tag:theconversation.com,2011:/global/topics/sunbeds-1258/articlesSunbeds – The Conversation2024-02-14T19:22:00Ztag:theconversation.com,2011:article/2231922024-02-14T19:22:00Z2024-02-14T19:22:00ZWhat are ‘collarium’ sunbeds? Here’s why you should stay away<figure><img src="https://images.theconversation.com/files/575176/original/file-20240213-24-k00ogz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beauty-girl-looking-mirror-while-touching-1868918950">Ground Picture/Shutterstock</a></span></figcaption></figure><p>Reports have recently emerged that solariums, or sunbeds – largely banned in Australia because they <a href="https://www.sunsmart.com.au/uv-radiation/solariums-and-tanning">increase the risk</a> of skin cancer – are being <a href="https://www.abc.net.au/news/2024-02-08/health-authorities-investigate-rebranded-collarium-sun-beds/103433306">rebranded</a> as “collarium” sunbeds (“coll” being short for collagen). </p>
<p>Commercial tanning and beauty salons in Queensland, New South Wales and Victoria are marketing collariums, with manufacturers and operators claiming they provide a longer lasting tan and stimulate collagen production, among other purported benefits.</p>
<p>A collarium sunbed emits both UV radiation and a mix of visible wavelength colours to produce a pink or red light. Like an old-school sunbed, the user lies in it for ten to 20 minute sessions to quickly develop a tan. </p>
<p>But as several experts <a href="https://cosmosmagazine.com/health/experts-warn-about-collarium-tanning-beds/">have argued</a>, the providers’ claims about safety and effectiveness don’t stack up.</p>
<h2>Why were sunbeds banned?</h2>
<p>Commercial sunbeds have been <a href="https://www.arpansa.gov.au/understanding-radiation/radiation-sources/more-radiation-sources/solaria">illegal</a> across Australia since 2016 (except for in the Northern Territory) under state-based radiation safety laws. It’s still legal to sell and own a sunbed for private use.</p>
<p>Their dangers were highlighted by <a href="https://www.dailytelegraph.com.au/newslocal/macarthur/melanoma-survivor-jay-allen-welcomes-nsw-government-ban-on-sunbeds/news-story/aa65a9a7072022b7c1c7d07e4bb54ebc">young Australians</a> including <a href="https://www.sunsmart.com.au/about-sunsmart/media-and-communications/media-releases/2017/clare-olivers-legacy-10-years-on.html">Clare Oliver</a> who developed melanoma after using sunbeds. Oliver featured in the <a href="https://www.sunsmart.com.au/about-sunsmart/media-and-communications/sunsmart-campaigns/2000s#clare-oliver">No Tan Is Worth Dying For campaign</a> and died from her melanoma at age 26 in 2007.</p>
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Read more:
<a href="https://theconversation.com/theres-no-such-thing-as-a-safe-tan-heres-whats-happening-underneath-your-summer-glow-109439">There's no such thing as a safe tan. Here's what's happening underneath your summer glow</a>
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<p>Sunbeds lead to tanning by emitting UV radiation – as much as <a href="https://www.sunsmart.com.au/uv-radiation/solariums-and-tanning">six times</a> the amount of UV we’re exposed to from the summer sun. When the skin detects <a href="https://pubmed.ncbi.nlm.nih.gov/23749111/">enough DNA damage</a>, it boosts the production of melanin, the brown pigment that gives you the tanned look, to try to filter some UV out before it hits the DNA. This is only partially successful, providing the equivalent of <a href="https://pubmed.ncbi.nlm.nih.gov/24891049/">two to four SPF</a>.</p>
<p>Essentially, if your body is <a href="https://theconversation.com/theres-no-such-thing-as-a-safe-tan-heres-whats-happening-underneath-your-summer-glow-109439">producing a tan</a>, it has detected a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709783/">significant amount</a> of DNA damage in your skin.</p>
<p><div data-react-class="TiktokEmbed" data-react-props="{"url":"https://www.tiktok.com/@morgansskinjournal/video/7223660400984837377?_r=1\u0026_t=8jpqp1j1qNu"}"></div></p>
<p>Research shows people who have used sunbeds at least once have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993823/">41% increased risk</a> of developing melanoma, while ten or more sunbed sessions led to a 100% increased risk. </p>
<p>In 2008, <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377.2008.tb02082.x">Australian researchers</a> estimated that each year, sunbeds caused 281 cases of melanoma, 2,572 cases of squamous cell carcinoma (another common type of skin cancer), and $3 million in heath-care costs, mostly to Medicare.</p>
<h2>How are collarium sunbeds supposed to be different?</h2>
<p>Australian sellers of collarium sunbeds imply they are safe, but their machine descriptions note the use of UV radiation, particularly <a href="https://dermnetnz.org/topics/ultraviolet-radiation-and-human-health">UVA</a>.</p>
