The $5 billion tanning industry has taken a bold step this week in a media campaign promoting the benefits and downplaying the risks of tanning.
A spokeswoman for the industry argues that studies linking tanning bed use with melanoma were “junk science.” She also argues that tanning beds increase your vitamin D levels, thus protecting you against some cancers.
Lastly, she accuses dermatologists (that would be me) of needlessly scaring you away from the sun and of profiting from sunscreens. The gall.
OK. So here is my much requested post on vitamin D, sun exposure, and tanning. Use it to make an informed decision about tanning for you and your family.
- There is good data to show that vitamin D might help protect against some cancers.
- Vitamin D3 can be obtained from sun exposure or from your diet; there is no difference in the vitamin D3 obtained from either source.
- Adequate vitamin D can be obtained in most people by getting 5-15 minutes of sun on your face and hands three times a week. In most people, a maximum amount of vitamin D is reached after about 20 minutes of sun exposure, after which, vitamin D levels do not increase.
- The amount of vitamin D obtained from sunlight varies tremendously depending on where you live and on the color of your skin.
- Vitamin D is formed in the skin by ultraviolet light B (UVB). This is an important point: Tanning beds and booths use very little UVB. They use mostly ultraviolet light A (UVA), which does not increase your vitamin D level.
- Ultraviolet light is radiation and causes mutations in your DNA.
- UVA and UVB cause skin cancer; UVB is more carcinogenic than UVA.
- Ultraviolet light, including both UVA and UVB, suppresses your skin’s immune system.
- Both basal cell skin cancer and squamous cell skin cancer can be caused by UVB; there are more cases of basal cell and squamous cell skin cancer than all other cancers combined.
- The cause of the more deadly skin cancer, melanoma, is not clear cut. Melanoma is related to sunburns, to UVA exposure, and to tanning, but there are melanomas that develop “even where the sun doesn’t shine,” such as the bottom of the feet or buttocks. This does not mean that there is no risk of melanoma from using a tanning bed. In fact, there is evidence that artificial tanning does increase your risk of getting melanoma.
- The risk of melanoma from tanning differs depending on how many sunburns you have had, your skin color, and other risk factors such as family history. It is similar to breast cancer in that there are multiple risks factors, each of which contributes to an overall increased risk.
- Tanning beds do not give you a natural tan. Have you ever noticed how people who use tanning beds are a funny, reddish orange color? That’s because artificial tanning uses UVA, not natural sunlight (which is both UVA and UVB).
- People think that getting a tan from a tanning bed or booth will protect them from a sunburn. That is wrong. Tanning bed tans do not protect you against UVB light, and therefore do not protect you against natural sunlight.
- UVA, the light used mostly in tanning booths, damages collagen, causes wrinkles, and causes spotty white and brown pigmentation (age spots) of the skin.
- A tan is sun damaged skin. To say a tan is healthy is wrong. A tan develops after ultraviolet light damages DNA in your skin, sending signals to your pigment cells to make more pigment. The only way to tan is to have damaged your DNA first.
- Many people cannot tan (for example some fair skinned, redheaded people) because they have very little pigment; they should avoid sun exposure as much as possible. Also, some people have medical conditions such as lupus or are taking medications such as doxycycline that make any significant sun exposure dangerous.
I do not believe that sun exposure is always bad for you. After all, I chose to live in San Diego, CA. It is OK for people to get some sun, especially when it is incidental, as when you are biking or surfing. In fact, for patients who have certain skin diseases such as psoriasis, I recommend they get some sunlight each day because it helps their psoriasis. I also regularly treat patients with ultraviolet light (medical booths in our office) for skin conditions such as psoriasis, eczema, and itching.
At the same time, I see a dozen or more patients every day with skin cancers, “liver or age” spots (solar lentigos), wrinkles, thin skin that tears and bruises easily, and scaly keratoses (pre-skin cancers). All of these are caused by ultraviolet light exposure. Nearly every day women tell me they wish they never lied out in the sun covered with baby oil and iodine when they were younger.
People tan because they like the way it makes them feel and look. If you go to tanning beds or lie in the sun because you like it, then that is a personal health choice you make. But if you justify doing so by saying you are doing it for your heath, then you are misinformed. There are safer, more effective ways to get your vitamin D.
- Artificial tanning uses mostly UVA which does not raise your vitamin D levels.
- Artificial tanning does not protect you against natural sunlight.
- Artificial tanning increases your risk for skin cancer, wrinkles, leathery skin , and age spots.
- Artificial tans usually look artificial.
- Ultraviolet light from artificial sources is listed by the National Institute of Health as a known carcinogen.
- The World Health Organization states that indoor tanning is dangerous and might be a significant risk for developing melanoma.
- Oral vitamin D3 supplements (1,000 IU a day) reliably and predictably increase your vitamin D levels without increasing your risk of skin cancer. Only in rare instances of patients who cannot absorb vitamins from their gut is this not true.
Here are my recommendations:
- For most of the country, for most skin types, you don’t need sunscreen in winter. In places like Florida, you still should apply sunscreen even in winter.
- In summertime, avoid sun exposure, especially between 10 AM and 2 PM.
- Wear a broad spectrum, UVA and UVB, sunscreen with an SPF of 30 or higher.
- Don’t get sunburned. Remember that a sunburn is damaged skin — a sunburn is a radiation burn.
- Take vitamin D3 1,000 IU as a diet supplement each day.
- Don’t use artificial tanning beds or booths to get your vitamin D or to protect your skin against sunburns.
- The amount of sun that is safe for you varies considerably depending on your skin color and where you are. Know how easily you burn and keep it in mind before you get sun exposure.
- Go outdoors. It is a wonderful way to stay fit and to enjoy life.
This post was written on behalf of two patients, a mother and daughter. Both of whom used tanning beds. Both of whom have melanoma.
I do not receive any compensation from sunscreens or diet supplements (or this blog for that matter). I recommend zinc oxide / titanium dioxide sunscreens and vitamin D3 supplements, both of which can be found in generic, drugstore, or name brand products. Photo credit: Bob from Flickr
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