UV Exposure, Sunbeds and Tanning: 6 Things You Probably Didn't Know
Taking proper care in the sun is extremely important, we all agree on that. Yet,
exposure to UV light carries both risks and benefits and over the last few decades, the focus has only been on the risk of over-exposure and that sunlight should be avoided at all costs. But in the last few years, an increasing number of studies have identified bias in older research and that moderate exposure to UV light may outweigh the risk of over-exposure.
It is important to have a balanced discussion in order to be part of the solution to address concrete challenges related to UV exposure, tanning and sunbed use. As policies need to rely on solid evidence, let’s take a look at the key misconceptions about UV tanning.
1. A SUNTAN IS NATURAL
“The dogma, now fossilised in print, is that any tan is a sign of skin damage. Tell that
to Darwin. Even if there was hard evidence that melanoma was UV-induced it would
be all the more important to keep a protective tan” - Emeritus Dermatology Professor Dr Sam Shuster, Newcastle University.
This is not the public health message we are getting today though, as sunlight and tanning are portrayed as something to be avoided at all costs. Sun avoidance has been repeatedly proven as harmful, as sunlight helps to keep healthy Vitamin D levels in the blood, along with other photoproducts like nitric oxide, which fights chronic diseases like hypertension and arteriosclerosis. Furthermore, a study showed the mortality rate is twice as high in women who avoid sun exposure compared to those who were more exposed to the sun1.
A 2019 commentary titled ‘Sun Exposure Public Health Directives’2 states “The public health directive regarding sun exposure and human health should be adjusted to reflect current scientific knowledge. We recommend a public health directive as follows: All persons in the world regardless of skin colour or latitude of residence, other than those with extraordinary sensitivity to sunlight, should get enough sun exposure to maintain a serum 25(OH)D level well over 20ng/mL desirably at 30-60 ng/mL) while taking care to avoid sunburn.”
2. SUNBEDS ARE BASICALLY LIKE THE SUN: ENJOY IN MODERATION!
UV emitted from sunlight and sunbeds are more similar than is generally thought: the UV in midday summer sunlight is made up of about 95% UVA light and 5% UVB light. Most indoor tanning equipment emit the same, with a maximum intensity equalling the midday sun in the Mediterranean. So a 10 minute sunbed session is equivalent to a 10 minute summer sunbathing session on the beach in Spain. This is guaranteed through the British Standard BS 60335-2-27, limiting UV output from sunbeds to 0.3W/m2. The major difference, however, is that UV from a sunbed is easily controlled to avoid over-exposure by trained operators following Professional Standards.
3. REGULAR UV EXPOSURE ACTUALLY LOWERS MELANOMA RISK
UV has a complex and often-misunderstood relationship with melanoma skin cancer risk. Consider: indoor workers who get less UV exposure get more melanomas than outdoor workers who get regular sun exposure. The largest meta-analysis of risk factors for melanoma found that people with the most UV exposure, chronic UV exposure which was defined as continuous regular exposure had a 5% reduced risk of melanoma3.
That is why sunburn – not regular sun exposure – is the main UV-related risk factor and total sun avoidance as proclaimed by the WHO4 is a major mistake.
4. THE RISKS AND BENEFITS OF SUNBED USE HAVE NOT BEEN PRESENTED ACCURATELY
The latest meta-analysis of research for sunbeds in Europe “did not show an association” with melanoma (OR=1.10; 95%CI=0.95-1.27, p=0.218)5 In addition, the report by SCHEER (Scientific Committee of the European Commission) and the WHO report (IARC) have been discredited in a review paper for being based on a “an incomplete, unbalanced and non-critical evaluation of the literature”6.
Research has shown tanning before a sunny holiday will reduce your risk of sunburning by 75% and DNA damage by 60%7. The relationship between solar UV radiation and skin cancer is so extremely complex, it is inappropriate to attribute any single factor to the development of a cancer. This may depend on the interaction between many variables, such as age, genetics, diet, smoking, alcohol, environment and lifestyle.
Recent studies confirmed that two cancers out of three are basically unavoidable, due to DNA copying errors rather than environmental factors8. This is why we cannot ignore such multi-layered context when designing public health policies, steering away from any simplification targeting a single factor.
5. INDOOR TANNING FACILITIES PROVIDE PERSONALISED ADVICE TO
Professional tanning salons offer thorough screening of customers, checking for any contra-indications to tanning and advise on controlled exposure to UV rays, in terms of an individual progressive tanning schedule that avoids sunburn. Very fair skinned people (with so-called ‘Type 1’ skin – always burn, never tan) and minors are not allowed to use sunbeds.
6. VITAMIN D DEFICIENCY IS A GLOBAL PUBLIC HEALTH ISSUE
Over one billion people in the world are either vitamin D deficient or insufficient, making it a proper global epidemic: current research shows that low vitamin D levels play a role in causing as many as 17 varieties of cancer, cardiovascular diseases and bone health9.
Sunlight is the natural way the body was designed to produce vitamin D (actually a hormone) and unlike with supplements you cannot go to toxic levels as the body limits its own production. Vitamin D deficiency is a sunlight deficiency considering most people are indoors most of the time. Sunbeds were originally invented to trigger vitamin D production in light deprived Northern European populations, and they continue to provide such benefit. In fact, a recent research paper on sunbeds and vitamin D found that sunbeds raise participants’ vitamin D to optimal levels for health10.
Vitamin D is only present in a few foods and in very low amounts (fatty fish like salmon, eggs, dairy) and obviously can also be taken through supplements. However, ‘when you ingest vitamin D, only about 60% of it sticks to vitamin-D binding protein, but when you make vitamin D in your skin, 100% binds to the protein’ as stated by Dr Michael Holick, vitamin D research pioneer from the Boston University School of Medicine, USA. Low Vitamin D blood levels may only be an indicator of a sunlight deficiency. Recent research shows that sunlight reduces the risk of Multiple Sclerosis11.
We are of the opinion that moderate UV exposure (less than the time required to burn, adapted individually according to skin type and precedent exposure) should be sought rather than avoided, whether in the sunshine or in a professional tanning salon.
1 Lindqvist PG, Epstein E, Nielson K, Landin-Olsson M, Ingvar C, Olsson H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort.
2 Hoel DG, de Gruijl FR. Sun Eposure Public Health Directives. Int. J. Environ. Res. Public Health
3 Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: II.
4 WHO IARC Monographs on the Evaluation of Carcinogenic Risk to Humans.
5 Burgard et al. Solarium Use and Risk for Malignant Melanoma: Meta-analysis and Evidence based MedicineSystematic Review.
6 Reichrath et al. A Critical Appraisal of the Recent Reports on Sunbeds from the European Commission’s Scientific Committee on Health, Environmental and Emerging Risks and from the World Health Organisation.
7 de Winter S, Vink AA, Roza I, Pavel S. Solar-simulated skin adaptation and its effect on subsequent UV-induced epidermal DNA damage
8 Tomasetti C, Vogelstein B. Variation in cancer risk among tissues can be explained by the number of stem cell divisions, 2015.
9 Naheem Z. Vitamin D deficiency – an ignored epidemic, 2010.
10 de Gruijl FR, Pvel S. The effects of a mid-winter 8-week course of sub-sunburn sunbed exposures on tanning, vitamin D status and colds
11 Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis
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