<p>UVA is one part of the spectrum of <a href="https://www.healthline.com/health/skin/uva-vs-uvb">UV radiation</a>. It penetrates deeper into the skin than UVB. While UVB promotes cancer-causing mutations by discharging energy straight into the DNA strand, UVA sets off damage by creating reactive oxygen species, which are unstable compounds that react easily with many types of cell structures and molecules. These damage cell membranes, protein structures and DNA. </p>
<p>Evidence shows <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883000/">all types</a> of sunbeds increase the risk of melanoma, including those that use only UVA.</p>
<p>Some manufacturers and clinics suggest the machine’s light spectrum increases UV compatibility, but it’s not clear what this means. Adding red or pink light to the mix won’t negate the harm from the UV. If you’re getting a tan, you have a significant amount of <a href="https://pubmed.ncbi.nlm.nih.gov/23749111/">DNA damage</a>.</p>
<h2>Collagen claims</h2>
<p>One particularly odd claim about collarium sunbeds is that they stimulate collagen.</p>
<p><a href="https://dermnetnz.org/topics/collagen">Collagen</a> is the main supportive tissue in our skin. It provides elasticity and strength, and a youthful appearance. Collagen is constantly synthesised and broken down, and when the balance between production and recycling is lost, the skin loses strength and develops wrinkles. The collagen bundles become thin and fragmented. This is a natural part of ageing, but is accelerated by UV exposure.</p>
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<img alt="Sun-damaged skin and sun-protected skin from the same person, and the microscopic image of each showing how the collagen bundles have been thinned out in the sun-damaged skin." src="https://images.theconversation.com/files/574816/original/file-20240212-19-v7wlqc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574816/original/file-20240212-19-v7wlqc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=585&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574816/original/file-20240212-19-v7wlqc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=585&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574816/original/file-20240212-19-v7wlqc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=585&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574816/original/file-20240212-19-v7wlqc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=735&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574816/original/file-20240212-19-v7wlqc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=735&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574816/original/file-20240212-19-v7wlqc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=735&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sun-protected skin (top) has thick bands of pink collagen (arrows) in the dermis, as seen on microscopic examination. Chronically sun-damaged skin (bottom) has much thinner collagen bands.</span>
<span class="attribution"><span class="source">Katie Lee/UQ</span></span>
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<p>The reactive oxygen species generated by UVA light damage <a href="https://pubmed.ncbi.nlm.nih.gov/24891049/">existing collagen</a> structures and kick off a <a href="https://pubmed.ncbi.nlm.nih.gov/17711532/">molecular chain of events</a> that downgrades collagen-producing enzymes and increases collagen-destroying enzymes. Over time, a build-up of degraded collagen fragments in the skin promotes even more destruction.</p>
<p>While there is growing evidence <a href="https://www.sciencedirect.com/science/article/pii/S0190962224001877?via%3Dihub">red light therapy</a> alone could be useful in wound healing and skin rejuvenation, the UV radiation in collarium sunbeds is likely to undo any benefit from the red light.</p>
<h2>What about phototherapy?</h2>
<p>There are <a href="https://dermnetnz.org/topics/uva1-phototherapy">medical treatments</a> that use controlled UV radiation doses to treat chronic inflammatory skin diseases like <a href="https://dermnetnz.org/topics/puva-photochemotherapy">psoriasis</a>. </p>
<p>The anti-collagen effects of UVA can also be used to treat thickened scars and <a href="https://dermnetnz.org/topics/keloid-and-hypertrophic-scar">keloids</a>. <a href="https://dermnetnz.org/topics/uva1-phototherapy">Side-effects</a> of UV phototherapy include tanning, itchiness, dryness, cold sore virus reactivation and, notably, premature skin ageing.</p>
<p>These treatments use the minimum exposure necessary to treat the condition, and are usually restricted to the affected body part to minimise risks of future cancer. They are administered under medical supervision and are not recommended for people already at high risk of skin cancer, such as people with <a href="https://dermnetnz.org/topics/atypical-melanocytic-naevus">atypical moles</a>.</p>
