Tanning

A tan is a sign of skin damage. Any method of tanning that involves exposure of the skin to ultraviolet (UV) radiation, either by sunlight or solarium, will cause skin damage. There is no such thing as a safe tan. Tanning is a photoprotective response to UV-induced DNA damage,^[1] resulting in pigmentation darkening due to increased melanin in the epidermis.^[2] In other words, when skin is over-exposed to UV radiation, more melanin is produced, thereby darkening the skin. A tan is a response to excessive UV exposure, and is therefore a sign that UV damage has occurred.

Although exposure to both UVA and UVB radiation can increase skin pigmentation, UVB is more effective at stimulating a tanning response compared with an equivalent UVA dosage. UVA-tanning appears to be due to a redistribution of melanin in the epidermis, while UVB exposure actually increases the amount of melanin produced.^[3] UVA-induced tanning appears to be the result of melanin/melanin-precursor oxidation or redistribution of melanosomes (organelles containing melanin) to higher skin levels, while UVB-induced tanning involves increased melanin content (through increased re-uptake) and melanocyte differentiation (i.e. non-specialised cells acquiring the specialised features of a melanocyte).^[3]

A tan only offers modest protection (SPF3) against sunburn^[4] and although it is an adaptive response triggered by harmful UV exposure, the protection it offers against further DNA damage is not absolute and varies in efficiency, depending on skin type.^[5][6] In an experiment where skin was irradiated with either UVA or UVB to induce a tan, subsequent exposure to an erythemal dose of UV showed that UVA tans confer no photo-protection, while UVB-induced tans are only minimally protective.^[3] Furthermore, research has also shown that a false sense of protection from a baseline tan encourages individuals to increase their time in the sun, thereby increasing their chance of sunburn.^[7]

There is research to show that regular tanning can become addictive. As UV light has biochemically reinforcing properties,^[8] studies have shown some solarium users can experience withdrawal-like symptoms^[9] and meet the criteria for addiction (DSM IV/DSM-IV-TR^[8][10] and CAGE^[10]). Furthermore, as frequent tanners are able to distinguish between ultraviolet and non-ultraviolet light,^[8] there is likely a physiological as well as psychological component to tanning addiction.^[11]

Tanning trends

The findings from five national surveys during summers between 2003-04 and 2016-17 suggest there has been a reduction in Australians’ pro-tanning attitudes and behaviours. In 2016-17, fewer adolescents and adults desired a suntan, held beliefs that a suntan is healthy, and attempted a suntan than in summer 2003-04.

The proportion of adults deliberately attempting to get a tan dropped from 15% in 2003/04 to 11% in 2016/17.^[12]

Table 1 Trends in adolescents’ and adults’ intentional tanning attitudes and behaviour^[13][14]

A nationally representative survey of Australian adults in January 2019 found that 40% liked to get a suntan, 31% agreed that a suntanned person looks more healthy and 46% had tanned skin from sun exposure.^[15]

Solarium tanning

Solariums emit harmful levels of UV radiation,^{[16][17][18][19]} which contributes to increased skin cancer risk,^[20][21] acute sunburn and blistering, photoageing, ocular diseases, and local and systemic immunosuppression.^[22] They are banned for commercial use in all Australian states and territories.

Fake tanning

Fake tanning products are lotions, creams, or sprays that simulate a suntan by dyeing the outer layer of skin, and do not include temporary bronzers or tinted powders.^[23][24] Topical dyes are typically vegetable dyes that stain the skin a darker colour, while spray tans coat the skin in a fake tanning solution.

Fake tanning lotions may be safer alternatives to sun-tanning. However there is no consistent data to show that users of fake-tanning products are more compliant with sun protection in general.^[25] Some tanning lotions include sunscreens, ranging from sun protection factors (SPF) 4 to 15. However, this protection only lasts for a short time following application and not for the duration of the fake tan. Promoting a tanning product as being protective against UV radiation may be misleading. All tanning products should be used in conjunction with the five sun protection measures – clothing, sunscreen, wide-brimmed hat, shade and sunglasses.

In the case of spray tanning, researchers studying cells in a lab in the US have expressed concerns over the potential inhaling of substances such as colour additive dihydroxyacetone (DHA).^[26][27] There is no evidence that DHA is harmful when applied topically in a cream or lotion, and the potential risk during a spray tan can be mitigated with use of goggles and a face mask.^[26]

Tanning accelerators and pills

Tanning accelerators/activators claim to stimulate the production of melanin (the pigment that is responsible for skin colour) in the body. Psoralen (an ingredient of bergamot oil) is the most common tanning accelerator. Use of tanning accelerators is not recommended as psoralen has been shown to be carcinogenic.^[28] Further, several cases of dysplastic naevi and melanoma development have been associated with Melanotan® injection use,^[29],[30] although there is currently no research that shows a causal relationship.^[29] Further studies are required on the safety of these products.^[28]

Tanning pills can also darken skin colour. The most common active ingredient in these pills is canthaxanthin which changes skin to an orange-brown colour by depositing in the epidermis and subcutaneous fat. Canthaxanthin pills have been linked a range of side effects and health conditions ranging from yellowing of the retinas (due to pigment deposits) to hepatitis.^[31]

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Last modified: 12 August 2022