Tanning Takes Center Stage
By Steve Feldman, M.D., dermatology, Wake Forest Baptist Medical Center
Tanning has captured center stage in the American consciousness with the reports of a New Jersey woman charged with second-degree child endangerment for allegedly taking her child to a tanning bed where she was burned. The mom claims the child had sunburn from playing in the yard and was never in the tanning bed.
The story and accompanying videos have spread like wildfire, becoming the common chatter at water coolers around the country. People’s attention has been captured not just by the idea of taking a young child to a tanning bed, but also by the very distinctive appearance of this mother. The mother, a self-proclaimed lifelong tanner, looks old, dark and wrinkled from tanning. Her leathery, unattractive complexion makes people wonder why on earth she is doing this to herself. Presumably, people go to tanning beds to look good, and this woman’s visage does not look good at all.
This New Jersey mom epitomizes what we dermatologists have seen for years — young women who look much older than they should, with faces that are mottled, leathery and wrinkled. These women tan regularly, arguably to the point of addiction. Other women have continued tanning even after getting skin cancer, even after getting multiple skin cancers, even after developing life threatening melanoma. Why would anyone tan so much, even when it is clearly hurting them?
An answer to this question came from studies of the effect of ultraviolet light on skin pigmentation done at Wake Forest Baptist Medical Center. When skin cells were exposed to ultraviolet light, they made a hormone that stimulates the pigment cells of the skin, melanocytes. But in addition to making the melanocyte-stimulating hormone, the cells also released a byproduct created when that hormone is made. The byproduct, endorphin, is that natural “feel good” hormone in the body. Opiate narcotics — morphine, heroin, and related drugs —bind to endorphin receptors. The pigment research seemed to indicate a possible reason why some women became addicted tanners or so called “tanorexics” because tanning releases endorphins from skin cells, and those endorphins give the tanner a high.
Our research team at Wake Forest Baptist tested this theory with funding from the National Institute of Drug Abuse. Two tanning beds were set up in a tanning research laboratory. The two tanning beds appeared identical, but one of them contained an acrylic sheet over the bulbs that transmitted ultraviolet light, while the other had an acrylic sheet that blocked the ultraviolet light. Aside from the difference in ultraviolet light, the beds were otherwise indistinguishable; they were the same temperature, and they had the same visible light. Frequent tanners, women who tanned more often than needed to achieve a tan, had tanning sessions in both beds on Monday and on Wednesday. This way, they were able to experience both beds but could not tell which bed was giving them a tan. On Fridays, they were allowed to tan in either bed. Nearly invariably they chose the bed that gave the ultraviolet light. They also reported that the bed with ultraviolet light was more relaxing than the other bed.
This groundbreaking experiment demonstrated that frequent tanners sought ultraviolet light for how it made them feel, not just how it made them look. In retrospect, this shouldn’t be surprising at all, and not just because of the New Jersey mom or the patients with skin cancer who continue to tan. Ultraviolet light is relaxing, as anyone who goes to a sunny beach knows. Sure, the temperature at the beach is more agreeable later in the evening, and the pleasant sounds of the waves are just as intense, but the crowds are on the beach soaking up the relaxing rays of the sun during the stinking hottest part of the day when the ultraviolet rays are at their maximum.
The initial research study showed that frequent tanners were tanning for how it made them feel, but it didn’t directly show that the effect was due to an effect on endorphins. A follow up study investigated this in a very powerful, straightforward way. Our research team repeated the study with the two beds, but subjects were first given naltrexone, a very specific blocker of the actions of endorphins and other opiates. Naltrexone is used in emergency rooms when narcotic addicts present for treatment of an overdose. In our study, not only did naltrexone block the tanners’ ability to distinguish the two beds, but several of the frequent tanners (and none of several control subjects who weren’t frequent tanners) developed symptoms consistent with a mild case of opiate withdrawal, a distinct sign of addiction.
Tanning behavior, like other addictive behaviors, is complex. The behavior is driven in part by the physiologic effect of tanning, by how it makes a person feel. But it is also driven by psychosocial factors — how our society seems to value a tanned appearance. Looking at magazine covers in the grocery aisle can give you a good sense of where our society stands on the issue. Getting young people to avoid tanning is a tough sell when the trade off appears to be a choice between preventing a skin cancer 20 years from now versus getting a date on Saturday. The addictive effect of ultraviolet light exposure raises quitting to a far higher level of difficulty, even when tanning is making a person lose their youth and beauty, leaving them with the leathery, old look of New Jersey’s tanning mom.
Like a number of other things that are bad for us, it’s probably best if we never start.
Department of Dermatology at Wake Forest Baptist