During a recent visit to a New York health club near my home, I decided to check out their sunbed section. There were token slots set near each unit like you might find in a video game arcade or next to a discount store carousel. $3.00 for 10 minutes. I headed toward the receptionist to get more information:

"Do you have instructions for the tanning beds?" I asked.

"No," was the receptionist's to-the-point reply.

"$3.00 for 10 minutes, eh? How many tokens should I buy?"

"That's up to you. We recommend 10 minutes to start with."

"Should I wear lotion?"

"If you want to."

"How about eye goggles?"

"Oh. We don't have those in yet. We've been waiting for them. Just put a towel over your eyes."

"Do you have any age requirement for using the beds?"

"Of course. We don't allow anyone younger than 10."

Years ago, suntans were considered not only fashionable, as they unfortunately still are with many people today, but physicians actually encouraged patients to sunbathe—it was considered healthy. Then, in the late 1970's and 1980s, there was increasing media awareness of the risks involved with lying in the sun to get a tan. This was the catalyst for the switch from the proliferation of suntanning oils to sunblocks and sun protectors. It was also the catalyst for the growth of the tanning salon industry. Tanning salons were seen as offering protection—the idea behind them was that suntanning was dangerous primarily because of burns. It was thought that if one received a tan through a gradual, controlled process, the dangers would be eliminated. We now know that to not be true. Burning is merely the most conspicuous problem associated with tanning.

Sunlight and artificial sunlight such as that used in tanning salons emits three different types of electromagnetic radiation in the ultraviolet range—UVA, UVB and UVC. All three can cause health problems. Since past studies had shown UVB to be the most dangerous, the tanning industry responded by lowering levels of UVB emitted by their equipment. However, new studies show that those lower levels of UVB still pose potentially significant health risks and that UVA may pose more of a risk than was previously thought. Tanning salons use high-intensity UVA devices, which gives us a practically chance to study the effects of UVA by itself. However, the UVA bulbs used by tanning salons still emit 0.3% to 4.6% UVB, a potentially significant amount.

Long-term exposure to the sun, to artificial sources of ultraviolet light or to both, contributes to the risk of the three kinds of skin cancer: basal cell, an otherwise benign skin cancer that can cause scarring; squamous cell, which is usually benign but which can spread through the body if left untreated; and the aforementioned melanoma, one of the most fatal kinds of cancer.

UVA primarily effects the dermis. Shortwave ultraviolet rays (UVB) can burn the outer layer of skin; longwave ultraviolet rays (UVA) penetrate more deeply and can weaken the skin's inner connective tissue. Some epidermal changes include intercellular edema, perinuclear vacuolization, nucleolar prominence and occasional exocytosis of lymphocytes.

There are over 20,000 tanning salons in the United States that are used by approximately two million people per day at peak times in the winter. Some one to two million Americans attend tanning salons more than 100 times per year. Over 1 million people develop some form of skin cancer each year. More than 90 percent of skins cancers occur on areas regularly exposed to ultraviolet radiation, which is considered to be the chief cause, and a major source of our ultraviolet radiation exposure is tanning beds. (footnote i)

According to a fact sheet from Associated Release Service, "In the United States, someone dies from skin cancer every hour. The overall incidence rate for melanoma is increasing faster than the rate of any other cancer." (footnote ii) One difficulty in pinpointing the source of skin cancers and one reason that many people assume they are safe is because skin cancers often do not develop until 20 years or so after exposure. Damage to your skin from ultraviolet radiation is cumulative, so continued exposure produces long-term effects. Even going to a tanning salon 10 times per year dramatically increases your chances of developing melanoma. That means that by tanning for 30 minutes, once a month, you are overexposing yourself.

Other than causing acute sunburns and increasing the chances of developing melanoma and other cancers, the dangerous effects of excessive exposure to ultraviolet radiation include erythema, various phototoxic reactions and actinic keratosis. Erythema has been shown in some cases to coincide with DNA damage. Studies have shown that UVA by itself can produce erythema. These UVA studies were performed by a group in Sweden, as reported in the Skin Cancer Foundation, by the Photobiology Task Force of the American Academy of Dermatology and by the British Photodermatology Group, who have all recommended that the cosmetic use of indoor tanning be discouraged. (footnote iii) The amount of UVA received from modern sunlamps is estimated to be anywhere from 2 times (for some salon lamps) to 10 times (for some home lamps) the amount of UVA received from the sun.

