A sunbed (British English), tanning bed (American English) or sun tanning bed is a device that emits ultraviolet radiation (typically 95% UVA and 5% UVB, +/-3%) to produce a cosmetic tan. Regular tanning beds use several fluorescent lamps that have phosphor blends designed to emit UV in a spectrum that is somewhat similar to the sun. Smaller, home tanning beds usually have 12 to 28 100 watt lamps while systems found in tanning salons can consist of 24 to 60 lamps, each of 100 to 200 watts.
There are also "high pressure" tanning beds that generate primarily UVA with some UVB by using highly specialized quartz lamps, reflector systems and filters. These are much more expensive, thus less commonly used. A tanning booth is similar to a tanning bed, but the person stands while tanning and the typical power output of booths is higher.
Because of the adverse effects on human health of overexposure to UV radiation, including skin cancer, cataracts, and premature skin aging, the World Health Organization does not recommend the use of UV tanning devices for cosmetic reasons. Studies have shown that tanning bed usage is associated with an increased risk of skin cancer, including melanoma. Misusing a sunbed by not wearing goggles may also lead to a condition known as arc eye (snow blindness). Occasional acute injuries occur where users carelessly fall asleep, as in the case of Marty Cordova.
- 1 Tanning lamps
- 2 Health effects
- 3 Regulation
- 4 Comparison to natural tanning
- 5 Ultraviolet radiation
- 6 Medical use
- 7 History
- 8 See also
- 9 References
- 10 External links
This section is written like a manual or guidebook. (August 2010)
Tanning lamps (sometimes called tanning bulbs in the United States or tanning tubes in Europe) are the part of a tanning bed, booth or other tanning device which produces ultraviolet light responsible for tanning. There are hundreds of different kinds of tanning lamps most of which can be classified in two basic groups: low pressure and high pressure. Within the industry, it is common to call high-pressure units "bulbs" and low-pressure units "lamps", although there are many exceptions and not everyone follows this example. This is likely due to the size of the unit, rather than the type. Both types require an oxygen free environment inside the lamp.
Fluorescent tanning lamps require an electrical ballast to limit the amount of current going through the lamp. While the resistance of an incandescent lamp filament inherently limits the current inside the lamp, tanning lamps do not and instead have negative resistance. They are plasma devices, like a neon sign, and will pass as much current as the external circuit will provide, even to the point of self-destruction. Thus a ballast is needed to regulate the current through them.
Efforts by the tanning industry to frame artificial UV radiation (UVR) as a product associated with health and fitness have been challenged successfully by proponents of public health such as the World Health Organization’s International Agency for Research on Cancer, the US Department of Health and Human Services, the European Union, the Canadian Cancer Society, the Canadian Pediatric Society, several provinces in Canada, and states throughout Australia and the United States.
The US FDA and the FTC forbid use of the words "safe" or "safer than" regarding indoor tanning, in response to a claim by the tanning industry that indoor tanning provides greater control over UV exposure to customers over outdoor exposure. E.g. it is claimed that a tanning bed offers an environment that delivers consistent, predictable exposure. However, there is no evidence that this provides a safe or even safer environment, and a number of studies demonstrate that indoor tanners are quite likely to get burned and suffer other skin damage during their indoor tanning sessions.
A frequently claimed benefit of artificial tanning is the increased production of vitamin D. UVR exposure is highly variable and depends on several factors. Skin phenotype, as measured on the Fitzpatrick scale, influences the skin’s response to UV radiation. Fitzpatrick Types I and II (fair skin, eyes, and hair) burn easily and can produce maximal vitamin D photosynthesis in less than 10 minutes of midday sun. People with Fitzpatrick Types I and II are at the highest risk of photodamage (whether from the sun or artificial tanning) and are at the lowest risk of vitamin D insufficiency if photosynthesis occurs. Other variables include quantity of skin exposed, and the degree of one's vitamin D deficiency. The human body can produce up to 10,000 IUs of vitamin D in 10 minutes, as it can with exposure to natural sunlight. Many people with indoor lifestyles may not receive enough. When artificial UVR was introduced commercially, devices used similar UVA and UVB ratios as the Sun. Tanning bed emitters have varied in the mix and intensity of UVA and UVB generated. Recently, high-intensity UVA-emitting lamps have been introduced to achieve more efficient tanning in shorter sessions; these have a much lower ratio of UVB to UVA, and are much less effective for the purpose of Vitamin D production.
