Characteristics of UVA-Induced Delayed Tanning: Seasonal Variation

We studied seasonal variation in UVA-induced delayed tanning and compared it to that in UVA + B-induced delayed tanning. The minimal tanning dose (MTD) and the minimal melanogenic dose (MMD) were determined one week after UVA exposure or UVA + B exposure, respectively. The MTD determined in the summer (June to August) was significantly higher than that in winter (December to February). In addition, while MTD in the winter correlated well with skin color, there was no correlation between MTD and skin color in summer. MTD tended to correlate with self-reported tanning history at the initiation of tanning in the winter, but they were not correlated with each other in the summer. The MMD measured in the summer was significantly lower than that in the winter. MMD correlated well with skin color in both seasons; the lighter the skin, the smaller the MMD. Also, a correlation was detected between MMD and self-reported tanning history. These results suggest that the susceptibilities of delayed tanning to UVA and UVA + B are affected by different factors.     

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.     

Can melanoma therapy change attitudes toward prevention and tanning?

Malignant melanoma is the most lethal skin cancer whose incidence is increasing worldwide. Important is knowledge of risk factors, early diagnosis, long‐term follow‐up on confirmed melanoma cases and prevention. In this study, we tested melanoma patients' attitudes toward solar radiation and perception of the value of follow‐up. The present cross‐sectional epidemiological study was carried out in a group of patients diagnosed with stage I and II of malignant melanoma (n = 124). They were monitored for at least 1 year. The research was carried out by anonymous questionnaire. The results revealed that the respondents welcomed the opportunity of follow‐up care. Its benefits were said to outweigh the inconvenience of repeated checkups. However, the esthetic importance of a suntan was still considered quite high. Substantial reserve was found in the use of sunscreen. The need for wide public education and the protection against excessive contact with solar radiation is evident. Regular monitoring seems to be just as important.     

Tanning salons in Santiago, Chile: the knowledge of the staff in charge and the quality of information provided to potential clients before and after a new regulatory law

Introduction: In recent years, the use of artificial tanning devices has become very popular in Chile. In April, 2007, a new law was established to regulate the non-medical use of tanning beds and tanning booths. The aim of this study was to evaluate the level and quality of information provided by tanning salon staff to clients before deciding on using the services. This information was collected before and 6 months after the law was enacted by researchers visiting tanning salons posing as potential clients.
Methods: Using a previously designed questionnaire, 24 tanning salons in Santiago, Chile, were evaluated by researchers acting as potential customers without experience with artificial tanning devices. Employees were questioned using a hidden questionnaire before and 6 months after enactment of the law.
Results: Before the law, 25% of the establishments gave spontaneous information about the risks of using tanning beds, which increased to 45.8% after enactment of the law. Clients never received written information, either before or after enactment of the law. On both evaluations, more than 1/3 of the employees affirmed that there were no risks in using tanning beds. Before enactment of the law, only 12.5% of the tanning salons required the use of goggles, while after the law, this increased to 25% ( P =NS). Only two establishments required that clients sign an informed consent form after enactment of the law.
Discussion: The level of knowledge among employees in tanning salons was very low and the quality of the information they provided to the clients was very poor. It was important to legislate on ultraviolet tanning services, but at present, the impact of the law has been very limited.     

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.     

Tanning as an addictive behavior: a literature review

Background: Recent studies have identified reinforcing properties associated with tanning and suggest a possible physiologic mechanism and addiction driving tanning behavior.
Objective: This article attempts to synthesize the existing literature on tanning and addiction to investigate possible associations.
Methods: We investigated a variety of substance dependence models to define what constitutes dependence/addiction and to determine how current studies on tanning meet these criteria.
Results: In some individuals, tanning has met Diagnostic and Statistical Manual criteria for a substance-related disorder or tanning-modified Cut Down, Annoyed, Guilt, Eye-opener criteria. Trial studies have demonstrated the induction of withdrawal symptoms in frequent tanners.
Limitations: Additional studies are needed to investigate the associated dependency and addiction more fully and to elucidate its similarities to other better-known addictive syndromes.
Discussion: Tanning is a problem behavior, both as a health risk and as a possible dependency. Future studies, especially in the area of cognitive mapping and cue-related stimuli are needed. Imaging studies may be important in elucidating whether the same areas of the brain are involved in tanning addiction as in other addictive syndromes.     