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Read more:
<a href="https://theconversation.com/thinking-about-trying-collagen-supplements-for-your-skin-a-healthy-diet-is-better-value-for-money-152240">Thinking about trying collagen supplements for your skin? A healthy diet is better value for money</a>
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<h2>So what happens now?</h2>
<p>It looks like many collariums are just sunbeds rebranded with red light. Queensland Health is currently <a href="https://www.abc.net.au/news/2024-02-08/health-authorities-investigate-rebranded-collarium-sun-beds/103433306">investigating</a> whether these salons are breaching the state’s <a href="https://www.legislation.qld.gov.au/view/html/inforce/current/sl-2021-0125#sec.67">Radiation Safety Act</a>, and operators could face large fines.</p>
<p>As the <a href="https://www.abc.net.au/listen/programs/adelaide-afternoons/tanning/103401358">2024 Australians of the Year</a> – melanoma treatment pioneers Georgina Long and Richard Scolyer – highlighted in their acceptance speech, “there is nothing healthy about a tan”, and we need to stop glamorising tanning. </p>
<p>However, if you’re desperate for the tanned look, there is a safer and easy way to get one – <a href="https://dermnetnz.org/topics/dihydroxyacetone">out of a bottle</a> or by visiting a salon for a spray tan.</p><img src="https://counter.theconversation.com/content/223192/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the National Health and Medical Research Council.</span></em></p><p class="fine-print"><em><span>Anne Cust receives funding from the National Health and Medical Research Council and Medical Research Future Fund. </span></em></p>Collarium sunbeds are promoted as a means to tan quickly, and reduce the effects of aging on the skin. Two experts explain what to make of their claims.Katie Lee, PhD Candidate, Dermatology Research Centre, The University of QueenslandAnne Cust, Professor of Cancer Epidemiology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/426752015-06-10T10:17:33Z2015-06-10T10:17:33ZThink indoor tanning is a safer alternative to sitting in the sun? Think again<figure><img src="https://images.theconversation.com/files/84237/original/image-20150608-8697-1m0f3g2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">International Agency for Research on Cancer has classified UV-emitting tanning devices as a Group I carcinogen -- the most dangerous cancer-causing substances. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-55286200/stock-photo-solarium-machine-in-spa-salon.html?src=eu2xLFDQk4rmrd32YsbwIw-1-8">Tanning bed via www.shutterstock.com.</a></span></figcaption></figure><p>June 21 marks the official start of summer, signaling months of long days spent in the sun, vacations to warm and tropical locations, and, of course, suntans. </p>
<p>In a quest for a perfect tan, many people – especially young white women between age 18 and 25 – may head to a tanning salon, using tanning booths, sunbeds and sunlamps to kick-start their tan. Others (including people who are more prone to burn instead of tan) may head to the salon to slowly develop a “base tan,” with the <a href="http://www.mayoclinic.org/diseases-conditions/sunburn/expert-answers/tanning/faq-20057866">mistaken</a> belief that it will prevent a sunburn. For many consumers of indoor tanning salons, this approach offers what they believe to be a safer alternative to outdoor tanning. But here’s the thing: indoor tanning is just as damaging to your health as lying out in the real sun.</p>
<h2>Indoor tanning isn’t risk-free</h2>
<p>In the US, approximately five million individuals are diagnosed and treated for skin cancer each year, making it the most common type of cancer in the country, so common that most of us know at least one person who has been diagnosed with skin cancer. Of these, <a href="http://www.mayoclinic.org/diseases-conditions/melanoma/basics/definition/con-20026009">melanoma</a> is the deadliest form of skin cancer (relative to others like <a href="http://www.cancer.org/cancer/skincancer-basalandsquamouscell/detailedguide/skin-cancer-basal-and-squamous-cell-what-is-basal-and-squamous-cell">basal and squamous cell carcinomas</a>), accounting for approximately <a href="http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/exec-summary.html">9,000 deaths each year</a> in the US.</p>
<p>Skin cancer is associated with ultra violet (UV) radiation exposure from both the sun, and artificial sources such as UV-emitting tanning devices found in indoor tanning salons. These devices emit UVA rays, UVB rays, or a combination of both. Exposure to UV radiation has well-documented <a href="http://www.ncbi.nlm.nih.gov/pubmed/2748244">adverse health effects</a>. It is a known human carcinogen, so exposure to UV radiation may cause cancer. To your skin, there isn’t a difference between UV radiation from the sun and UV radiation from a tanning device.</p>
