A pilot study of genetic variants in dopamine regulators with indoor tanning and melanoma

Many people frequently tan indoors despite being aware of the increased risk of melanoma. Ultraviolet radiation is hypothesized to modify biological reward pathways, for example, through the dopamine neurotransmitter system, to reinforce tanning behaviour. In this pilot study, we relied on questionnaire and DNA data from a recently completed case–control study to examine 67 single‐nucleotide polymorphisms (SNPs) and related haplotypes in five dopamine receptor and drug metabolism genes in relation to indoor tanning among controls. We also examined the association between individual SNPS and likelihood of melanoma, adjusting for or stratifying on indoor tanning status. In candidate and haplotype gene analyses, variants only in the DRD2 dopamine receptor and ANKK1 signalling genes were positively associated with indoor tanning use among controls; only associations for ANKK1 remained statistically significant (P < 0.05) after adjustment. Several SNPs in ANKK1 and DRD2 associated with indoor tanning among controls were also found to be associated with increased risk of melanoma. Upon stratifying for indoor tanning status, one ANKK1 SNP was positively associated with melanoma among non‐tanners, while three DRD2 SNPS were positively associated with melanoma among tanners or non‐tanners, depending on the SNP. These alleles represent important genomic regions to further explore addictive tanning behaviour.     

Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults

Background Despite the increasing use of indoor tanning facilities, little is known regarding the behaviour of adults with respect to artificial and natural ultraviolet (UV) radiation exposure and the relationship between the two forms of exposure. Objectives To describe the beliefs and behaviour of French middle‐aged volunteers regarding artificial and natural UV exposure. Methods Cross‐sectional study of a French national cohort using a self‐completed questionnaire. Results Participants were identified as ‘indoor UV tanners’ (n= 1076) and as ‘non‐users’ (n= 6124). Predictor factors associated with indoor tanning were gender, age, smoking, phototype, region of residence, sun exposure during hobbies, voluntary sun exposure in particular during the hottest hours of the day, nudism practice, facial sunscreen habits, sunglass use, importance for lying in the sun and the claim ‘ever heard of melanoma’. Limitations The quality of information may be limited by the data collection method. Conclusion Whereas indoor tanning should be discouraged, it seems that indoor tanners are also regular sunbathers unconcerned about the risk of photoageing and skin cancer occurrence. Moreover, indoor tanners seem to have more behavioural risk factors for cancer, such as smoking.     

Prevalence of sunless tanning product use and related behaviors among adults in the United States: results from a national survey

Little is known about the use of sunless tanning products in the United States. This report describes the prevalence and correlates of sunless tanning use, comparing exclusive sunless tanners, exclusive indoor tanners, both sunless and indoor tanners, and non-tanners with respect to sociodemographic and sun protection behaviors.     

Indoor tanning in North Rhine-Westphalia Germany: a self-reported survey

Background/aims: We examined the prevalence of indoor tanning in North Rhine-Westphalia and identified correlates of sunbed use.
Methods: During regular skin cancer screening campaigns 1242 subjects completed and returned a structured questionnaire on constitutional parameters and indoor tanning habits.
Results: The regular sunbed user rate (more than 10 exposures/year) was 15.4% (191/1242). Most sunbed users were under 29 years of age. The number of female sunbed users was greater than the number of male users. Respondents with secondary modern school qualification used sunbeds more infrequently than respondents with junior high school and high school qualifications. Respondents with skin type III and IV used sunbeds more frequently. Tanning and preparation for sunny holidays were the main reasons for sunbed use. The most frequently reported positive effects experienced by means of sunbed use were improved appearance and relaxation. Most respondents indicated that they hardly or never had sunburns following indoor tanning. Almost half of respondents consider radiation generated by sunbeds somewhat dangerous.
Conclusions: Use of indoor tanning in North Rhine-Westphalia has increased and is significantly associated with female gender, younger age, high-level education, and skin type III and IV. The motivation for sunbed use and benefits experienced are mainly based on the perception of improved appearance due to tan and increased sense of well-being.     