In a research project funded by the United States National Institutes of Health and a grant from the UV Foundation, Tangpricha, V. et al. identified, "the regular use of a tanning bed that emits vitamin D–producing ultraviolet radiation is associated with higher 25(OH)D concentrations and thus may have a benefit for the skeleton." Michael F. Holick, an investigator in the study, declared a conflict of interest because he serves as a consultant to the UV Foundation. The UV Foundation garners financial support from the Indoor Tanning Association, OSRAM (a German lamp and lighting company), and Future Industries (a United States importer of tanning beds, tanning bed supplies, and lamps). Most scientists thus question the study's validity and disagree with these conclusions. The Institute of Medicine (IOM) recently completed an exhaustive review of Vitamin D benefits and requirements, and concluded that at present, conclusive evidence of Vitamin D's benefit can only be stated for bone health, but that many more areas require further study.
Humans can acquire Vitamin D from dietary sources and vitamin supplements, without the need for UVR exposure for vitamin D production, an exposure that carries substantial overlap with DNA damage. The European Commission Health and Consumer Protection Directorate (Scientific Committee on Consumer Products) has concluded that dietary vitamin D intake, along with oral supplements and intermittent testing of Vitamin D levels, is thought to be likely more effective than tanning, without incurring a carcinogenic risk
In Canada, following a complaint to the Competition Bureau in 2005 by the Canadian Cancer society, a subsequent consent agreement with the largest chain of tanning salons in the country stipulated that they: 1) "Stop making representations to the public linking indoor tanning with the unproven benefits of Vitamin D," 2) acknowledge in any promotion of artificial UVR that "Tanning is not required to generate vitamin D. Vitamin D levels in the body may be maintained by oral supplements without tanning," and (3) pay an administrative monetary penalty
The Indoor Tanning Association settled with the FTC in January 2010 regarding false health and safety claims about indoor tanning. Contrary to claims in the association’s advertising, indoor tanning increases the risk of squamous cell and melanoma skin cancers, according to the FTC complaint. The association has agreed to a settlement that bars it from any further deception. "The messages promoted by the indoor tanning industry fly in the face of scientific evidence," said David C. Vladeck, Director of the FTC’s Bureau of Consumer Protection. "The industry needs to do a better job of communicating the risks of tanning to consumers." The FTC complaint alleges that in March 2008, the association launched an advertising campaign designed to portray indoor tanning as safe and beneficial. The campaign included two national newspaper ads, television and video advertising, two Web sites, a communications guide, and point-of-sale materials that were provided to association members for distribution in local markets.
Overexposure to ultraviolet radiation is known to cause skin cancer, advance skin aging and wrinkling, mutate DNA, and reduce immune system response. Tanning bed use is associated with an increased risk of being diagnosed with melanoma. Children and adolescents who use tanning beds are at greater risk because of biological vulnerability to ultraviolet radiation.
Government and skin cancers
The US Public Health Service states that UV radiation, including the use of sun lamps and sun beds are "known to be a human carcinogen." It further states that the risk of developing cancer in the years after exposure is greatest in people under 30 years old. A Report of the International Agency for Research on Cancer (IARC) suggested in 2005 that policymakers should consider enacting measures, such as prohibiting minors and discouraging young adults from using indoor tanning facilities. Since then, many states have mandated parental consent for persons under the age of 18 prior to tanning bed use.
There is scientific evidence that each of the three main types of skin cancer, basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma, is caused by UV exposure. Women who visited a tanning parlor at least once a month were 55% more likely to later develop melanoma than women who did not artificially suntan.
Young women who used sun lamps for tanning while in their 20s had the largest increase in subsequent cancer risk – about 150% higher than similar women who did not use tanning beds. Overexposure to ultraviolet radiation induces at least two common genetic mutations. Those include cyclobutane–pyrimidine dimers (CPDs) and 6–4 photoproducts (6–4PPs) and their Dewar valence isomers.
