Dangers of Indoor Tanning

Several studies have shown that the use of tanning devices is associated with an increased risk of developing melanoma and nonmelanoma skin cancer, including squamous cell carcinoma and basal cell carcinoma. The use of tanning devices is also associated with malignant melanoma of the eye, premature skin aging, and the development of cataracts.

Learn more about tanning and burning

How Artificial Tanning Devices Work

In the same way that the sun emits ultraviolet (UV) radiation, artificial tanning devices such as tanning beds and sunlamps also emit UV radiation.

One misconception promoted by the indoor tanning industry is that tanning devices give off only the “safe, tanning rays,” of UV radiation. However, there is no such thing as safe UV radiation. Remember, your skin produces a tan when it has been damaged by ultraviolet light. The skin does not care what the source is, or whether someone labels it as “safe.” If your skin has tanned, it is because damage has already occurred, and the skin is doing its best to prevent it from happening again.

In fact, exposure to highly concentrated UV rays of tanning devices may be even more dangerous than exposure to the sun. Tanning devices may emit UV radiation up to 15 times the strength of the midday summer sun. 12  The only difference is that the specific type and quantity of UV radiation produced from an artificial tanning device can be controlled.

Who Tans and How Often?

  • Approximately 7.8 million adult women and 1.9 million adult men in the United States tan indoors. 3
  • Thirty-five percent of American adults, 59 percent of college students, and 17 percent of teens have reported using a tanning device in their lifetime. 4
  • Nearly 70 percent of tanning salon customers are Caucasian girls and women, primarily between the ages of 15 to 29. 5,6
  • Teens are not just using indoor tanning devices for proms and homecoming; a 2015 national survey of high school students concluded that 7.3% used indoor tanning devices at least once in the past year. The prevalence of indoor tanning device use was higher among females at 10.6% than male students which was 4.0%. 7
  • Research indicates that more than half of indoor tanners (52.5 percent) start tanning before the of age 21. Forty-four point five percent of those who started tanning before age 16 reported they did so with a family member. Forty-nine point two percent of those who started tanning with a family member did so with their mother. 8

Dangers of Indoor Tanning: A Fact Sheet

Human Carcinogen

  • The United States Department of Health and Human Services and the International Agency of Research on Cancer, a division of the World Health Organization, has declared ultraviolet (UV) radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known human carcinogen. 9
  • As of September 2, 2014, UV tanning devices were classified  by the Food and Drug Administration from class I (low to moderate risk) to class II (moderate to high risk) devices. 10

Stronger than the Sun

Indoor tanning equipment, which includes all artificial light sources, including beds, lamps, bulbs, booths, etc., emits UVA and UVB radiation. The amount of the radiation produced during indoor tanning is similar to the sun, and in some cases, may be emit UV radiation up to 15 times the strength of the midday summer sun. 1,2

The Younger You Start, the Higher Your Risk

  • Those who begin tanning before the age of 35 increase their melanoma risk by 59 percent, and the risk increases with each use. 11,12
  • The use of tanning devices by young people aged 18 to 39 increases their risk of developing melanoma by 41 percent. 13
  • Women younger than 30 are 6 times more likely to develop melanoma if they tan indoors. 14

DNA Damage

Studies have found that exposure to UV radiation during indoor tanning damages the DNA in the skin cells. Excessive exposure to UV radiation during indoor tanning can lead to premature skin aging, immune suppression, and eye damage, including cataracts and ocular melanoma. 1,15,16,17,18

Higher Rate of Cancer

  • Those who use an indoor tanning bed are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basel cell carcinoma. 19
  • Individuals who have used tanning devices 10 or more times in their lives have a 34% increased risk of developing melanoma compared to those who have never used tanning devices. 20
  • A 2014 study estimated that more than 400,000 cases of skin cancer may be related to indoor tanning in the United States each year: 245,000 basal cell carcinomas, 168,000 squamous cell carcinomas, and 6,000 melanomas. 21
  • More people develop skin cancer because of tanning than develop lung cancer because of smoking. 22

What about Vitamin D?

Indoor tanning devices should be avoided and should not be used to obtain Vitamin D because UV radiation from indoor tanning is a risk factor for skin cancer. Vitamin D can be obtained by eating a healthy diet and by taking oral supplements.

Injuries

  • In a 2009 study, 58 percent of adolescent tanning bed users had burns due to frequent exposure to indoor tanning beds/lamps. 23
  • An estimated 3,234 indoor tanning-related injuries were treated each year in US hospital emergency departments from 2003 to 2012. 24
  • A recent study found that 6.7 percent of indoor tanners reported having been burned by a tanning machine. 25

Cost

The estimated cost of treating skin cancers attributable to indoor tanning is $343.1 million a year, leading to a total economic loss of $127.3 billion over the lifetime of those affected. 26

Phototherapy Devices

The only time an artificial tanning device should be used is in the medical procedure of phototherapy. This process of exposing the body to UV radiation may be useful in the treatment of a number of skin conditions, including psoriasis and dermatitis. These treatments should only be conducted under medical supervision.

Regulations Governing the Use of Tanning Devices

In the United States, only 19 states and the District of Columbia completely ban the use of tanning devices for those under the age of 18. Two states allow minors to use tanning devices with a doctor’s prescription. Many states have some form of restrictions for minors which range from a parental permission to a partial ban, or combination thereof.

