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/).
Depending on a person’s skin type and location with respect to the equator, the effect of sunlight for the body’s production of vitamin D can be highly variable. For example the same amount of sun exposure in Boston would not yield as much vitamin D production from sunlight as it would in Miami, and even standing in the same location two different individuals would produce different amounts of vitamin D depending on their skin types. This was seen in research study on surfers in Hawaii, who all had tanned skin and spent 15-30 hours per week in the sun and among whom over 50% were found to be vitamin D deficient. Thus dietary sources are a much more reliable means of getting vitamin D and also much safer, since they do not increase the risk of skin cancer.
From Bleached to Baked to…Balanced and Benificial
As a dermatologist, I don’t expect everyone to practice a vampire-style vigilance of sun protection and avoidance. The concept is really about avoiding major and known sources of skin damage – tanning beds, sunburns, etc., and to think about prevention of skin cancer in the long run. For a civilization whose life expectancy has jumped from dying in one’s 30’s to living into one’s 90’s in a relatively short amount of time, our approach and habits need to be mindful of preventing cancer in the context of that kind of longevity. I encourage my patients who are physically active and enjoy outdoor sports and nature – I just want them to remember that there is a way to keep their skin healthy and prevent cancer while doing so.
- Choose a sunscreen that is SPF 30 or higher with Broad Spectrum UVA, UVB protection.
- SPF 50 or higher is better for fairer skin types or for intense sun exposure for example the
beach or high altitudes.
- Seek shade or stay indoors between 10am-4pm when UV exposure is the most intense.
- Wear sun protective hats and clothing that contain UPF (Ultraviolet Protection Factor), which is sun
protective fabric, the equivalent of sunblock. UPF hats and clothing are available in many stores and online.
In terms of sunblock, there are two main categories: physical vs. chemical types. For those with sensitive skin, a physical sunblock (containing zinc or titanium as active ingredients) may be preferable to products with chemical sunscreens as the active ingredients, as physical types of sunblock are less likely to cause allergies, are considered safer and preferable for children. Physical sunscreens also tend to be more effective at blocking a wider range of UV rays.
So as you enjoy the outdoors, the Cape and a little more sunshine, I hope you will also remember your hat, sunglasses, sunblock, and most importantly, moderation.
1. Tsoureli-Nikita E, Watson RE, Griffiths CE. Photoageing: the darker side of the sun. Photochem Photobiol Sci 2006; 5(2):160-4.
2. National Cancer Institute. SEER Stat Fact Sheets: Melanoma of the Skin. http://seer.cancer.gov/statfacts/html/melan.html. Last updated Nov. 10, 2011. Accessed Feb. 23, 2012.
3. Levine JA, Sorace M, Spencer J, Siegel DM. The indoor UV tanning industry: a review of skin cancer risk, health benefit claims, and regulation. J Am Acad Dermatol 2005; 53 (6):1038-44.
4. American Academy of Dermatology. Research shows popularity of indoor tanning contributes to increased incidence of skin cancer. PRNewswire. http://www.prnewswire.com/news-releases/research-shows-popularity-of-indoor-tanning
-contributes-to-increased-incidence-of-skin-cancer-53497177.html Jan. 12, 2006.
5. Binkley N, Novotny R, Krueger D, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 92(6):2130-5 (2007 Jun).