The mutation types generally differ between UVA and UVB light. Mutant cells may die, or become cancerous, depending on which genes were mutated. While DNA repair enzymes can fix some mutations, they are not sufficiently effective, as demonstrated by the relation to cancer, aging and other types of persistent mutation and cell death. For example, squamous cell carcinoma (a type of skin cancer) is caused by a UVB induced mutation in the p53 gene.
UVA light specifically (sometimes called 'bronzing light') is clearly associated with increased skin aging and wrinkle production. UVA and UVB both penetrate the skin, creating free radicals and reactive oxygen species, which in turn damage DNA. Most aging of skin is due to UVA rays destroying collagen and connective tissue beneath the superficial layer of the skin. UVB rays cause skin to burn and directly damages DNA by interfering with its replication cycle. Excessive exposure to UVA radiation has its risks, which may cause premature aging, including wrinkles, sunspots, and loss of skin elasticity.
In July 2009, the IARC released a report that placed tanning beds in its highest cancer risk category, "carcinogenic to humans." The agency, which is part of the World Health Organization (WHO), previously classified tanning beds as "probably carcinogenic." The change comes after an analysis of more than 20 epidemiological studies indicating that people who begin using tanning devices before age 30 are 75% more likely to develop melanoma, the most deadly type of skin cancer.
A 2009 Associated Press article stated, "International cancer experts have moved tanning beds and other sources of ultraviolet radiation into the top cancer risk category, deeming them as deadly as arsenic and mustard gas."
The Irish Health Minister in August 2009 said that she is considering outlawing the industry completely given that tanning beds are dangerous and are hugely contributing to people developing skin cancer. In June 2014, Ireland announced it was implementing a law banning the use of, hire and sale of tanning beds, which they termed sunbeds, involving people under 18 from July 2014. A similar measure was introduced in neighboring Northern Ireland in May 2012.
From a recent review of the literature by the Canadian Pediatric Society: "Up to one-quarter of sunbed users report one or more adverse health effects other than skin cancer. Erythema and sunburn are the most common artificial UVR-exposure complications. Also reported are more serious burn and other injuries, as well various potential infections. Other frequent side effects include skin dryness, pruritus, nausea, photodrug reactions (including popular acne medications used by teens), disease exacerbation and disease induction. Long-term health effects include skin-aging and effects on the eyes similar to that arising from natural UVR exposure"
The Canadian Pediatric Society has also raised the concern that "repeated UVR exposures, and the use of indoor tanning beds specifically, may have important systemic and behavioural consequences, including mood changes, compulsive disorders, pain and physical dependency."  Evidence for this comes from several scientific articles. In one, indoor tanners reported mood enhancement, relaxation and socialization consistent with reinforcement patterns seen with smoking addiction. In a randomized clinical trial, the administration of an opiate-receptor blocker induced withdrawal-like symptoms among frequent tanners, suggesting an opiate-like addiction. Study of youthful frequent indoor tanning bed users demonstrated addictive-like behaviors.
One biologic explanation for the addictive potential of tanning may be that the UV-tanning response involves melanin stimulating hormone (MSH) production, and this may accompanied by the release of β-endorphin, which shares the same precursor peptide (propriomelanocortin). The production of ß-endorphin is produced in the same pathway was shown in a study exploring the pathway of the tanning response. Another study, however, concluded that there were no significant differences in the mean plasma levels of β-endorphin between people who were exposed to tanning beds and those who were not.
Tanning beds can contain many microbes, some of which are pathogens that can cause skin infections or can be ingested and cause gastric distress. The most common pathogens found on tanning beds are: Pseudomonas spp. (aeruginosa and putida), Bacillus spp., Klebsiella pneumoniae, Enterococcus species, Staphylococcus aureus, and Enterobacter cloacae.
Children and adolescents who use tanning beds are at greater risk because of biological vulnerability to UV radiation. Epidemiological studies have shown that exposure to artificial tanning increases the risk of malignant melanoma and that the longer the exposure, the greater the risk, particularly in individuals exposed before the age of 30 or who have been sunburned.
Melanoma is increasing faster in females 15–29 years old than males in the same age group. In females 15–29 years old, the torso is the most common location for developing melanoma, which may be the result of high-risk tanning behaviors.
