IN THE TROPICS TANNING Q & A

INDOOR TANNING Q & A

Here are answers to the most frequently asked questions we receive about indoor tanning.

Q. Is moderate exposure to the sun or ultraviolet (UV) light good for your health?

Absolutely. There is a mountain of well conducted, validated science that demonstrates that the production of the
activated form of vitamin D is one of the most effective ways the body controls abnormal cell growth. Moderate
exposure to sunlight is the only way for the body manufacture the vitamin D which is necessary for the body to
produce activated vitamin D.

Q. How much vitamin D do you need?

A 1997 report by the National Academy of Sciences Institute of Medicine recommends 200 IU/day of vitamin D for
women aged 50 years or younger, 400 IU/day for those aged 51-70 and 600 IU/day for those older than 70 years. In
fact, leading experts in the field believe these recommendations are totally inadequate to protect public health. There
is no question that the country faces a severe vitamin D deficiency epidemic. New science strongly supports changing
the current recommendation to 1000 IU/day for adults.

Q. What is the best way to help the body produce the activated form of vitamin D?

Moderate exposure to sunlight is the only way to help the body manufacture the vitamin D it needs. While eating
salmon or mackerel and drinking fortified milk or juices is a step in the right direction, it is practically impossible to
consume enough of these products every day to meet dietary needs. For example, one would have to consume ten
glasses a day of fortified juices or milk every day of the year to meet nutritional requirements.

Q. How does the skin make vitamin D and what limits its production?

Sun or UV light is the fuel that permits to body to manufacture vitamin D. But the amount of vitamin D formed in a given
period of exposure depends on the color of your skin -- that is, how rich the skin is in melanin. Melanin absorbs UV
radiation therefore it diminishes the production of vitamin D. The darker a person's skin, the longer he or she has to
be in sun or exposed to UVB radiation to form a significant amount of vitamin D. Like melanin, sunscreen also absorbs
UV radiation and therefore greatly diminishes vitamin D production by the skin. For example, a sunscreen with a PDF
of 8 diminishes ability to produce vitamin D by 95%. In addition, winter sunlight in the northern latitudes (New York City,
Boston, and San Francisco) does not have enough UVB radiation to produce vitamin D in the skin. This is the reason
most Americans are at risk for vitamin D deficiency, especially in the winter. A national study showed that 42% of
African-American women ages 15 to 49 were deficient in vitamin D by the end of winter. In addition, a recent study of
young Caucasian women ages 9-11 in Maine found 48% were vitamin D deficient at the end of the winter.

Q. When do people get most of their exposure to UV light?

Most people receive the highest percentage of their lifetime exposure to UV light after the age of 40. People receive
less than 25% of their lifetime dose by the age of 18.

Q. Is, moderate exposure to UVB radiation associated with decreased rates of cancer and other disease?

Yes. In fact, the inaugural edition of The Journal of Cancer in 1941 reported that the increased risk of non-melanoma
cancer was a price to be paid for a decrease in internal cancer. According to the world’s leading expert in the field, Dr.
Michael F. Holick, a professor of medicine, dermatology, physiology and biophysics at the Boston University School of
Medicine, relatively brief exposure to sunshine or its equivalent several times a week in tanning beds can help to ward
off a host of debilitating and sometimes deadly diseases, including osteoporosis, hypertension, diabetes, depression,
and cancer of the bladder, breast, colon, ovary, uterus, kidney, and prostate, as well as multiple myeloma and non-
Hodgkin’s lymphoma.

Q. How do the “risks and benefits” of, moderate UV radiation exposure net out?

The protective benefits of UV radiation are undeniable. Warnings about limited and sensible exposure to the sun or
UV radiation are greatly exaggerated. Several researchers, most notably Dr. William Grant have published peer-
reviewed articles that demonstrate, that in America, for example, increased sun exposure would result in 185,000
fewer cases of internal cancer and 30,000 fewer deaths from cancer of the breast, ovaries, colon, prostate, bladder,
uterus, esophagus, rectum and stomach. By comparison, about 7500 die each year from skin cancer. UV exposure
also protects against the development of multiple sclerosis, a devastating autoimmune disease. During adolescence,
higher sun exposure (average 2-3 hours or more a day in summer during weekends and holidays) is associated with a
69% decreased risk of developing multiple sclerosis. Similar protective benefits of sun exposure and/or increase in the
intake of vitamin D have been reported with other autoimmune diseases like rheumatoid arthritis and Type 1 diabetes,
which is usually diagnosed in children and young adults. In addition, studies have show that sun exposure and/or
increase in the intake of vitamin D can delay of onset of prostate cancer 3-5 years.