<p>In 2009 the International Agency for Research on Cancer (IRAC), part of the World Health Organization (WHO), classified UV-emitting tanning devices as a <a href="http://monographs.iarc.fr/ENG/Classification/index.php">Group I carcinogen</a> – the classification for the most dangerous cancer-causing substances. That means tanning booths and beds, sunlamps and other artificial tanning devices are in same category as tobacco smoke. That’s right, the world’s leading authority on cancer research considers indoor tanning devices to be as dangerous as <a href="http://www.ncbi.nlm.nih.gov/pubmed/12738186">tobacco smoke</a> from cigarettes.</p>
<p>That’s a strong statement to make, but it is backed up by a robust and growing body of evidence linking UV tanning devices to health problems. The use of UV tanning devices has been linked to <a href="http://www.ncbi.nlm.nih.gov/pubmed/17131335">skin</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/2400347">eye melanomas</a>. Of the five million cases of skin cancer diagnosed each year in the US, researchers have estimated that 8% (or 400,000) of these cases can be attributed to indoor tanning.</p>
<p>About <a href="https://www.aad.org/media-resources/stats-and-facts/prevention-and-care/dangers-of-indoor-tanning">30 million people tan indoors</a> in the US every year, and about 2.3 million of them are teens. And research indicates, for example, that the lifetime risk of skin melanoma <a href="http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm186687.htm">increases by 75%</a> among people who began using UV tanning devices before age of 35 (called young exposure). Yes – 75%. That figure alone should be enough to make some of us rethink the importance of that tan. </p>
<p>And if the increased risk of skin cancer isn’t enough, what about the increased risk of eye damage, wrinkles and other forms of premature aging of the skin? It begs the question – is that tan really worth it?</p>
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<img alt="" src="https://images.theconversation.com/files/84239/original/image-20150608-8732-19ztwgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84239/original/image-20150608-8732-19ztwgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84239/original/image-20150608-8732-19ztwgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84239/original/image-20150608-8732-19ztwgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84239/original/image-20150608-8732-19ztwgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84239/original/image-20150608-8732-19ztwgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84239/original/image-20150608-8732-19ztwgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">8% of skin cancer cases diagnosed in US annually can be attributed to indoor tanning.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-7010602/stock-photo-illuminated-green-and-blue-tanning-neon-sign-on-black.html?src=TkjqbD6SYxlzhum3lArXqw-2-72">Tanning sign via www.shutterstock.com.</a></span>
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<h2>Limited regulatory oversight for indoor tanning</h2>
<p>Indoor tanning might be unhealthy, but its popularity, especially among young people, hasn’t dampened. Researchers in Texas found that apartment buildings near some college campuses offer free indoor tanning <a href="http://www.npr.org/sections/health-shots/2015/06/04/411739662/apartments-lure-students-with-free-access-to-tanning-beds">to lure students</a>. And a study of 125 college and university campuses in the US found <a href="http://archderm.jamanetwork.com/article.aspx?articleid=1919438">that almost half</a> had indoor tanning facilities on campus or in off-campus housing. </p>
<p>Why haven’t governments taken a more aggressive role in regulating the industry, including implementing partial or complete bans for cosmetic tanning? This seems a pretty obvious question, given the flurry of legislative and regulatory action that we have witnessed over the last decade or two in relation to the tobacco industry. Today, smoking cigarettes is more and more expensive (due to ever-increasing taxes), highly regulated, and, in many regions, socially unacceptable. </p>
<p>Several countries have taken steps to <a href="http://archderm.jamanetwork.com/article.aspx?articleid=1216974">regulate indoor tanning</a>. In 2011, Brazil became the first country in the world to ban the use of commercial indoor tanning for nontherapeutic purposes for all age groups (the country had already banned tanning for minors in 2002). Australia quickly followed. As of today, all but one Australian state prohibit individuals from operating a commercial tanning business. There are significant financial penalties for breaking the law. It is anticipated that the ban will help to reduce the incidence of skin cancer in the Australian public over time. </p>