Most phototoxic reactions are activated in the UVA range. Psoralens in common vegetables may exacerbate the situation as well—one case involved a woman who suffered a severe phototoxic burn from tanning after ingesting celery root. Ingestion of medicinal psoralens can be even more disastrous, as is evidenced by the infamous case of a woman who died after massive burns exacerbated by medicinal psoralens. (footnote iv) While that case is extreme, minor side effects are not. Birth control and antihistamines can also aggravate phototoxic effects. (footnote v) Erythema has been found to occur in 22% of subjects in a study of tanning salon clients, pruritis in 27%, dryness of the skin in 15% and nausea in 4%. (footnote vi) Numerous studies have confirmed similar percentages. There is also ample documentation of large numbers of dermatologists, emergency room physicians and even ophthalmologists who have had to treat burns from tanning devices. (footnote vii)

To complicate matters even further, too much exposure to ultraviolet rays, including UVA rays, can severely damage the retina. Over-exposure can burn the cornea, and repeated exposure over many years can change the structure of an eye lens so that it begins to cloud, forming a cataract. (footnote viii) If left untreated, cataracts result in blindness.

Many experts believe that the most dangerous option is to tan at home under home sunlamps. One of the problems that UVA causes is an increased susceptibility to the negative effects to UVB. This occurs because ultraviolet light actually thins the skin, making it less able to heal. So tanning under artificial UVA producers with 2 to 10 times the sun's UVA make any sun exposure much more dangerous. (footnote ix) Also, according to the FDA's Center for Devices and Radiological Health, up to 20% of the light given off by home lamps consists of UVB. (footnote x)

People often forget that UV rays can penetrate through clouds, and UV rays reflect off water, concrete, white sand and snow. It is often mistakenly thought that tanning helps prevent sun damage. As the American Association of Dermatology has reminded us, "A tan does not prevent sun damage, it is sun damage." (footnote xi) Manhattan dermatologist Dr. Leon Demar emphasizes this point; "There is no such thing as a safe suntan. Whether you get it from the sun or from a tanning bed, it is risky."

Legislatures in many states and counties have intervened to increase the regulation of tanning salons. Specifically, the new regulations call for salons to report injuries, limit access by minors, warn patrons of health hazards and provide protective eyewear. They have also increased the enforcement of a regulation disallowing tanning salons from making any claims regarding "healthy tans"—the most that can be claimed is the cosmetic nature of tans. (footnote xii)

The Food and Drug Administration requires tanning salons to direct all customers to wear protective eye goggles. Closing your eyes, wearing ordinary sunglasses, or using cotton wads are not strong enough measures to protect the cornea from the intensity of UV radiation in tanning devices.

The Federal Trade Commission has also got in on the act, stating that consumers can be harmed if tanning salon advertising leads them to believe that they can get a tan without the harmful effects of the sun.

Surveys have shown poor rates of compliance with these recommendations, making my experience not unusual. In one survey, an estimated 1 in 10 tanning salon clients did not wear protective goggles while tanning. (footnote xiii) Other surveys have shown that tanning salons are not consistently issuing the mandated health warnings and instructions to clients.

I can only agree with the medical community that, because there is no rationale for visiting tanning salons and in fact, there are many health risk reasons to discourage it, patronage of such salons should be discouraged. Estheticians and the medical community must play a role in educating the public about the adverse effects of indoor tanning. That temporary darker skin tone is just not worth it.

Annette Hanson is the founder of Atelier Esthétique, a New York State licensed esthetics school, a postgraduate facility, and a distribution center. Her professional experience in skin care spans more than 20 years as an esthetician, body therapist, salon manager, educator, and spa consultant. She is an active member of the New York State Cosmetology Association and currently is a director for the Esthetics Manufacturers and Distributors Alliance (EMDA). She served on The Appearance Enhancement Advisory Committee to the New York Department of State. She was instrumental in the development of the 600-hour curriculum for the New York State Esthetics License as well as the written and practical exam. She is the East Coast Chair of the California Barbering and Cosmetology Legislative Alliance.

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