Q. What is moderate exposure?

Moderate exposure is the most responsible way to maximize the potential benefits of sun or UV exposure while
minimizing the potential risks associated with either too much or too little sunlight. Avoiding sunburns is a critical to
moderation. Painful sunburns before the age of 20, not lifetime sun exposure, is associated with an increased risk of
malignant melanoma, the most serious type of skin cancer. According to Holick, optimal sunlight exposure time-and, in
turn, optimal vitamin D production-will vary according to skin color, location, and time of year. African-American,
Hispanics and people with a Mediterranean heritage require more. Blue-eyed, red heads from northern Europe need
far less. The one basic rule that applies to everyone is avoiding sun burn. It is the burning of the skin and chronic
excessive exposures, not the limited sensible exposure to ultraviolet light or sunlight, that creates the concern about
skin cancer.

Q. What are the risks of overexposure to UV radiation?

Overexposure to UV radiation, particularly when it results in burns, may increase the risk of skin cancer. About 1
million new skin cancer cases are likely to be diagnosed in the U.S. this year. Older men are the most at risk.

Q. What is melanoma?

Melanoma is a cancer of the pigment producing cells (melanocytes). There has been an association with increase risk
of melanoma if you have moles or repeated sunburn experiences as a child or young adult. Most melanomas occur on
non-sun exposed parts of the body For example, melanoma is infrequently found on the face. Although melanoma
accounts for only 5% of all newly diagnosed skin cancer cases each year, it is responsible for the majority of skin
cancer deaths.

Q. Is melanoma associated with UV exposure from tanning beds?

No. To date, no well-designed studies support the connection between melanoma and UV exposure from tanning
beds. The relationship between melanoma and UV light exposure is complex. For example, melanoma is more common
in people who work indoors than in those who work outdoors, and those who work both indoors and outdoors develop
the fewest melanomas. Further, melanoma most commonly appears on parts of the body that do not receive regular
exposure to UV light

Q. Who regulates the indoor tanning industry?

The FDA provides extensive regulation of the indoor tanning industry. FDA regulations require each device to bear
detailed consumer information to avoid over exposure. The label displays a recommended exposure schedule for skin
types II-V. The label warns that certain medications or cosmetics may increase sensitivity to UV light. Those
regulations can be found at 21CFR 1040.20.

MORE INFORMATION ABOUT THE TANNING INDUSTRY

Q. What are the roots of the professional indoor tanning industry?

A. Europeans started tanning indoors with sunlamps that emitted ultraviolet light as a therapeutic exercise to harness
the positive psychological and physiological effects of exposure to ultraviolet light. This practice became widespread in
Europe, particularly in sun-deprived countries, in the 1970s long before the first indoor tanning facility was established
in the United States in the late 1970s. Although indoor tanning in the United States is considered a cosmetic exercise,
the industry’s roots are therapeutic and many customers come to tanning facilities for that purpose.

Q. How large is the professional indoor tanning industry in the United States today?

A. With professional indoor tanning businesses in most every town in America, the indoor tanning industry has grown
substantially in 25 years and today is a strong part of the American small business community. About 10 percent of
the American population will visit an indoor tanning facility at some point during the year.

Total Number of Professional Indoor Tanning Facility Businesses
25,000

Total Employment at Professional Tanning Businesses
160,000

Total Professional Indoor Tanning Facility Customer Base
28 million

Total Economic Impact of Professional Indoor Tanning Facilities
$5 billion

Q. Who owns indoor tanning facilities?

A. Most indoor tanning facilities in the United States are small businesses, and more than 50 percent of them have
female ownership, as compared to 25 percent of businesses in other industries, according to the U.S. Census.

Q. Why do people patronize indoor tanning facilities?

A. People enjoy sunlight and tanning - outdoors under the sun, or indoors in a professional tanning facility - for myriad
reasons. While tanning facilities in the United States are geared up to deliver cosmetic tans using protocol designed to
minimize the risk of sunburn, we know that clients are coming to facilities for more than just a good tan, but also to
enjoy the positive psychological and physiological effects of regular exposure to ultraviolet light.