In search of the perfect tan: Chemical activity,biological effects,business considerations,and consumer implications of dihydroxyacetone sunless tanning products

As the desire and popularity of a tanned appearance continues, the social effects of UV-free tanning are becoming more important. Dihydroxyacetone (DHA) has seen extensive use as the main tanning agent in sunless tanners. The DHA-induced tan is a result of brown melanoidins formed by a non-enzymatic Maillard reaction between DHA and amino acid species found in the stratum corneum. DHA, thereby, provides a safer route to a tanned appearance compared with exposure to ultraviolet radiation. However, DHA is a highly reactive molecule, posing a multitude of challenges for potential product formulations. With their increased use, the safety considerations of topically applied DHA tanners have been investigated. Many different vehicles have been used for topical delivery of DHA, and they are becoming increasingly multifunctional. This review provides a holistic overview of dihydroxyacetone sunless tanning products.     

Promotion of frequent tanning sessions by indoor tanning facilities: two studies

BACKGROUND: Indoor tanning may increase the risk of melanoma and other health problems. Frequent users of indoor tanning facilities may be at particularly high risk. OBJECTIVE: In study 1 our purpose was to assess the prevalence and nature of indoor tanning advertisements; in study 2 we aimed to assess tanning facility compliance to recommended exposure schedules. METHODS: In study 1, tanning facility advertisements over a 4-month period from 24 San Diego County newspapers were monitored. In study 2, we assessed compliance with recommended exposure schedules via a telephone interview of 60 San Diego County tanning facilities. RESULTS: Approximately 75% of the indoor tanning advertisements promoted unlimited tanning. Only 5% of facilities were in compliance with recommended tanning schedules, and 100% offered "unlimited" tanning packages. CONCLUSIONS: These findings suggest that the indoor tanning industry, through pricing incentives that allow frequent sessions, may be promoting overexposure to UVR. Stronger legislation is needed to address this issue.     

Sunburns, Sun Protection and Indoor Tanning Behaviors, and Attitudes Regarding Sun Protection Benefits and Tan Appeal among Parents of U.S. Adolescents—1998 Compared to 2004

Abstract:  This study presents nationally representative trends (1998–2004) and patterns in skin cancer risk behaviors, including sunburns, sun protection, and indoor tanning behaviors, and attitudes regarding ultraviolet radiation exposure among parents of U.S. adolescents. Data were from the American Cancer Society Sun Surveys I and II, telephone-based random digit dialed cross-sectional surveys of U.S. adolescents and their parents conducted in the summers of 1998 and 2004. Between 1998 and 2004, use of sunscreen, wide-brimmed hats and composite use of three to five behaviors increased significantly; concurrently, indoor tanning use increased significantly and sunburn prevalence changed a little. In 2004, 47% reported summer sunburns and more than half of those received painful sunburns. Parents continued to report low compliance with recommended behaviors; sunscreen use was most frequently reported, but many followed inappropriate application practices. About 13% practiced indoor tanning in the past year. Parents reported high levels of positive attitudes toward sun protection benefit, but at the same time, significant proportions reported positive tan appeal and outdoor sun exposure attitudes. The low rates and mixed progress in safe ultraviolet radiation exposure behaviors demand more attention for primary skin cancer prevention among parents of adolescents that focuses on changing beliefs about tanning appeal and promotes comprehensive ultraviolet radiation exposure protection.     

A narrative review of the potential for self‐tanning products to substitute for solaria use among people seeking a tanned appearance

Skin cancers including melanoma and non‐melanoma skin cancers are a high‐cost and largely preventable form of cancer. While limiting exposure to solar ultraviolet (UV) light via outdoor activities is a focus of public health efforts, indoor UV exposure via solaria or ‘tanning booths’ has also become a cause for concern. In recent decades the availability of less harmful non‐UV self‐tanning products such as sprays and lotions has increased. This review explores (i) the available data regarding the prevalence and behavioural factors associated with use of solaria and self‐tanning products and (ii) data that may shed light on the likelihood of solaria users substituting self‐tanning products as a less harmful alternative to solaria exposure. While there are insufficient data on which to draw a firm conclusion about the potential for substitution, it appears unlikely that most solaria users would readily substitute self‐tanning products in place of solaria exposure. Public health advocates may need to consider whether a robust research study of the cost‐effectiveness of encouraging substitutional use of self‐tanners is desirable, or whether efforts to severely restrict access to solaria may be a better approach.     