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.     

A hazard assessment of artificial tanning units

As a result of increasing concern over the use of artificial tanning units, many local government recreation departments are phasing out the use of sunbeds on their premises, resulting in some clients switching to high street parlours about which little is known. An Environmental Health survey was conducted in all 32 tanning premises within a local government area (Perth & Kinross, Scotland). A number of significant problems emerged in the private sector. In this group, there was no form of cumulative UV exposure control in 89% of premises and 81% failed to give adequate advice and information to customers. We conducted UV spectral irradiation measurements in 38 tanning units using a double grating spectroradiometer. When a carcinogenic weighting factor was applied to these measurements, it was found that a 10 min exposure in a high intensity stand-up cabinet carried the same carcinogenic risk as approximately 30 min of local (56° North) mid-day summer sunlight or 10 min of Mediterranean sunlight at mid-day. A questionnaire completed by 57 customers revealed a wide pattern of usage; 6 (10%) had more than 20 h exposure in the previous 12 months and 3 (5%) had made regular use of sunbeds for the previous 16 to 20 years. These results indicate that there is a need for continuing public education and surveillance of commercial artificial tanning units.     

The physiological and phenotypic determinants of human tanning measured as change in skin colour following a single dose of ultraviolet B radiation

Please cite this paper as: The physiological and phenotypic determinants of human tanning measured as change in skin colour following a single dose of ultraviolet B radiation. Experimental Dermatology 2010; 19 : 667–673. Abstract: Experimental study of the in vivo kinetics of tanning in human skin has been limited by the difficulties in measuring changes in melanin pigmentation independent of the ultraviolet‐induced changes in erythema. The present study attempted to experimentally circumvent this issue. We have studied erythemal and tanning responses following a single exposure to a range of doses of ultraviolet B irradiation on the buttock and the lower back in 98 subjects. Erythema was assessed using reflectance techniques at 24 h and tanning measured as the L* spectrophotometric score at 7 days following noradrenaline iontophoresis. We show that dose (P < 0.0001), body site (P < 0.0001), skin colour (P < 0.0001), ancestry (P = 0.0074), phototype (P = 0.0019) and sex (P = 0.04) are all independent predictors of erythema. Quantitative estimates of the effects of these variables are reported, but the effects of ancestry and phototype do not appear solely explainable in terms of L* score. Dose (P < 0.0001), body site (P < 0.0001) and skin colour (P = 0.0365) or, as an alternative to skin colour, skin type (P = 0.0193) predict tanning, with those with lighter skin tanning slightly more to a defined UVB dose. If erythema is factored into the regression, then only dose and body site remain significant predictors of tanning: therefore neither phototype nor pigmentary factors, such as baseline skin colour, or eye or hair colour, predict change in skin colour to a unit erythemal response.     

New insights into pigmentary pathways and skin cancer

The ability of cells to respond to and to mitigate environmental stress is crucial for their survival. Constitutive and facultative pigmentation have evolved in order for human skin to contend with high levels of terrestrial ultraviolet radiation (UVR). When this melanin 'shield' is compromised, individuals are exposed to increased skin cancer risk. The purpose of this review is to discuss new insights into the genetic basis of phenotypic risk factors for skin cancer, their connection to pigmentation and tanning, the precise molecular connections linking UVR to the tanning response, and potential methods of modulating pigmentation that avoid genotoxic damage. Highly translational implications of this research include a scientific basis on which to counsel patients regarding the carcinogenicity of UVR exposure related to tanning and potential new tanning agents that may actually protect against skin cancer by circumventing the need for UVR exposure.     

