Risks of Ultraviolet Rays and Indoor Tanning

According to a report, as of 2007, 27% percent of U.S. adults said they used indoor tanning facilities--up from just one in 1% Americans who had used tanning beds back in '88. This has fueled an exponential rise, particularly among young white women, and it occurs as tanning salons are using stronger UV lamps that greatly enhance the danger.
Today, the ideology of perfect brown skin still remains firm and strong. But hidden behind this pursuit for that "perfect tan" is something very sinister: a very real and serious health hazard from radiation from tanning beds.

While the tanning industry promotes indoor tanning as safe and healthy, the science shows that it is dangerous-from premature aging to deadly skin cancers, the unrecognized dangers of the artificial tan significantly outweigh the supposed cosmetic benefits.

Image Source: solesence

UV-B rays make it past the top layers of skin and cause sunburns. The ultraviolet rays cause the DNA in skin cells to change, which can lead to mutations and increase people's risk of developing skin cancer. UV-B is also more effective at inducing the production of vitamin D in the skin, a quality that has been exploited to sell people on getting some artificial tans.

UV-A rays were believed to be the less dangerous type of ultraviolet ray, That penetrates deeper into your skin.

Ultraviolet ray stimulate DNA damage at the molecular level and triggers the tanning process. When UV rays damage the DNA of keratinocytes, P53 is turned on and this also initiates angiogenesis. This, in response, activates the pro-opiomelanocortin (POMC) gene and creates melanin, responsible for skin tanning. The key point is that tanning treatment itself induces DNA damage. There's no such thing as a 'safe tan'.

UV radiation of tanning beds can be as much as 15 times strong as the midday sun. And that level of exposure (without protection) can lead to sunburns, then early signs of aging and those changes in the skin which are precursors to cancer. Experiments indicate that even at doses of ultraviolet ray so low as to not cause any visible long-lasting reddening of the skin, significant DNA damage is introduced and carcinogenesis may be initiated following exposure.

Image Source: Vox

Basal Cell Carcinoma (BCC): A 2002 study found that ever using a tanning device increased BCC risk by 50%. BCC is not aggressive compared to some other types of skin cancer, but if neglected, it can be locally destructive and slowly disfiguring. BCC is the most common form of skin cancer around the world affecting millions per year.

Squamous Cell Carcinoma (SCC): The same study also found that indoor tanning doubled the risk of SCC. Given these SCC generally have a higher metastatic potential than BCC this is worrying. The mortality rate due to SCC in the U. S. exceeds 15,000 every year.

Melanoma: Tanning bed use in individuals below 35 years of their age may appear to raise the melanoma risk by almost 75% based on a meta-analysis. In 2021, approximately 207,390 incidences of melanoma are believed to be diagnosed in the United States, with around 7,180 fatal outcomes. The following chart is the graphic display of the estimated new cases and deaths by sex of all ages in the year 2020, globally.

Image Source: Researchgate

Collagen and elastin are two fundamental fibers in the skin, but ultraviolet ray exposure weakens these compounds by breaking them down at a faster rate. This can cause wrinkles, age spots and people lose their skin firmness years before it would naturally happen. Frequent tanners are prone to developing leathery skin texture and increased skin laxity—an indication of cumulative UV-induced damage.

Without proper eye protection, even laying in a tanning bed can eventually cause problems for the eyes. Potential problems include photokeratitis (giving corneal burns), cataracts, and ocular melanoma. Tanning devices that emit ultraviolet ray exposure have been associated with ocular cancer, especially among regular users.

Myth 1: Getting a "base tan" prevents sunburn.

Fact: A base tan provides minimal sun protection, equivalent to an SPF of 3 or less. This negligible benefit comes at the cost of DNA damage that increases skin cancer risk. A tan, whether from the indoors or outdoors, causes skin damage. Believing in a 'safe' base tan is dangerous. This can result in subjecting people to misconceptions regarding tanning and can lead to the development of riskier tanning practices.

Myth 2: They are safe and a good way to get a tan and replenish Vitamin D levels.

Fact: UV radiation is useful in the production of vitamin D. Tanning beds emit mainly UVA rays which are involved in the formation of vitamin D as well as skin degradation. The dangers of tanning bed use are so high that no potential levels of vitamin D can really give you a health benefit. There are better and safer sources of vitamin D by consuming foods rich in Beta-carotene.

Myth 3: Tanning is safe as long as you don't burn.

Fact: The damage caused by UV is happening down at the DNA level before you see your skin start to burn. Even low-dose ultraviolet ray exposure can cause erythema and produce skin carcinogenesis as illustrated in recent laboratory investigations. Just because you don't burn does not mean there is no damage. Each tan increases your UV burden. This raises the risks of skin cancer-causing radiation.

Myth 4: Indoor tanning is FDA-approved and safe.

Fact: Tanning devices are regulated by the FDA. Yet, that doesn't mean they're safe. Using them exposes users to ultraviolet radiation which is a known human carcinogen. The FDA now has strict requirements for placing warning labels about potential cancer dangers on indoor tanning equipment.