<p>A number of other countries – including France, Italy and the United Kingdom – prohibit people under 18 from indoor cosmetic tanning. </p>
<p>But regulations in the US aren’t nearly as strict. Commercial indoor tanning operations <a href="http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx">are regulated</a> through a patchwork of state registration, licensing and/or inspection requirements. The nature of the regulations varies greatly and so too does the strength of enforcement. </p>
<p>The majority of states regulate the use of tanning devices by minors in some way. Seventeen states <a href="http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx">require</a> parental accompaniment, or parental consent, for the use of a tanning bed by minors. Maximum exposure times and the provision of eye protection to the minor are also common in these states. <a href="http://www.nature.com/nature/journal/v515/n7527_supp/box/515S114a_BX1.html">Eleven states</a> – including <a href="http://well.blogs.nytimes.com/2011/10/10/california-bans-indoor-tanning-for-minors/">California</a> and <a href="http://www.texastribune.org/2013/08/30/minors-no-longer-allowed-use-tanning-salons/">Texas</a> – have gone further and created legislation that prohibits indoor tanning by minors. But eight states still have no such protections. In these states, despite the overwhelming epidemiological evidence, minors may engage in unhealthy tanning practices without any checks and balances to help minimize the risks. </p>
<p>On the federal side, the Food and Drug Administration (FDA) <a href="http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/exec-summary.html">reclassified</a> indoor tanning devices as <a href="https://www.federalregister.gov/articles/2014/06/02/2014-12546/general-and-plastic-surgery-devices-reclassification-of-ultraviolet-lamps-for-tanning-henceforth-to#h-7">Class II medical devices</a> in 2014. That means manufacturers will need to include a warning that people under 18 shouldn’t use these devices and need to meet other regulatory requirements. And as of 2010 there is a <a href="http://money.cnn.com/2012/06/28/pf/taxes/tanning-tax/">10% federal excise tax</a> on tanning services. </p>
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<img alt="" src="https://images.theconversation.com/files/84241/original/image-20150608-8677-6awxbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84241/original/image-20150608-8677-6awxbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84241/original/image-20150608-8677-6awxbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84241/original/image-20150608-8677-6awxbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84241/original/image-20150608-8677-6awxbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84241/original/image-20150608-8677-6awxbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84241/original/image-20150608-8677-6awxbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Lifetime risk of skin melanoma increases by 75% among people who began using UV tanning devices before 35.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-189514670/stock-photo-sunbathing-on-tanning-bed-beautiful-young-woman-lying-on-tanning-bed-and-keeping-eyes-closed.html?src=eu2xLFDQk4rmrd32YsbwIw-1-45">Woman in tanning bed via www.shutterstock.com.</a></span>
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<h2>What can be done to protect minors?</h2>
<p>The demand for that bronzed look remains high (the indoor tanning industry is valued at US$2.6 billion) and this is unlikely to change any time soon given the aesthetic appeal. And while a call for an outright ban may make sense from a public health perspective, such a call would be highly unpalatable to consumers, business operators and the states, which benefit from the economic activity. </p>
<p>But more should and can be done to protect young tanners. A first step would be for all states to follow the lead set by, for example, California, and enact legislation that prohibits minors from using indoor tanning facilities. Across all states, maximum exposure times and requirements for the provision of eye protection for all clients, regardless of age, should be introduced and strictly enforced. Greater education around the risks of exposure, but especially young exposure, is also needed.