Reduction of the UV burden to indoor tanners through new exposure schedules: a pilot study

BACKGROUND: The development of new pigmentation (tan) in human skin after UV exposure requires several days. Once it is developed, the tan can last for weeks. Current recommendations for tanning exposure schedules in the USA (FDA Letter to Manufacturers: Policy on maximum timer interval and exposure schedule for sunlamps, August 21, 1986) allow exposures three times per week for the development of a tan, and one to two times per week for maintenance exposures. However, this policy is often interpreted in the indoor tanning industry as allowing three exposures per week on a continuous basis. We believe that the reduction of the recommended cumulative dose to indoor tanners should be explored. Two approaches for achieving this are (1) decreasing the number of exposures and (2) increasing the time interval between exposures. To explore such changes, we conducted a pilot study. METHODS: The pilot study involved three exposure schedules (evaluated on each of six subjects) that evolved throughout the course of the study. Digital photography, visual assessment and diffuse reflectance spectrometry were used to assess skin color changes. The six pilot subjects were studied for 8-18 weeks. The changes in skin color obtained through the use of the different exposure schedules were compared with changes reported by Caswell (Caswell M, The kinetics of the tanning response to tanning bed exposures, Photodermatol Photoimmunol Photomed 2000: 16: 10-14) who used schedules based on current recommendations. RESULTS: Two out of the three experimental schedules produced tans comparable with those reported by Caswell. In these two schedules, cumulative doses were a factor of 2-3 below doses from current schedules. CONCLUSION: The UV burden to indoor tanners can be substantially reduced without compromising the cosmetic effect. These results need to be confirmed in a larger study.     

Durability of the sun protection factor provided by dihydroxyacetone

BACKGROUND/PURPOSE: The sunless tanning agent dihydroxyacetone (DHA) is known to protect against longwave ultraviolet radiation (UVA) and visible light. Recently, our laboratory has shown that DHA in addition offers a modest sun protection factor (SPF) in humans. We conducted this study in order to investigate the durability of the SPF provided by DHA. METHODS: Ten healthy volunteers were treated with 20% DHA cream twice in three areas on the volar forearm. One, 5 and 7 days after the second application the participants were phototested with simulated sunlight in each area. Blue reflectance was used to measure the skin coloration by DHA in the test sites. RESULTS: DHA generated a significant SPF of 3.0 at day 1, 2.0 at day 5 and 1.7 at day 7 (P<0.0001). The SPF was positively correlated to the change in blue reflectance (r=0.39, P=0.034). The loss of SPF unit/day was not significantly different between the subjects (P<0.122). However, the intercepts were significantly different (P<0.0001) indicating differences in the initial SPF obtained among the subjects. CONCLUSIONS: The SPF of DHA decreases with the same loss of SPF unit/day between humans and the durability of the SPF thus depends on the initial SPF provided.     

Novel gene identified in an exome‐wide association study of tanning dependence

Growing evidence suggests that some individuals may exhibit symptoms of dependence to ultraviolet light, a known carcinogen, in the context of tanning. Genetic associations with tanning dependence (TD) have not yet been explored. We conducted an exome‐wide association study in 79 individuals who exhibited symptoms of TD and 213 individuals with volitional exposure to ultraviolet light, but who were not TD based on three TD scales. A total of 300 000 mostly exomic single nucleotide polymorphisms primarily in coding regions were assessed using an Affymetrix Axiom array. We performed a gene burden test with Bonferroni correction for the number of genes examined (P < 0.05/14 904 = 3.36 × 10^?6). One gene, patched domain containing 2 (PTCHD2), yielded a statistically significant P‐value of 2.5 × 10^?6 (OR = 0.27) with fewer individuals classified as TD having a minor allele at this locus. These results require replication, but are the first to support a specific genetic association with TD.