Look Who's Talking: Suntan Risks - More Than Skin Deep

Article | Dr Roger Henderson, Senior GP, Media Advisor and Health Writer

As the summer months arrive, more and more people are jetting off for their first overseas holiday since the start of the COVID-19 pandemic. Many of them will say they are looking forward to a well-earned break or to ‘get some sun’, and they might have tried to get a suntan in advance by using a tanning booth.

Part of this taps into one of the biggest health myths around, which is that a bronzed and tanned appearance is linked to good health and wellbeing.

The use of tanning salons in the UK is continuing to increase. A major motivating factor in people wanting to get a suntan is to enhance their general appearance to others and make them more attractive to potential partners if they are looking for a relationship. In adolescent women, the desire to tan is driven by appearance and mood enhancement; young men who are bullied, are overweight or have low selfesteem are also more likely to tan. Ninety per cent of women perceive tanned skin as more attractive than pale skin.

There is – of course – a gaping hole in this narrative: there’s no such thing as a safe or healthy tan. In fact, it’s the complete opposite. When your skin reacts to ultraviolet (UV) radiation from the sun or a tanning bed, this is actually evidence of visible DNA injury to your skin, damaging your skin cells and speeding up the visible signs of ageing.

Worse than this, tanning significantly increases your risk of all skin cancers, such as basal and squamous cell cancer and melanoma. This damage starts with your very first tan and every time you subsequently expose your skin to UV rays the damage increases, creating more genetic mutations and greater risk.

One study that looked at women diagnosed with melanoma before the age of 30 found that 97% of them had used tanning beds. The risk of melanoma is also increased by up to 20% for those who have ever used indoor tanning devices. Worldwide, there are more skin cancer cases due to indoor tanning than there are lung cancer cases due to smoking – a truly remarkable statistic – and in the UK, numbers of melanoma cases have rapidly risen to the point where it is now the fifth most common cancer overall.

A tan starts when the skin is exposed to UV radiation and genetic damage is triggered to cells on its outermost layer. To try to prevent further damage, the skin produces the pigment melanin, which darkens the skin and so causes what we know as a tan.

Different types of skin are at greater risk of sun damage, although all types of skin are susceptible to it. The paler your skin, the greater your risk of sun damage and skin cancer.

Having a tan doesn’t increase your protection from sun damage – it’s your skin type, as determined by your genes, that matters.

Despite all these salutary facts, having a ‘healthy’ tan appears to be embedded in the mindset of many people – especially younger adults – and this has led to the rise in demand for so-called tanning pills and tanning injections as a ‘sun-free’ way of getting that desirable healthy glow. Easily obtained online, such products are promoted on social media, often without any balanced understanding of their health risks that would help consumers weigh up whether they are safe.

Tanning pills are non-prescription formulations with variable levels of different ingredients in them. The three usual constituents are canthaxanthin, betacarotene and tyrosine.

• Canthaxanthin is a carotenoid, which is a group of yellow, orange or red pigments. It occurs in mushrooms and crustaceans and is used as food colouring. When ingested, it is deposited in the fat under the skin, creating an orange-brown appearance. Tanning pills containing canthaxanthin have been banned by the American Food and Drug Administration because of side effects including hepatitis, retinopathy (yellow deposits on the retina) and aplastic anaemia, a condition that stops your body producing enough blood cells and can cause death.

• Beta-carotene is a different type of carotenoid, usually obtained through eating fresh fruit and vegetables, which can cause a yellow pigmentation in the skin. High doses are associated with an increased risk of lung cancer in smokers.

• Tyrosine is a precursor to the production of melanin. Users claim that by boosting the level of tyrosine in the body, more melanin is produced. However, there is no evidence to support this claim and tyrosine pills haven’t been shown to work.

All these ingredients also have the potential to be toxic to an unborn baby. Tanning pills are banned in the UK, so they shouldn’t be used by anyone.

Tanning injections – commonly known by the name ‘melanotan’ – have become increasingly popular despite multiple national health organisations warning against their use and the UK government making it illegal to sell unlicensed melanotan injections.

The majority of people who use melanotan injections do so to try to achieve a tanned look. However, it is also claimed that these injections assist with weight loss and improve sexual performance, which has given them the nickname ‘the Barbie drug’.

Usually purchased from the internet or through gyms, spas and tanning salons, melanotan injections carry the usual risks of any self-administered agent (such as anabolic steroids) associated with sterility, chemical composition and dosage. There is also the risk of viral infections (such as hepatitis C or HIV) from needle-sharing.

Melanotan is also available to purchase online in the form of a nasal spray, but injections and sprays alike carry the risk of multiple side effects, including nausea, dizziness, kidney dysfunction and rhabdomyolysis (muscle wastage).

Many online stores promote melanotan as a quick and easy way to get a tan, making unsubstantiated claims about its safety and effectiveness, but health bodies in multiple countries have issued warnings to the public about their safety.

If you are someone who feels they need tanned skin to look and feel good, there’s no way of getting around one simple hard fact – the best way to protect your skin is to avoid tanning entirely, including from sunbeds, tanning pills and injections.

To keep your skin as protected as possible:

Spend time in the shade when the sun is strongest and when your shadow is shorter than you are (typically between 11am and 3pm).

Never allow your skin to burn.

Cover up with loose clothing and sunglasses.

Always use a sunscreen of at least factor 30 when in the sun and apply it regularly. Make sure it’s not past its expiry date: most sunscreens have a shelf life of 2 to 3 years.

Wear a largebrimmed hat.

If in doubt, it’s always worth remembering one thing: beauty may be skin deep, but skin cancer isn’t.

Dr Roger Henderson

Senior GP, Media Advisor and Health Writer

Dr Roger Henderson has worked in the NHS for almost 40 years and has been a GP since 1990. He is a health broadcaster, conference speaker and columnist for many national newspapers and magazines, including the Times and Spectator.

He is the consultant clinical writer for the Healthily website and a judge for the annual national GP awards.

His spare time is spent wondering what it would be like to have some spare time. His website is www.drhenderson.co.uk.