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Solarium effects
Solariums
Immunological effects of solarium exposure
Normal volunteers underwent a standard course of treatment to acquire a suntan in a commercial solarium, and tests of immune function were carried out before, on completion, and 2 weeks after completion of radiation exposure. Compared with age and sex matched concurrent controls, the test subjects had reduced skin test responses to dinitrochlorobenzene (DNCB), slightly reduced blood lymphocyte numbers, and changes in the proportion of lymphocyte subpopulations. This included a relative increase in total (OKT3+) T-cell numbers which was attributable to an increase in the OKT8+ suppressor/cytotoxic subset of T cells. OKT4+ helper T cells were reduced and there was a significant decrease in the OKT4/OKT8 ratio. Other changes included a significant increase in suppressor T-cell activity against IgG production in vitro and depression of natural killer cell activity. These changes were still present in some subjects 2 weeks after solarium exposure.
Recommendations
The Australasian College of Dermatologists, The Cancer Council Australia and its affiliated member organisations and the Cancer Society of New Zealand recommend that:
The public avoid use of any type of artificial ultraviolet (UV) radiation tanning device (solarium) for cosmetic purposes.
The public be informed of the risks associated with solarium use.
State and territory governments be encouraged to implement comprehensive legislation governing the operation of solariums that prohibits access for those under 18 years of age, provides for informed client consent, bans unsupervised solarium operations and ensures adequate training of staff.
Introduction
The desire to acquire a tan for fashion or cosmetic purposes has led to the development of a large solarium industry in Australia and New Zealand. There has been considerable growth particularly in the last decade. A 2006 audit shows a 400% increase in the number of solaria advertised in the Yellow Pages business directories for Australia's capital cities in the last decade(1).
Solariums may emit much higher concentrations of ultraviolet (UV) radiation than the sun - up to five times as strong as the midday summer sun (2). Solariums emit UVA and UVB radiation, both known causes of skin cancer. In general, solariums predominantly emit UVA, however in recent years, solariums have been manufactured to produce higher levels of UVB to mimic the solar spectrum and higher levels of UV radiation intensity to speed up the tanning process.
Overexposure to ultraviolet radiation from the sun and artificial sources is of considerable public health concern. UV radiation plays an important role in the development of skin cancer, cataracts and other eye conditions, and suppresses the immune system. Cumulative UV radiation also results in premature skin ageing.
Given the health risks associated with the use of solariums, The Cancer Council Australia, the Cancer Society of New Zealand and the Australasian College of Dermatologists does not recommend the use of artificial UV radiation tanning devices for cosmetic purposes. For the same reason it is not recommended that solariums be used to boost vitamin D levels.
It is recognised however, that while solariums continue to be available to the public, there is a need to reduce the risks associated with their use.
The assocation of solarium use with skin cancer, skin ageing and eye damage
No solarium can give a safe tan (3).
Adverse health affects associated with ultraviolet radiation including skin cancer and premature skin ageing have been well documented in international and national reports for many years (4, 5, 6, 7). Furthermore, the body of evidence directly linking solarium use to adverse health effects continues to grow.
Skin and eye cancers
Exposure to solariums was first listed as a known human carcinogen linked to malignant melanoma of the skin and eye in the Ninth Report on Carcinogens in 2000 (8).
In 2006 the International Agency for Research on Cancer (IARC) convened an International Working Group that assessed the available evidence relating to health effects, both positive and detrimental, of exposure to artificial UV radiation through the use of indoor tanning facilities, in particular whether their use increases the risk of developing skin cancer.
The findings from this systematic review are summarised below (9):
Increase in melanoma risk associated with use of sunbedsA positive association with melanoma risk was found amongst those who had ever used a solarium. People who used sunbeds had a 15% increased risk of melanoma, although there was no consistent evidence for a dose-response relationship. This risk was further increased among those who had first used a solarium before the age of 35 - a significant 75% increased risk.
Increase in risk of squamous cell carcinoma of the skin associated with use of sunbedsThe risk of squamous cell carcinoma is increased among people who have ever used solariums.
No conclusive evidence was found in regard to a relationship between basal cell carcinoma and solarium use.
The results suggest detrimental effects from use of solariums on the skin's immune response.
Artificial tanning offers little if any protection against solar damage to the skin from subsequent sun exposure.
Pre-cancerous lesions
Pre-cancerous actinic keratoses and Bowen's disease (squamous cell carcinoma in situ) have also been reported in the sunlight-protected but solarium-exposed skin of fair-skinned users after just two to three years of regular solarium use (10).
Skin ageing
Ultraviolet radiation such as from a solarium causes premature ageing of the skin. This may be evident as increased skin wrinkling, irregular pigmentation and
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