Brazil, New South Wales, and Australia have passed complete bans on indoor tanning.  France, Spain, Portugal, Germany, Austria, Belgium, the United Kingdom, Iceland, Italy, Finland, Norway and parts of Canada prohibit indoor tanning for youth under age 18.

Learn about indoor tanning statutes and legislation in your state

References:

1. Autier P. Perspectives in melanoma prevention: the case of sunbeds. Eur J Cancer. 2004;40(16):2367–2376.
2. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012;345:e4757.
3. Guy GP, Berkowitz Z, Holman D and Hartman A. Recent Changes in the Prevalence and Factors Associated With Frequency of Indoor Tanning Among U.S. Adults. JAMA Dermatol 2015; Published online July 1, 2015.
4. Wehner MR, Chren M, Nameth D, et al. International Prevalence of Indoor Tanning: A Systematic Review and Meta-analysis.JAMA Dermatol. 2014;150 (4): 390-400. doi:10.1001/jamadermatol.2013.6896.
5. Choi, K., Lazovich, D., Southwell, B., Forster, J., Rolnick, S. J., and Jackson, J. Prevalence and characteristics of indoor tanning use among men and women in the United States. Archives of Dermatology, Vol. 146 2010, No. 12, pp. 1356-61.
6. NAACCR Fast Stats: An interactive tool for quick access to key NAACCR cancer statistics. North American Association of Central Cancer Registries. http://www.naaccr.org/. (Accessed on 3-10-2016)
7. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance — United States, 2015. MMWR Surveill Summ 2016;65(No. SS-6):1–174. DOI: http://dx.doi.org/10.15585/mmwr.ss6506a1.
8. Watson M, Shoemaker M, Baker K. Indoor Tanning Initiation Among Tanners in the United States. JAMA Dermatol. Published online March 22, 2017. doi:10.1001/jamadermatol.2016.5898.
9. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on Carcinogens, 11th ed: Exposure to Sunlamps or Sunbeds.
10. Ogden N. General and Plastic Surgery Devices: Reclassification of Ultraviolet Lamps for Tanning, Henceforth To Be Known as Sunlamp Products and Ultraviolet Lamps Intended for Use in Sunlamp Products.https://www.federalregister.gov/articles/2014/06/02/2014-12546/general-and-plastic-surgery-devices-reclassification-of-ultraviolet-lamps-for-tanning-henceforth-to Accessed June 9, 2014.
11. Boniol B, Autier P, Boyle P, Gandini S. "Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis". British Medical Journal, 2012; 345:e4757. Correction published December 2012; 345:e8503.
12. The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer "The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review." International Journal of Cancer. 2007 March 1;120:111-1122.
13. Cust AE, Armstrong BK, Goumas C, Jenkins MA, Schmid H, Hopper JL, Kefford, RF et al. Sunbed Use During Adolescence and Early Adulthood is Associated with Increased Risk of Early-Onset Melanoma. Int Journal of Cancer. 2011 May 1:128(10):2425-35.
14. Lazovich D, et al. Association Between Indoor Tanning and Melanoma in Younger Men and Women. JAMA Dermtol. 2016; 152(3):268-275. doi:10.1001/jamadermatol.2015.2938.
15. Piepkorn M. Melanoma Genetics: An Update With Focus on the CDKN2A(p16)/ARF Tumor Suppressors. J. Am Acad Dermatol. 2000 May;42(5 Pt 1):705-22; quiz 723-6.
16. Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken JF, Giles GG, Armstrong BK. Artificial Ultraviolet Radiation and Ocular Melanoma in Australia. Int J Cancer. 2004 Dec 10;112(5):896-900.
17. Walters BL, Kelly TM. Commerical Tanning Facilities: A New Source of Eye Injury. Am J Emerg Med 1987;120:767-77.
18. Clingen PH, Berneburg M. Petit=Frere C, Woollons A, Lowe JE, Arlett CF, Green MH. Contrasting Effects of an Ultraviolet B and an Ultraviolet A Tanning Lamp on Interleukin-6. Tumour Necrosis Factor-Alpha and Intercellurlar Adhesion Molecule-1 Expression. Br J Dermatol. 2001 Jul;145(1):54-62.
19. Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of Tanning Devices and Risk of Basel Cell Squamous Cell Skin Cancers. J Natl Cancer Inst 2002;94:224-6.
20. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014; 70(5):847-857.e1-118. doi: 10.1016/j.jaad.2013.11.050. Epub 2014 Mar 12.
21. Wehner MR, Chren M, Nameth D, et al. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol. 2014;150(4):390-400.
22. Wehner M, Chren M-M, Nameth D, et al. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150(4):390-400. Doi: 10.1001/jamadermatol.2013.6896.
23. Cokkinides V, Weinstock MA, Lazovich D, Ward E, Thun M. Indoor Tanning Use Among Adolescents in the US, 1998-2004. Cancer 2009:115:190-98.
24. Guy G, et al. JAMA Internal Medicine Published online December 15, 2014.
25. Gery P. Guy Jr., et al. Trends in Indoor Tanning and Its Association with Sunburn Among US Adults. J. Dermatol. 2017 June;76(6):1191-93.
26. Waters HR and Adamson A. The health and economic implications of using tanning devices. J Cancer Policy. 2016. http://dx.doi.org/10.1016/j.jcpo.2016.12.003.

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