Q. What is the tanning industry’s position on UV light?

A. The professional indoor tanning industry’s scientifically supported position is summed up in this declaration:
Moderate tanning, for individuals who can develop a tan, is the smartest way to maximize the potential benefits of sun
exposure while minimizing the potential risks associated with either too much or too little sunlight.
The professional indoor tanning industry teaches sunburn prevention - both indoors in the salon and outdoors under
the sun. And evidence suggests we teach this message more effectively than those who promote complete sun
avoidance. According to tanning industry research, non-tanners sunburn more often than people who tan indoors.
Since the mid-1980s, there has been considerable public health concern and attention on the risks of overexposure to
ultraviolet light. The indoor tanning industry shares that concern. Unfortunately, much of the discussion went too far -
the risks about UV light were overstated and the benefits were completely ignored.
Thankfully, public awareness of this issue is coming back into focus. There are known physiological and psychological
benefits associated with UV light exposure and there are many other potential benefits that appear likely and need
further research. The risks of UV light exposure, on the other hand, are mainly associated with sunburn and
overexposure (particularly among individuals who are fair skinned or genetically predisposed to skin damage) and are
easily managed by practicing sunburn prevention.
The professional indoor tanning salon industry is part of the solution in the ongoing battle against sunburn and in
teaching people how to identify a proper and practical life-long skin care regimen.

Q. What is a base tan?

A tan is the body’s natural protection against sunburn. Your skin is designed to tan as a natural body function.
Each year, millions of American patronize professional indoor tanning facilities in the spring, prior to sun-filled
vacations or outdoor summertime activities, to establish what tanners know as a “base tan.” Doing so enables
vacationers to gradually increase their exposure to ultraviolet light in a non-burning fashion.

Q. Why is indoor tanning more responsible than outdoor tanning?

A. Indoor tanning, for individuals who can tan, is an intelligent way to minimize the risk of contracting sunburn while
maximizing the enjoyment and benefit of having a tan. In a professional indoor tanning facility, tanners are taught by
trained personnel how their skin type reacts to sunlight and how to avoid sunburn outdoors, as well as in a salon.
Tanning in a professional facility today minimizes risk because commercial tanning salons in the United States and in
most Canadian provinces are regulated by the government. In the United States, exposure times for every tanning
session are derived from a schedule present on every piece of equipment that takes into account the tanner’s skin
type and the intensity of the equipment to deliver a dosage of sunlight designed to minimize the risk of sunburn. The
schedule, regulated by the Food and Drug Administration, also takes into account how long an individual has been
tanning, increasing exposure times gradually to minimize the possibility of burning. That kind of control is impossible
outdoors, where variables including seasonality, time of day, weather conditions, reflective surfaces and altitude all
make outdoor tanning a random act and sunburn prevention more difficult.

Q. Is Tanning Natural?

A. Yes. Tanning is your body’s natural protection against sunburn - it is what your body is designed to do. Anti-tanning
lobbyists falsely refer to this process as “damage” to your skin, but calling a tan “damage” is a dangerous
oversimplification. Here is why:
Calling a tan damage to your skin is like calling exercise damage to your muscles. Consider, when one exercises you
are actually tearing tiny muscle fibers in your body. On the surface, examined at the micro-level, that could be called
“damage.” But that damage on the micro-level is your body’s natural way on the macro-level of building stronger
muscle tissue. So to call exercise “damaging” to muscles would be terribly deceiving. The same can be said of sun
exposure: Your body is designed to repair any damage to the skin caused by ultraviolet light exposure. Developing a
tan is its natural way to protect against the dangers of sunburn and further exposure.
Saying that any ultraviolet light exposure causes skin damage is a dangerous oversimplification. It would be like saying
that since water causes drowning, humans should avoid all water. Yes, water causes drowning, but our bodies also
need water; we would die without it. Similarly, we need ultraviolet light exposure; we would die without it. It is the
professional indoor tanning industry’s position that sunburn prevention is a more effective message than total
abstinence, which ultimately encourages abuse. It is a responsible, honest approach to the issue.