</p><img src="https://counter.theconversation.com/content/42675/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diana Bowman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers have estimated that 8% of the five million cases of skin cancer diagnosed each year in the US can be attributed to indoor tanning.Diana Bowman, Associate Professor of Health Management Policy, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/282832014-06-20T11:41:46Z2014-06-20T11:41:46ZSunshine addiction is a hot topic – but does ‘tanorexia’ really exist?<figure><img src="https://images.theconversation.com/files/51771/original/qkrnctpb-1403261598.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Half-baked.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hjl/14062720616/sizes/l/in/photolist-nqF7Uh-Hy1SJ-51BMvz-NKvQZ-9UVhtC-6ASz29-43wtzb-cw8d9L-8gqAPx-bKCp5M-2Nj2f-2wUCf-c1Lo17-coZFh-3giweQ-2yewT-8jnAcB-K3D6K-4dVEu7-6yJLTe-hKDtE-4CeQi-9xckjW-ckeV81-ckeTMo-ckeRZW-ckeVjN-ckeSoW-ckePHA-4JK6qM-bbw6fP-9zcCEu-eoiwct-YLVH-FaWtB-b3s5xM-coZAC-coZDD-wAWfR-4LC7oF-ddE5RA-coZCp-coZA9-64MiU7-9AAMiZ-fxBSs-3D6WK-6owBmg-5N2FfT-6WtoYX-2LbZza/">Hjl</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>If the many <a href="http://www.telegraph.co.uk/health/healthnews/10912105/Sunshine-can-be-addictive-like-heroin.html">media reports</a> are to be believed: “Sunshine can be addictive like heroin.” The claim comes via a <a href="http://bit.ly/1iLJpal">study published in Cell</a> based on an experiment carried out on mice at Harvard Medical School. Researchers found that ultraviolet light exposure leads to elevated endorphin levels – the body’s own “feel good” internal morphine – that mice experience withdrawal effects after exposure, and that chronic ultraviolet light exposure causes dependency and “addiction-like” behaviour.</p>
<p>Although the study was carried out on animals, the authors speculated that their findings may help to explain why we love lying in the sun and that in addition to topping up our tans, sunbathing may be the most natural way to satisfy our cravings for a “sunshine fix” in the same way that drug addicts yearn for their drug of choice.</p>
<h2>Summer of ‘98</h2>
<p>Reading the findings of this new study took me back to 1998 when I appeared as a “behavioural addiction expert” on a daytime BBC television alongside people who claimed they were addicted to tanning (dubbed by the researchers on the programme as “tanorexia”). I have to admit that none of the case studies on the show appeared to be addicted to tanning – at least based on my own six behavioural addiction criteria: salience (being the most important and preoccupying activity in the person’s life), mood modifying, tolerance, withdrawal, conflict, and relapse. But it did at least alert me to the fact that some people thought sunbathing and tanning was addictive.</p>
<p>On the show, people likened their excessive tanning to nicotine addiction and there certainly appeared to be some similarities between the people interviewed and nicotine addiction, in the sense that the “tanorexics” knew they were significantly increasing their chances of getting skin cancer as a direct result of their risky behaviour but felt they were unable to stop doing it, which you could argue is very similar to smoking despite knowing the health warnings.</p>
<p>Since then, tanorexia has become a topic for scientific investigation. A <a href="http://archderm.jamanetwork.com/article.aspx?articleid=398011">2005 study published</a> in the Archives of Dermatology claimed that a quarter of the sample of 145 “sun worshippers” would qualify as having a substance-related disorder if ultraviolet light was classed as the substance they craved. The paper also reported that frequent tanners experienced a “loss of control” over their tanning schedule and displayed a pattern of addiction similar to smokers and alcoholics.</p>
<p><a href="http://bit.ly/1yrJb29">A 2006 study</a>, published in the Journal of the American Academy of Dermatology, reported that frequent tanners (those who tanned eight to 15 times a month) that took naltrexone, an endorphin blocker normally used to treat drug addictions, significantly reduced the amount of time spent tanning compared to a control group of light tanners.</p>
<p>Two years later, <a href="http://www.ingentaconnect.com/content/png/ajhb/2008/00000032/00000005/art00001">another study</a> published in the American Journal of Health Behavior reported that 27% of 400 surveyed students were classified as “tanning dependent”. The authors claimed that those classed as being tanning dependent had a number of similarities to substance use, including a higher prevalence among youth; an initial perception that the behaviour was image enhancing; high health risks and disregard for warnings about those risks; and the activity being mood enhancing.</p>
<p>Another <a href="http://ajhpcontents.org/doi/abs/10.4278/ajhp.120912-QUAN-442">just published study</a> in the American Journal of Health Promotion surveyed 306 female students, and classed 25% of the respondents as “tanning dependent” based upon a self-devised tanning dependence questionnaire. </p>