The kinetics of the tanning response to tanning bed exposures

No clinical studies have been published documenting the development of pigmentation following the use of the Food and Drug Administration (FDA) recommended exposures from a tanning bed. Panelists were exposed three times weekly for eight weeks (24 exposures) using the FDA recommended exposure schedule. The initial tan was noted after only six exposures and quantitatively increased through the remainder of the study.     

Compliance with federal and state legislation by indoor tanning facilities in San Diego

BACKGROUND: The prevalence rates of both skin cancers and indoor tanning among the US population are high and have increased substantially in recent years. Low compliance by indoor tanning facilities with safety regulations may place consumers at greater risk of skin and ocular damage. OBJECTIVE: This study quantified the level of compliance by indoor tanning facilities with selected federal and state regulations and recommendations. METHODS: Tanning facilities (N = 54) in San Diego County, California, were visited by a confederate posing as a prospective customer. Compliance with 13 regulations/recommendations were assessed by either direct query or observation of the presence/absence of signs and warning labels. Operators' responses to 5 risk-based questions also were noted. RESULTS: No facility complied with all 13 regulations/recommendations. Compliance with 3 protective eyewear regulations was high (89%-100%). In contrast, compliance with maximum tanning frequency recommendations (approximately 6%) and parental consent regulations (approximately 43%) was disturbingly low. CONCLUSION: The investigators recommend instituting mandatory, comprehensive training for operators, as well as systematic compliance monitoring with enforcement of penalties for noncompliance.     

Indoor tanning: Evidence surrounding advertised health claims

Indoor tanning continues to remain common, despite evidence of an increased risk of skin cancer from artificial ultraviolet (UV) radiation. In the hopes of gaining customers, the tanning bed industry has marketed health benefits of indoor tanning such as increased vitamin D production, development of a base tan, enhanced mood, and treatment of certain dermatologic conditions. To better educate their patients, providers need a comprehensive reference reviewing the evidence that support or oppose these claims. In this work, we conducted an evidence-based review of the literature to identify and grade studies that investigate health claims related to UV exposure. Results indicate that there is little evidence to support each of these proposed health benefits. Tanning beds emit primarily UVA radiation, which is relatively ineffective at activating vitamin D or mood enhancing pathways, and the effects are minimal in regard to tanning beds generating a protective base tan or treating dermatologic conditions compared with the increased risk of skin cancer. Health care providers must continue to warn and educate patients about the misleading information propagated by the tanning bed industry as well as about the dangers of artificial UV radiation.     

Indoor Tanning Practices of Colorado High School Students

For the first time, the 2013 Colorado Youth Risk Behavior Survey assessed indoor tanning practices of Colorado high school students. The survey revealed that girls are more likely to use indoor tanning devices than boys and that the majority of students who tan do so once or twice annually. Health care professionals and policymakers should focus on these groups in efforts to curtail indoor tanning and the associated risk of skin cancer in youth.     

Comparative protection efficiency of UVA- and UVB-induced tans against erythema and formation of endonuclease-sensitive sites in DNA by UVB in human skin