Q. But What About the Increasing Rates of Skin Cancer?

A. You must realize that skin cancer has a 20- to 30-year latency period; the rates of skin cancer we are seeing today
are a function of the ignorant misbehavior of the 1960s, 1970s and 1980s. Recall: Society used to view sunburns as
an inconvenient right of spring - a precursor to developing a summer tan. Society felt that sunburns would “fade” into
tans, and so tanners hit the beaches and blacktops with baby oil and reflectors. Severe burns were commonplace.
Today we know how reckless that approach was, and the rates of skin cancer we are seeing today reflect that
ignorance.
What’s more, you must realize that the photobiology research community has determined that most skin cancers are
related to a strong pattern of intermittent exposure to ultraviolet light in those people who are genetically predisposed
to skin cancer, and not simply to cumulative exposure. That again suggests that heredity and a pattern of repeated
sunburning is what we need to prevent. And that kind of prevention is exactly what the indoor tanning industry is doing
effectively.
The indoor tanning industry believes that our role in teaching sunburn prevention will help to reverse the increases
that largely are a result of misbehavior that took place years ago before the professional tanning industry existed and
before we were organized to teach sunburn prevention.

Q. What About Melanoma Skin Cancer?

A. Melanoma is the only form of skin cancer that is aggressive with any regularity. But you need to understand this
clearly: Melanoma skin cancer does not fit the mold of other skin cancers for the following reasons:
Melanoma is more common in people who work indoors than in those who work outdoors.
Melanoma most commonly appears on parts of the body that do not receive regular exposure to sunlight.
Heredity, fair skin, an abnormally high number of moles on one’s body (above 40) and a history of repeated childhood
sunburns have all been implicated as potential risk factors for this disease. But because people who receive regular
exposure to sunlight get fewer melanomas, blanket statements that ultraviolet light causes melanoma cannot be made.
Indeed, some studies have found that an individual’s genetic susceptibility to sunburn, and not the actual sunburn
incidence itself, is the risk factor. Further, most studies on indoor tanning have not shown a statistically significant
connection between commercial use of tanning equipment and an increased risk of melanoma.
That is important, considering that most of the studies did not account for confounding variables such as outdoor
exposure to sunlight, childhood sunburns, type of tanning equipment utilized and duration and quantity of exposures.
(What’s more, European studies on this topic do not account for regulations in place in the United States governing
maximum exposure times for people of all skin types.)
So the professional indoor tanning industry is doing its part to help individuals of all skin types minimize their risks by
teaching them how to avoid sunburn at all costs. We are promoting smart, moderate tanning for those individuals who
can develop a tan.

Q. How Do You Define Moderate Tanning?

A. The term “moderate tanning” means something different for every different individual, and that is an important
point. The bottom line - what we call “The Golden Rule of Smart Tanning” - is simple: Don’t EVER sunburn. A fair-
skinned, red-headed, green-eyed person may not have the ability to develop a tan without sunburning. This person
should not attempt to tan then. On the other hand, most of us have the ability to develop a tan, and the majority of us
tan very easily. Moderation, in our view, means avoiding sunburn at all costs. Going about that agenda will mean
something different to every different person.

Q. How Does Your Skin Tan?

A. The tanning process is the same, whether you tan outdoors under the sun or indoors in a professional indoor
tanning facility. This natural process takes place when your skin is exposed to ultraviolet light. Here is an overview.
Light is composed of energy waves that travel from the sun to the Earth. Each energy wave can be identified by its
length in nanometers, (nm), which is one-billionth of a meter. Light can be broken into three general categories:
infrared, visible and invisible. Ultraviolet light is in the invisible light spectrum.
There are three kinds of ultraviolet light: UVA, UVB and UVC. Two of those categories, UVA and UVB, are utilized in
indoor tanning equipment.
Tanning equipment is designed to replicate UVA and UVB produced by the sun, but tanning lamps emit the light in
carefully controlled and government-regulated combinations. The end result is that the user has control over their
exposure. That is why people risk greater skin damage tanning outdoors than they do by using tanning equipment.
Tanning itself takes place in the skin’s outermost layer: the epidermis. There are three major types of skin cells in your
epidermis: Basal cells, keratinocytes and melanocytes. All play different roles in the tanning process.
Everyone has roughly the same number of melanocytes in their bodies-about 5 million. Your heredity determines how
much pigment your melanocytes can produce.
Melanocytes release extra melanosomes whenever ultraviolet light waves touch them. This produces a tan in your skin.
The tanning process is your skin’s natural way of protecting itself from sunburn and overexposure. Calling a tan
“damage” to the skin isn’t doing justice to the whole truth. Your skin is designed to tan to protect itself.

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