The Rising Sun - Evolution of the Concept of the "Healthy Tan"

Our current culture largely views tanned skin as healthy and attractive, but this has not always been the case. The Romans and Greeks valued pale skin and used cosmetics to whiten their skin. Pale skin was also the fashion in Elizabethan England, where bronze skin indicated a working class person who toiled in the sun. The Industrial Revolution diminished this distinction, however, as workers moved from the country to the cities, and large numbers of them began working in factories, Perceptions about the effect of sun on health also evolved. The absence of sun took a toll that was both psychological and physical. The working class lived in cramped buildings with small courtyards that blocked out the sun, and the enormous increase in coal burning during the Industrial Revolution generated clouds of soot that blocked the sunlight and contributed to the development of rickets in children. The link between insufficient sunlight and rickets was recognized as early as 1822. Then, evidence began to emerge regarding the benefits of sunlight. In 1903 Dr. Auguste Rollier opened a clinic in the Swiss alps that offered sunlight and fresh air to patients with tuberculosis. During the same year Dr. Niels Ryburg Finsen was awarded the Nobel Prize for using artificial sunlight to treat tuberculosis of the skin. French designer Coco Chanel allegedly contributed to the concept that tan is beautiful after acquiring a tan during a vacation on a yacht in 1923. Sunbathing became increasingly popular in Britain in the 1920s. In order to prevent rickets, the US government began making recommendations about sun exposure in the the 1930s, and milk began to be fortified with vitamin D during the same decade. The introduction of the bikini in the 1950s further fueled the popularity of sunbathing. By 1968 about 58% of young adults believed that a tan improved appearance, and by 2007 this view was held by 81%. In the 1980s tanning salons began to spring up, and they have become increasingly popular; the tanning industry claims that tanning salons are now used by as much as 10% of the US population. In fact, some studies suggest that tanning may be addictive, perhaps as a result of beta-endorphins that are generated in the skin during tanning. Exposure to sunlight also initiates biochemical reactions in skin that lead to the generation of vitamin D, which has beneficial effects on health. However, a number of studies have documented an alarming increase in the incidence of melanoma, a highly dangerous form of skin cancer, over the past few decades. Because of the health benefits of vitamin D, some have tried to frame the issue of tanning as a controversy. However, if one critically considers the evidence, there is compelling evidence that we should limit our exposure very carefully.

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Ultraviolet Radiation

The health effects of both natural and artificial sunlight are the result of exposure to ultraviolet (UV) radiation. Ultraviolet (UV) light is part of the electromagnetic radiation that reaches the earth from the sun. UV radiation has shorter, more energetic wavelengths (400-100 nm) than visible light (750-400 nm).

UV radiation is further categorized as UV-A, UV-B, and UV-C. The earth's ozone layer filters out all of the sun's UV-C and most of the UV-B. However, much of the UV-A and some UV-B reach the earth. All three types of UV can be generated by man-made devices, and all three can have harmful effects. UV-A and UV-B are generated from tanning beds and lights, and UV-C, which is particularly dangerous, is generated by germicidal lamps. The World Health Organization has web pages (in six languages) with succinct summaries of environmental factors that influence our exposure, health effects of ultraviolet radiation, and protective measures. They also provide a link to information about WHO's INTERSUN Program, which strives to provide education about UV exposure and to promote measures that reduce the harmful effects of UV. They also provide a publication entitled "Artificial Tanning Sunbeds: Risk and Guidance," with a number of very specific recommendations that would be relevant to local boards of health and health departments.

It is important to note that UV emitted from artificial sources varies greatly in terms of both the amount of light emitted and the specific wavelengths of UV, which can in turn result in more serious health effects.

 The UV Index

The UV Index, developed by the National Weather Service and EPA, indicates the strength of solar UV radiation on a scale from 1 (low) to 11+ (extremely high). The scale provides a means of gauging appropriate precautions in order to avoid overexposure to UV radiation.

The US Environmental Protection Agency's SunWise Program explains the UV Index and provides several valuable resources for local health departments. These include:

1. A UV Index map of the United States that gives 1, 2, 3, and 4-day forecasts of the UV Index.
2. A UV Index Alert
3. "Apps" that can be installed on your smart phone in order to look up UV Index information.
4. A UV Index "look-up function. You enter your local zip code, and it looks up your current index. There is also a 'widget' that enables you to add the function to your own web page, as shown here:

Artificial Sources of Ultraviolet Radiation

In addition to the UV radiation from the sun, there are many man-made sources of UV. These include:

• tanning booths
• black lights
• curing lamps
• germicidal lamps
• mercury vapor lamps
• halogen lights
• high-intensity discharge lamps
• fluorescent and incandescent sources
• some types of lasers (excimer lasers, nitrogen lasers, and third harmonic Nd:YAG lasers).

Ultraviolet light exposure affords us some potential benefits, but also substantial risks of skin cancer, photo-aging of skin, and burning. The next section will but these potential risks and benefits into perspective.

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