UVA- and UVB-induced tans which were visually identical with each other were induced in separate sites on the lower back of 5 normal human volunteers of good tanning ability. Tanning was achieved by 4 exposures to UVA and UVB administered over an 8-day period. One week after the last exposure the protection afforded by the two types of tan against UVB-induced erythema and against UVB-induced DNA damage was measured. Protection against erythema was measured by comparison of the minimal erythema doses of UVB in tanned and untanned skin. Protection against DNA damage was assessed by comparing the numbers of endonuclease-sensitive sites in epidermal DNA extracted from biopsies taken from tanned and untanned sites exposed to the same dose of UVB. The UVB tans conferred significant protection (mean 2.98-fold) against UVB-induced erythema. UVA tans were not associated with significant protection (mean 1.4-fold). In contrast, both UVA- and UVB-induced tans were associated with a similar reduction in yield of endonuclease-sensitive sites in epidermal DNA (in UVA tan to 47% and in UVB tan to 45% of the yield in untanned skin). Protection conferred by the tans against erythema was therefore not paralleled by protection against DNA damage.     

Addictive‐like behaviours to ultraviolet light among frequent indoor tanners

Background. Frequent, purposeful exposure to ultraviolet (UV) light may induce a compulsive desire to tan despite the negative consequences being known, suggesting a behavioural complex similar to addictive disorders. Aim. To assess the presence of addictive‐like behaviours in subjects using indoor tanning salons. Methods. Subjects (n = 100) were surveyed by two questionnaires: a modified CAGE questionnaire to assess behaviours consistent with problem tanning and a modified Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‐IV) (‘substance dependence’ criteria) to assess behaviours consistent with a dependence‐like disorder. Results. In total, 41% of subjects met criteria consistent with a ‘tanning addictive disorder’, and an additional 33% met criteria for problematic tanning behaviour based on the modified CAGE criteria or subthreshold criteria on the modified DSM‐IV criteria. Female gender and early age of onset were associated with meeting tanning addiction criteria. Conclusion. A high percentage of subjects who tan frequently in indoor salons experience behaviours and consequences to their tanning consistent with other identified addictive disorders.     

Sunbeds and carcinogenesis: the need for new regulations and restrictions in Europe from the Euromelanoma perspective

Experimental investigations have definitely assessed that ultraviolet A (UVA) as well as ultraviolet B (UVB) radiation induce mutagenic DNA photoproducts and other cell damages with a carcinogenic potential. Artificial tanning increases significantly the lifetime risk for basal cell carcinoma, squamous cell carcinoma and melanoma particularly in subjects with fair skin type, subjects with a history of skin cancer or frequent childhood sunburn or if exposures took place at an age younger than 18 years. In addition, experimental and clinical evidence indicate that UVA exposure promotes skin photoageing. Therefore we are dealing with a recreational activity (for customers) and a profitable business (for the tanning industry) with human costs, i.e. an increase in morbidity and mortality by skin cancer, and health and social costs leading to an increased expenditure by the European national health systems. In a few European countries, legislation has recently prohibited the use of sunbeds for minors, pregnant women, people with skin cancer or a history of skin cancer and individuals who do not tan or who burn easily from sun exposure. However, this legislation seems to be insufficient from a photobiological perspective, and importantly, it is largely disregarded by consumers and tanning industry. Therefore the Euromelanoma group proposes a new, more stringent regulation for the tanning industry and restrictions for customers, particularly for those individuals with constitutional and anamnestic risk factors. Finally, we ask for an enhanced commitment to increase the awareness of the general population on the risk of artificial tanning.     

Tanning and skin cancer

Skin cancer is a large and growing problem in the United States. Sun and other ultraviolet (UV) light exposures play a key role in the development of skin cancer. Pediatricians can play an important role in counseling patients and are in a position to help educate children and their families about skin cancer. The purpose of this review is to familiarize pediatricians with the magnitude of the skin cancer problem and the evidence that ultraviolet light exposure, particularly indoor tanning, contributes to this problem. We reviewed the literature on ultraviolet light and skin cancer (based on a MEDLINE search of articles using the headings "ultraviolet light" and "skin cancer") and found that skin cancer is the most rapidly growing cause of cancer deaths in the United State. There is strong epidemiologic evidence for the relationship between UV exposure and nonmelanoma skin cancer and growing evidence for the relationship between indoor tanning and melanoma. We recommend that pediatricians counsel children and their parents about UV protection. Measures such as use of sunscreen and hats for outdoor play, both at home and in school, should be encouraged.     