After years of tentative evidence, the sunlamp products were moved from Class I (low risk) to Class II (moderate-risk) devices by the FDA in 2014 when studies finally confirmed those long-suspected and serious health risks.

The compulsion to tan is persistent and can become so much more than a beauty routine that it becomes addictive. One study found 12–26% of frequent tanners (mainly in adolescents and young adults) exhibit signs of tanning dependence. Tanning addiction, also called "tanorexia," may be associated with a release of endogenous opioids during the tanning process.

Tanning addiction is in many ways like other substance abuse disorders. Frequent tanners experience a sense of relaxation and enhanced mood after an ultraviolet ray exposure, but feel the onset of withdrawal symptoms when unable to tan.

It is for this reason that tanning is particularly dangerous because repeat use over time significantly increases their chances of developing skin cancer and causing premature aging. That psychological element is part of what makes tanning addiction difficult to quit — even for some who know they are putting their health at risk.

As with other addictions, counseling and support should be available to those who wish to stop problematic tanning behavior. Cognitive-behavioral therapies and support groups have been demonstrated as potentially effective in remission from tanning addiction.

Teenagers and Young Adults
●70% of tanning salons patrons are Caucasian girls and women between ages 16 to29
●Initial indoor tanning exposure before the age of 35 years increases melanoma risk by up to 75%
●Tanning behaviors established in youth promote UV-induced skin damage and higher risk for developing skin cancers.
●Increased tanning in this age range is encouraged by peer pressure and media influences.
●The skin in adolescents may be less able to prevent ultraviolet ray damage due to being more delicate.

Fair-skinned Individuals
●People with fair skin, blonde or red hair, blue or green eyes are most prone to damage from UV.
●MC1R gene variant carriers (most redheads) can not tan and even worse, are especially susceptible to UV-induced DNA damage.
●People with fair skin have less natural protection from melanin in the first place, and it can quicken burns as well expose you to greater health risks.
●Whites have about 20-fold higher risk of developing melanoma than African Americans and a slightly lower but similar level compared with Hispanics.

Those with History of Sunburns or Skin Cancer
●A history of one or more severe sunburns, especially in childhood or adolescence, is a risk factor for developing melanoma.
●A personal history of skin cancer increases risk for getting new cancers.
●This group should be especially careful to avoid ultraviolet ray exposure, from tanning beds as well.
●Regular skin checks and dermatologist visits are crucial for early detection of new cancers.
●Even a single blistering sunburn during childhood or adolescence can nearly double a person's lifetime risk of melanoma.

Regulations and Public Health Initiatives
Increasing evidence that indoor tanning can cause skin cancer has led to regulations in many places, including:

●In 2022, only 20 states in the United States have any sort of law on indoor tanning and all are primarily aimed at limiting access for minors.
●Many states have specific restrictions, such as requiring parental permission for a minor to use tanning beds or banning anyone under 18 completely.

The challenge, however, remains the enforcement of these regulations. One study in Minnesota and Massachusetts found that approximately 81% of tanning facilities allowed underage to illegally tan without parental consent. This also points to the importance of better enforcement — and continued public health education.

Want to still look bronzed without the risks? Here are your options;

●Sunless tanning products: The FDA approves DHA. It safely reacts with the amino acids in your skin to turn it tan. Some of the products will still leave your skin looking glowy and golden for a solid week when applied correctly.
●Spray tans: Professional spray tanning services offer a more even application of DHA-based products, often providing longer-lasting results than at-home options.
●Bronzing makeup: Temporary bronzers and tinted moisturizers can provide an immediate tanned look without any chemical reaction or lasting effects on the skin.

●Exfoliate before application for even coverage
●Use a mitt or gloves to avoid staining palms
●Moisturize dry areas (elbows, knees) to prevent over-absorption
●Allow product to dry completely before dressing

Safe alternatives for obtaining adequate vitamin D include:

1. Diet: Fatty fish, egg yolks, and fortified foods like milk and cereals contain vitamin D.
2. Supplements: Over-the-counter vitamin D supplements can easily meet daily requirements.
3. Limited, protected sun exposure: Brief periods in the sun with proper protection can stimulate vitamin D production without significant damage risk.

Table 1: Table showing vitamin D source and their corresponding risk levels

Getting a tan definitely gives your skin that healthy glow which you love. However, with more evidence pointing to the risks involved in using tanning beds, it's better to be safe than sorry. You can explore other alternatives to achieve the same tanning results on your skin as we’ve discussed. In addition, by consuming food rich in Vitamin D, such as fatty fish, you can safely achieve your vitamin D requirement without the risk associated with ultraviolet ray exposure.

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Meersens. (2024, March 1). Artificial tanning: what dangers for the skin and health? Meersens.

The Skin Cancer Foundation. (2024, January 11). Tanning - the Skin Cancer foundation. 

Ultraviolet (UV) radiation tanning equipment | US EPA. (2024, January 24). US EPA. 

Harper, E., & Harper, E. (2023, March 1). SPF, UVA, UVB: What protection do I need? - Solésence. Solésence. 

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