<p>But the problem with this and most of the psychological research on tanorexia to date is that almost all of the research is carried out on relatively small convenience samples using self-reporting and non-psychometrically validated “tanning addiction” measurement scales.</p>
<p>Although some studies suggest that some of my addiction criteria appear to have been met, I have yet to be convinced that any of the published studies to date show all of them. In short, empirical research evidence demonstrating a genuine addiction to tanning that encompasses all the known and expected physical and psychological consequences of addiction has yet to be proven.</p><img src="https://counter.theconversation.com/content/28283/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Mark Griffiths has received research funding from a wide range of organizations including the Economic and Social Research Council, the British Academy and the Responsibility in Gambling Trust. He has also carried out consultancy for numerous gaming companies in the area of social responsibility and responsible gaming.</span></em></p>If the many media reports are to be believed: “Sunshine can be addictive like heroin.” The claim comes via a study published in Cell based on an experiment carried out on mice at Harvard Medical School…Mark Griffiths, Director of the International Gaming Research Unit and Professor of Gambling Studies, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/21792011-08-23T04:15:56Z2011-08-23T04:15:56ZNot a sunny outlook: tighter sunbed regulation is long overdue<figure><img src="https://images.theconversation.com/files/3087/original/Cadillac_Solarium.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sunbeds session pose a significant risk of developing melanomas that is completely avoidable.</span> <span class="attribution"><span class="source">Froztbyte/Wikimedia Commons</span></span></figcaption></figure><p>Before she died in September 2007 of melanoma attributed to solarium tanning sessions, 26-year-old Clare Oliver waged a public campaign from her hospital bed to raise awareness of the risks of using sunbeds. </p>
<p>Oliver called for a ban on solaria and expressed frustration that governments had failed to effectively regulate the industry despite knowing of associated risks.</p>
<p>Her efforts attracted significant media and public attention to scientific evidence about the dangers of sunbed sessions. </p>
<p>Politicians at state and federal levels were forced to address seeming official reluctance to regulate an industry that operated under a <a href="http://www.mja.com.au/public/issues/189_07_061008/mac10610_fm.html">voluntary code of conduct despite constituting a significant and wholly avoidable risk</a> for melanoma. </p>
<p>The significance of official reluctance to ban the industry has been magnified by <a href="http://onlinelibrary.wiley.com/doi/10.1002/ijc.25576/abstract">findings of a recent Australian study</a> on the links between sunbed use and early onset malignant melanoma.</p>
<p>Analysis on 604 diagnoses of melanoma in people aged 18 to 39 years in Sydney, Melbourne and Brisbane found the risk of early onset melanoma was 41% greater among sunbed users.</p>
<p>And the risk was roughly double for those who had undergone more than ten sessions in their lifetime.</p>
<p>Sunbed use is also estimated to be responsible for three-quarters of melanomas occurring among 18- to 29-year-olds who have ever used one, accounting for 16% of all melanomas diagnosed in this age group. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/3089/original/Tanning_bed_in_use__282_29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/3089/original/Tanning_bed_in_use__282_29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/3089/original/Tanning_bed_in_use__282_29.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/3089/original/Tanning_bed_in_use__282_29.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/3089/original/Tanning_bed_in_use__282_29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/3089/original/Tanning_bed_in_use__282_29.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/3089/original/Tanning_bed_in_use__282_29.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sunbeds may be responsible for three-quarters of all melanomas in people aged 18 to 29. Alexis O’Toole.</span>
</figcaption>
</figure>
<h2>Failure of self-regulation</h2>
<p>At the time of Clare Oliver’s campaign, the solarium industry was expanding rapidly due largely to misguided perceptions about the cosmetic benefits of tanned skin.</p>
<p>The number of outlets in Melbourne, for instance, grew by more than five times between 1996 and 2006. </p>
<p>The industry’s voluntary code of practice included guidelines on UV radiation, session length, and hygiene. </p>