One study conducted amongst a college student population found that awareness of the risks of tanning beds did not deter the students from using them. A study published in Pediatrics in 2002 identified the main psychosocial factors of children and adolescents who using tanning beds as: having friends who tan, the belief that it’s ok to get burned in order to achieve a good tan, and that having tanned skin is more attractive and healthier looking than pale skin.
In a national sample of non-Hispanic white teenagers, 24% of respondents [or 2.9 million teens] between the ages of 13 to 19 reported using a tanning facility at least once in their lives. Nationally, more than 25% of teenage girls have used tanning salons three or more times in their lives. Ten percent of teens visit tanning salons weekly. Teenagers are frequent targets of the tanning industry’s highly visible marketing tactics, attracting teens through coupons and media outlets, and going as far as placing ads in high school newspapers. It is difficult for a teen to resist offers for free tanning trial periods, membership deals, steep discounts, or "unlimited tanning".
For children and adolescents who use indoor tanning facilities for cosmetic reasons, the focus on perceived, immediate benefits overshadows the cumulative risks and consequences in the future. Parents, pediatricians, public health practitioners, and lawmakers are rallying support to provide more comprehensive information and support to young people who use tanning beds.
In May 2012 Northern Ireland banned the use, hire and sale of tanning beds for children and teenagers under 18. A similar law was announced in Ireland in June 2014, to be effective from July 2014.
On 2003, Brazil outlawed the use of tanning beds for people less than 18 years old. The National Health Surveillance Agency expanded the ban to use of tanning beds for aesthetic purposes in 2009. The Brazilian government also deemed the use of tanning beds unnecessary, due to the tropical temperatures in Latin America.
The European Union is discussing new regulations that would limit the amount of UVB allowed in tanning lamps and devices. In the United Kingdom (except for Northern Ireland), anyone under 18 years of age will be banned from using sunbeds, as this legislation was passed by Parliament. This also includes salons. Elsewhere in Europe, under 18s are prohibited from indoor tanning in Belgium, The Netherlands, Finland, France, Germany, Spain, Iceland, Norway, Ireland and Lithuania.
The Province of Ontario re-introduced the Skin Cancer Prevention Act (Bill 74) on April 26, 2012, with the goal of protecting youth under the age of 18 from the dangers associated with indoor tanning by restricting youth access and requiring that all indoor tanning facilities post health warnings in clear view of customers.
On December 9, 2010, the Province of Nova Scotia passed Bill 102 - this bill effectively bans minors under 19 from indoor tanning.
On January 12, 2011, the Capital Regional District (CRD) of Victoria British Columbia passed Bylaw No.3711. The bylaw regulates the indoor tanning industry, and includes provisions to ban teens under 18 from using tanning beds in thirteen municipalities and two regional districts on lower Vancouver Island. The CRD staff reported that Vancouver, Toronto and ten other Canadian cities have expressed interest.
In June, 2012, the province of Quebec adopted the law 74. This law prohibit tanning bed for minors under 18.
As of July 2012, the provinces of British Columbia, Quebec and Newfoundland have also announced plans to ban minors from indoor tanning.
In the fall of 2012, Canadians MP's will be voting on Private Member's Bill C-386 tabled by conservative MP James Bezan in an attempt to ban tanning beds for those under 18 years of age, and strengthen warning labels on tanning beds for Canadians of all ages. http://www.jamesbezan.com/news.asp?newsID=2103
On August 13, 2012, the Town of Oakville became the first municipality in Ontario to ban the use of tanning beds for individuals under the age of 18.
The sunbed industry in New Zealand operates under a voluntary code of practice. A 2009 survey, as well as surveys in other years by Consumer New Zealand, found that there was a high level of non-compliance with the code. Various health organisations are calling for mandatory regulation of the industry.
Between 2009 and 2012, the number of sunbed operators in Auckland dropped from 73 to 39, as tougher regulations were introduced.
In the United States, the maximum exposure time in most tanning beds is 20 minutes but varies from bed to bed. This is calculated by the manufacturer according to the amount of time needed to produce four MEDs (minimal erythemal doses). This is essentially four times the amount of UV that is required to produce a reddening on unexposed skin. A person would start with a much shorter session time and work their way to the maximum exposure time in about four weeks. Every tanning bed is required to have a "Recommended Exposure Schedule" on both the front of the tanning bed and in the owners manual. It must also list the original lamp that was certified for that particular tanning bed, and salon owners must replace the lamps with either exactly the same lamp, or a lamp that is certified by the lamp manufacturer to be . Lamp replacement and salon compliance is regulated by the individual state in the USA, whereas the manufacturing and sale of new equipment is regulated by the federal government.