Sunless tanning

BACKGROUND: Americans continue to desire and pursue the tan. Recent data indicate continued high incidence of sunburn and ultraviolet tanning despite public health skin cancer prevention messages. The rising popularity of recently available sunless tanning booths prompted this review. OBJECTIVE: To present an overview of the history of sunless tanning and the sunless tanning booth industry, and to describe the current availability and safety practices of sunless tanning booth providers. METHODS: The current literature and internet resources were reviewed. Phone surveys of 300 businesses were conducted in July, 2003. RESULTS: Sunless tanning services were offered by 43% (39/90) of businesses with tanning services of any type. Sunless tanning booths were the most commonly offered sunless tanning application modality. The safety precautions most commonly offered to sunless tanning customers were recommendations to close their eyes (100%, 17/17), hold their breath (77%, 13/17), and utilize post-sunless tanning sun protection (82%, 14/17). CONCLUSION: Uniform guidelines should be developed to address safety issues associated with sunless tanning booth use. Future investigations are warranted to assess both the medical and behavioral implications of perpetuating the aesthetic appeal of the tan.     

Solar-simulated skin adaptation and its effect on subsequent UV-induced epidermal DNA damage

Repeated skin exposure to ultraviolet radiation leads to increased tolerance for erythema. Whether this tolerance is accompanied by a significant protection against epidermal DNA injury has never been thoroughly investigated. In a first set of experiments we irradiated 25 healthy volunteers three times a week for 3 wk using solar-simulating tanning lamps. In addition, all individuals were exposed to a (challenge) dose of three times the initial minimal erythema dose on a small area of skin before the first and after the final exposure. On both occasions, cyclobutane pyrimidine dimers were quantified in biopsies. As expected, repeated ultraviolet exposures resulted in increased epidermal pigmentation and thickness. The ultraviolet sensitivity for erythema decreased on average by 75%. The cyclobutane pyrimidine dimer formation was reduced on average by 60%. In a second set of experiments, with a group of 13 subjects, DNA repair kinetics were assessed. Within a period of 5 d after a single, slightly erythemal dose (1.2 minimal erythema dose), levels of cyclobutane pyrimidine dimer and p53-expressing cells were determined in skin biopsies. Both markers of DNA damage were elevated upon the single ultraviolet exposure and returned to background levels after 3-4 d. This information is important when trying to minimize the risk of DNA damage accumulation after repeated exposures during a tanning course.     

French teenagers and artificial tanning

Background  Exposure to solar and artificial ultraviolet (UV) radiations is a major risk factor for skin cancers. France has enacted one of the strictest laws that, notably, restrict tanning‐bed access to adults ≥18 years old. Objective  We evaluated artificial tanning behaviours of French teenagers (11–17 years old): sunless‐tanning products, sunlamps and artificial tanning beds. Methods  An anonymous questionnaire evaluating sunburn history, skin phototype, behaviours with sunless‐tanning products and indoor tanning, and parents’ behaviours was distributed to students enrolled in two middle and high schools in Antony, a typical city of the middle class French population, located in the Paris suburbs. Results  Among 713 teenagers (mean age: 13.5 years: male/female: 1.1) responding, more than half declared that it was important to be tanned during the summer, 1% reported having already used tanning pills, 9.9% tanning creams and 1.4% indoor tanning. Female teenagers significantly more frequently resorted to indoor tanning (P = 0.02), cited the importance of being tanned all year long (P < 0.0001), used tanning pills (P < 0.0001) or tanning creams (P < 0.006), and their parents relied on indoor tanning (P < 0.0001). Profiles of tanning‐pill and ‐cream users were similar. Mean ages for the two groups were comparable. Conclusion  French regulations for indoor tanning seem quite effective. Our analyses revealed a typical teenager profile with sun‐exposure risk behaviours, for example, indoor tanning, and use of tanning pills or creams. They could be a selective target for sun‐protection information campaigns.     

Tanning salon exposure and molecular alterations

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.