<p>Potential users with Type 1 skin, defined by the World Health Organization (WHO) as <a href="http://www.who.int/uv/publications/en/sunbeds.pdf">skin that cannot tan and is most susceptible to sunburn</a>, and those under 15 were prohibited.</p>
<p>Fifteen to 18-year-olds required written parental permission and all clients were to be informed of associated cancer risks. </p>
<p>But the code allowed for UV radiation levels five times higher than levels possible from sun exposure. </p>
<p>And assessments of solaria operations at the time <a href="http://www.mja.com.au/public/issues/189_07_061008/gor10291_fm.html">found lax compliance with guidelines</a> on users with Type 1 skin, age limits, informed consent, and posting of warning notices. </p>
<p>A <a href="http://tiny.cc/v6ku7">survey in Melbourne</a>, for instance, found:</p>
<ul>
<li><p>over half the operations observed allowed teenagers access without parental permission; </p></li>
<li><p>90% allowed access to customers with type I skin and; </p></li>
<li><p>staff at three-quarters of solaria contravened the code by reassuring clients about the safety of sunbed tanning.</p></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/3083/original/Clare_Oliver_AAP.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/3083/original/Clare_Oliver_AAP.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=484&fit=crop&dpr=1 600w, https://images.theconversation.com/files/3083/original/Clare_Oliver_AAP.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=484&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/3083/original/Clare_Oliver_AAP.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=484&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/3083/original/Clare_Oliver_AAP.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=608&fit=crop&dpr=1 754w, https://images.theconversation.com/files/3083/original/Clare_Oliver_AAP.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=608&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/3083/original/Clare_Oliver_AAP.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=608&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The solarium industry was found to have made false and misleading claims in the aftermath of Clare Oliver’s death. AAP.</span>
</figcaption>
</figure>
<h2>Steps in the right direction?</h2>
<p>Since Clare Oliver’s campaign, the Federal Court has ruled that the solarium industry made false and misleading claims on Internet sites about the safety of indoor tanning days after her death.</p>
<p>The Court required outlets to post signs informing customers of the risks associated with their facilities. And state governments enacted regulations, primarily around skin type and age. </p>
<p>Typically heralded as tough by policymakers, these <a href="http://www.mja.com.au/public/issues/189_07_061008/mac10610_fm.html">regulations wouldn’t have impeded Clare Oliver using solaria</a>, as she was not fair-skinned and was 19 years old at the time of her sessions.</p>
<p>Worryingly, these regulations could also unintentionally reassure the public about sunbed use and potentially protect the industry from legal action. </p>
<p>Solarium numbers have dropped in the wake of unfavourable media attention and regulation, possibly by as much as one-third. But <a href="http://www.environment.nsw.gov.au/resources/radiation/09814solicarus.pdf">recent reports</a> by the NSW Depart of Environment, Climate Change & Water pointing to <a href="http://www.environment.nsw.gov.au/resources/radiation/10310solaurora.pdf">poor compliance</a> with new state regulations suggest key problems with the industry have not been adequately resolved. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2009.00436.x/full">Estimates</a> of 281 new melanoma diagnoses and 43 related deaths in Australia annually due to solarium visits, raise the question of why governments fail to ban the industry outright. </p>
<p>Sunbed sessions offer no positive consequences while posing significant and wholly avoidable risks for melanoma. </p>
<p>Campaigns to convince people to reduce exposure to the sun have achieved mixed results but the solarium industry represents an easily managed risk factor if governments act decisively. </p>
<p>The demise of the industry would be mourned by few.</p><img src="https://counter.theconversation.com/content/2179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ross MacKenzie has previously worked for Cancer Council NSW, which has called for stricter regulation of the solarium industry. </span></em></p>Before she died in September 2007 of melanoma attributed to solarium tanning sessions, 26-year-old Clare Oliver waged a public campaign from her hospital bed to raise awareness of the risks of using sunbeds…Ross MacKenzie, Lecturer in Health Studies, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.