Since many factors can change the performance of any given individual lamp, the United States Food and Drug Administration requires that every tanning bed model is certified separately, and lamps themselves do not have MED ratings. Lamps do have typical TE (or Time Exposure) ratings, but these are not used for certifying beds. Session times on beds can range from 5 minutes to 20 minutes, depending on many factors. In 2010, an FDA panel recommended banning the use of tanning beds for people under 18 years old.
In 2010, to help fund the $940 billion health care overhaul, a 10% tax on individuals receiving indoor tanning services was tacked on, and the initiative is expected to generate $2.7 billion over ten years. The IRS has created audit guides for revenue agents concerning indoor tanning services.
The Food and Drug Administration advisory board, World Health Organization, American Medical Association, American Academy for Dermatology, and the American Academy of Pediatrics (AAP) support legislation for a federal ban against the use of tanning salons by persons under the age of 18. Numerous states have proposed or enacted bills for restricting use of tanning beds by children and adolescents. Factors influencing the passage or failure of these bills include: lawmakers’ unwillingness to infringe on young people’s freedom of choice, and the glamorization of a tan leading to inadequate skin protection.
Regulation of Tanning Beds for Minors
Some states have regulated the use of tanning beds for minors. California banned minors under the age of 18 from using tanning beds. The previous law allowed tanning bed use for minors between the age of 14 and 18 only by parental consent. Lawmakers in the state cited health concerns over the use of ultraviolet rays in tanning beds. Texas, a state known for limited regulation, signed Senate Bill 238 into law in 2013 banning minors from indoor tanning. The bill overturned a law allowing minors between 16 1/2 and 18 to tan with parental consent.
Regulation in Colorado
Starting January 1, 1993, and every year following, owners of artificial tanning facilities must register the facility with Colorado Department of Public Health and Environment (CDPHE) and pay appropriate registration fees. Owners of such facilities are required to: 1) Provide CDPHE with the safe and proper operation of the tanning device 2) Post a sign on the premises notifying patrons of the safety and health risks associated with using the tanning devices. This notice must be of a noticeable size and be easily read and found by users. 3) Provide patrons with a written handout, which includes the negative health effects of the device, UV radiation exposure, safety equipment that should be used while tanning and information about the device itself. 4) Provide the users with the safety equipment required by CDPHE. 5) Provide and maintain sanitation and cleaning of equipment. 6) Report accidents or adverse reactions to CDPHE. 7) Employees or owner of facility cannot promote or advertise that using tanning beds is safe and risk-free.
Policies in other states: most state require written parental/guardian permission for children under 18. Some states ban tanning for 16 and 14-year-olds (and under). 21 states to introduce new regulations in 2011-2012, most would prohibit under-18-year-olds from using facilities.
In Australia, the solarium industry is regulated on a state by state basis. The first states to regulate solarium use were Victoria, South Australia and Western Australia in 2008 following the death of skin cancer victim Clare Oliver. The 2008 regulations cited that solarium operators must be licensed, unsupervised solariums were banned and health warnings must be displayed. In Victoria, those under the age of 16 and people with fair skin were banned from using solariums and those aged 16 and 17 were required to have parental consent whereas in South Australia and Western Australia, an outright ban for the under 18s was applied.
In February 2009, the Victorian Government introduced further changes to the management licence for tanning units, including applying a ban for the under 18s, consistent with the revised Australian standard, released in January 2009. Victorian solarium legalisation was revised in late 2010, strengthening some controls around sighting evidence of age documents in relation to excluding persons under 18.
The Australian standard requires that operators must: (a) ban people under 18 years of age from using their solarium, (b) cite evidence-of-age documents for clients who may be under 18, (c) ban people with very fair skin (skin type I) from using their solarium, (d) display mandatory health warnings, (e) provide a consent form outlining the risks of solarium use for customers to read and sign, (f) complete a skin assessment of all clients, (g) ensure all staff have completed training in carrying out skin assessments and determining exposure times, and (h) ensure clients wear protective eyewear.
