The Many Faces of Tanning Behavior

T anning is a fascinating, complex behavior featuring complex, compound interplay between physiologic, psychological and social dimensions. This month, Skin & Aging considers a number of issues involved in tanning, including photoaging and adverse reactions. Tanning is one of the prime public health issues in dermatology, and it’s essential that we think about this behavior from a very broad perspective if we ever hope to change the behavior. At the physiologic level, ultraviolet (UV) exposure has many effects beyond simply darkening the skin. Clearly, UV has carcinogenic effects on the skin, though the magnitude of these effects is not entirely well defined. Mutagenic effects are probably magnified by the many effects of UV on immune function, including direct effects on immune effector cells. And we have only begun to scratch the surface of the indirect effects of UV on immune function and cutaneous neuropeptide activity. We know that, at the psychological level, UV exposure directly effects mood, how people perceive themselves and how they believe they are perceived by others. However, the relationship between these psychological variables and the physiologic effects of UV exposure have been almost completely unexplored. It is clear from talking with patients who are truly abusing UV exposure that a tanned appearance is not the sole goal of tanning behavior. Many patients report that tanning also provides relaxation and pain relief. There’s probably a lot more going on here than meets the eye. The societal dimensions of tanning have their own complexity. Educating patients about the risks of UV exposure seems to have little, if any, effect on their behavior. Societal changes in how tanned skin is valued seem to have more impact, at least based on the Australian experience; yet altering societal norms is a daunting task. Efforts to regulate the tanning industry to protect public health may be an easier goal to achieve, but this goal seems at odds with the principles of our current medical culture that value personal responsibility. Perhaps if we start to better understand and explore the many faces of tanning, we will find the answers to how to change society’s perspective on tanning. And perhaps, from this greater understanding, we can help those that abuse UV exposure recognize the hazardous effects of tanning and limit this dangerous behavior. Steven R. Feldman, M.D., Ph.D. Chief Medical Editor

T anning is a fascinating, complex behavior featuring complex, compound interplay between physiologic, psychological and social dimensions. This month, Skin & Aging considers a number of issues involved in tanning, including photoaging and adverse reactions. Tanning is one of the prime public health issues in dermatology, and it’s essential that we think about this behavior from a very broad perspective if we ever hope to change the behavior. At the physiologic level, ultraviolet (UV) exposure has many effects beyond simply darkening the skin. Clearly, UV has carcinogenic effects on the skin, though the magnitude of these effects is not entirely well defined. Mutagenic effects are probably magnified by the many effects of UV on immune function, including direct effects on immune effector cells. And we have only begun to scratch the surface of the indirect effects of UV on immune function and cutaneous neuropeptide activity. We know that, at the psychological level, UV exposure directly effects mood, how people perceive themselves and how they believe they are perceived by others. However, the relationship between these psychological variables and the physiologic effects of UV exposure have been almost completely unexplored. It is clear from talking with patients who are truly abusing UV exposure that a tanned appearance is not the sole goal of tanning behavior. Many patients report that tanning also provides relaxation and pain relief. There’s probably a lot more going on here than meets the eye. The societal dimensions of tanning have their own complexity. Educating patients about the risks of UV exposure seems to have little, if any, effect on their behavior. Societal changes in how tanned skin is valued seem to have more impact, at least based on the Australian experience; yet altering societal norms is a daunting task. Efforts to regulate the tanning industry to protect public health may be an easier goal to achieve, but this goal seems at odds with the principles of our current medical culture that value personal responsibility. Perhaps if we start to better understand and explore the many faces of tanning, we will find the answers to how to change society’s perspective on tanning. And perhaps, from this greater understanding, we can help those that abuse UV exposure recognize the hazardous effects of tanning and limit this dangerous behavior. Steven R. Feldman, M.D., Ph.D. Chief Medical Editor