New South Wales, Queensland, ACT and Tasmania introduced legislation applying these standards in 2009 and 2010. In 2011, the New South Wales government called for public submissions in relation to a proposal to extend the age ban from using solariums to those under 30. In February 2012 the New South Wales Government announced its intention to ban tanning beds, starting in 2014. In October 2013, the Victorian parliament passed an official ban on solariums, which will take effect by 2015.
Comparison to natural tanning
Most tanning beds have about the same amount of UVA as sunlight (as opposed to UVB), while the 'warning signs' of overexposure, such as sunburn, do not appear at the same rate indoors as out. Furthermore, the radiation levels are more intense, requiring individuals to limit their exposure to very brief periods. The carcinogenic mutations in some skin cancers have been linked to UVA radiation more than UVB, suggesting that beds have different risks than natural light. The UVA light is also more strongly associated with skin aging than UVB, and with genetic damage.
The sun emits UVR in the form of A, B, and C waves. They are named according to the length of the wave and are associated with various health events. The ozone affects UVR from the sun and different amounts reach the earth's surface depending on the wavelength. Sunbeds can have the same health effects as UVR from the sun.
UVA wavelengths (315-400 nm) are the longest wavelengths, and are only slightly affected by ozone levels. Most UVA radiation is able to reach Earth's surface and can contribute to skin aging, eye damage, and can suppress the immune system.
- Most of the UV radiation in tanning beds is UVA, but may be 10 to 15 times more intense than midday sun.
- UVA penetrates the skin more deeply and does not cause a burn.
- UVA does not damage DNA directly like UVB and UVC, but it can generate highly reactive chemical intermediates, such as hydroxyl and oxygen radicals, which in turn damage DNA.
UVB wavelengths (280-315 nm) are strongly affected by ozone levels. Decreases in stratospheric ozone mean that more UVB radiation can reach Earth's surface.
- UVB causes burns, snow blindness, immune system suppression, and a variety of skin problems including skin cancer and premature aging.
- Short-wavelength UVB has been recognized for some time as carcinogenic in experimental animals.
UVC wavelengths (180-280 nm) have the shortest wavelengths, and are very strongly affected by ozone levels. Virtually all UVC radiation is absorbed by ozone, water vapor, oxygen and carbon dioxide before reaching Earth’s surface.
- Tanning lamps do not emit UVC.
Some people with keratosis, psoriasis, and eczema are treated with UVB light therapy. This is typically in the 310 nm to 315 nm portion of the UVB spectrum. Virtually all fluorescent tanning lamps have one spectral peak within this region of the UVB spectrum, making them an effective tool in mild to moderate cases. In some circumstances, salon memberships have been prescribed and more rarely the purchase of home tanning beds have been prescribed by doctors and may be covered by insurance policies.
Tanning may temporarily help some forms of acne by drying out the skin, but it is not a solution that lasts for very long. Further, most prescription or over the counter acne medications (e.g. Accutane, benzoyl peroxide, Retin-A), when used in combination with ultraviolet exposure, may lead to burning or delayed healing due to photosensitivity that these drugs (and many others) can create.
In the United States, sunbeds have been regulated by the Food and Drug Administration's 21CFR 1040.20, which was amended in 1986 to include lamp compliance, warning labels and eye protection. This regulation was designed primarily to ensure that all sunbeds sold or used in salons adhered to a general set of safety rules, with the primary focus on sunbed and lamp manufacturers in regards to maximum exposure times and product equivalence. In addition, states have the opportunity to extend regulations for salons themselves, regarding the operator training, the sanitization of the sunbed and eyewear, and additional warning signs. For a comprehensive list of states with indoor tanning restrictions for minors and their specific laws, see the National Conference of State Legislatures.
More American states are seeking to ban young adults from commercial salons.
Wolff System Technology published surveys in 2004 showing that there is a 30 million customer base in the U.S.—about 10% of the total US population. 2.3 million of these customers are teens. 18.1% of women tan indoors while 6.3% of men tan indoors. 13% of indoor tanners are teens, 20.4% are young adults (age 18-29), 13% are adults (age 30-64) and 9.8% are older adults (age 65+).
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