Summer brings out sun lovers once again competing for the perfect spot on the beach, at the park, the pool scene and backyard to get that perfect tan.

Historically, tanning was an art that converts animal skins into leather. Prior to the industrial revolution, a tanned body belonged to the poor who had to work outdoors while the fashionable pale skin belonged to the upper classes. Parasols and hats were a must when going out.

In the 1920s, when heliotherapy ("sun therapy") was a popular prescription for conditions such as fatigue and tuberculosis, a French fashion designer, Gabrielle "Coco" Chanel came back with a golden tan after cruising from France to Caanes. The search for that perfect tan now lives. Among the most famous choices, basking in the sun, the wipe-ons pioneered by Coppertone, spray-ons, tanning beds and the most recently air brushed tanning.

This series will review the historical background of the golden look choices now available in the market including known advantages and disadvantages to allow the consumers to make an intelligent decision and will provide historical and scientific references.

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"Free" tanning option - THE SUN.
Sun exposure is a great source of Vitamin D and a 20-minute sun exposure's enough to get the recommended Vitamin D. This is relevant because a "deficiency of vitamin D can occur when dietary intake of vitamin D is inadequate, when there is limited exposure to sunlight, when the kidney cannot convert vitamin D to its active form, or when someone cannot adequately absorb vitamin D from the gastrointestinal tract" (1,2).

"The classic vitamin D deficiency diseases are rickets and osteomalacia. In children, vitamin D deficiency causes rickets, which results in skeletal deformities. In adults, vitamin D deficiency can lead to osteomalacia, which results in muscular weakness in addition to weak bones." (1, 2).
However, the sun also emits ultraviolet rays: UVC, UVB and UVA, all can be attributed to skin damage and worse, melanoma. (8). Fortunately, the most damaging with the strongest but shortest wavelength, UVA, is absorbed by our ozone layer.

The other two: UVB's partially absorbed and can burn the epidermis, the thin outer layer of the kin; UVA's completely absorbed and reaches the dermis. Both are attributed to skin damage including cancer.
In 1991 Professor Johan Moan of the Norwegian Cancer Institute made an astounding discovery. He found that the yearly incidence of melanoma in Norway had increased by 350% for men and by 440% for women during the period 1957 to 1984. He also determined that there had been no change in the ozone layer over this period of time. He concludes his report in the British Journal of Cancer by stating "Ozone depletion is not the cause of the increase in skin cancers"(9) and therefore is attributed to sun exposure.

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Most sunscreens do a good job blocking UVB but few filters out most of the UVA including photo aging (wrinkles) and the development of skin cancers. UVB and UVA damage the skin's collagen resulting in microscopic scars, later macro-scars or wrinkles. FDA advises best sunning for about 20 minute increments before 10 am and after 4pm while also wearing hats and hourly application of a good sunblock with minimum of SPF15 or after each swim. However, caution should be exercised to really get a very good sunblock rather than just sunscreen due to reports that sunscreens may increase the risk of skin cancer due to one's false sense of security (4, 5)

For centuries, the "white look" signifying the upper social strata was the way to go. So, makeup and beauty products included face whiteners, carbonate, hydroxide and lead oxide. Regretfully, some cases resulted in muscle paralysis or death. (7) Later, other substances were used: zinc oxide (facial powder), lead & antimony sulfide (eye shadow), "lipsticks" (mercuric sulfide), and eye sparklers (belladonna).Where Coco Chanel popularized the golden look, silent movie actress, Theda Bara (3) sensationalized the new technicolor screens by appearing with Helena Rubinstein's colored cosmetics. Later, makeup artist, Max Factor, developed pancake makeup. During World War I, women earned a living and paid for these cosmetics and in the 1950s, television promoted them even more. During a brief period of pantyhose shortage, leg cosmetics hit the market.

Perennial tanned celebrities like from Gidget, The Beach Boys, Farrah Fawcett, George Hamilton and Bo Derek to Jennifer Lopez and Britney Spears of today sold the idea that health, glamour and even wealth = TAN. For years, uninformed about the danger of UV's, many used baby oil or silver metallic UV enhancers to get tanned.

In 1953, we embraced Coppertone's response to our society's attitude of quick-fix, results-yesterday: "Tan don't Burn" products and its 3-year old Jodi Foster as its icon. Many other companies joined the band wagon and flooded the market with tanning sprays, lotions, creams, gels and bronzers. The benefits: fairly inexpensive; wide availability; more moisturizers; many with SPF's as high as 40+. Though not all, many posed some challenges: orangey look; were messy; lasted only for a few minutes or after a shower; were difficult to apply in certain areas; uneven or streaky applications; allergic reactions; staining on clothing or other fabric; sticky feeling. Some provided immediate results while others took 45 minutes to over an hour see results. Caution: No self tanner can completely block the UV's; please apply sunblocks and sunscreens. (4, 5)

In 1970, the first tan-through bathing suits came out followed by the first tanning beds and tanning booths. The average 15-20 minutes on the bed can be quite relaxing. However, FDA and the American Academy of Dermatology frequently published about the negative side effects to frequent users: interactions with some common medications like naproxen (Aleve) resulting in photosensitivity; aggravate certain conditions like lupus and diabetes; leathery, dry skin; exposure to the UV-A used in the sun lamps resulting in leathery, dry skin, photo aging (wrinkles); and worst yet, cancer of the skin.

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"Tanning Trends magazine, a trade publication, writes: "Moderate tanning has never been linked scientifically to skin cancer. In fact, by helping people tan with a reduced incidence of sunburn, indoor tanning may reduce your risk of ever contracting skin cancer." Indeed, quite the reverse is true: By increasing exposure to carcinogenic UV rays, the risk of skin cancer is increased." (18)

The Journal of National Institute of Cancer concluded their study that "Similar to outdoor sun exposure, short-term recreational tanning salon exposure causes molecular alterations believed essential in the development of skin cancer." (10)

"Most studies suggest young women are the most frequent patrons of tanning salons. The development of photoaging and skin cancer will take years to become apparent in these young tanners, while the perceived social value of a tan is apparent immediately." "'Our study strongly suggests that sunbed and sunlamp use may increase the incidence of nonmelanoma skin cancers,'" says lead author Margaret R. Karagas, PhD. (18)
If one must use tanning bed, the user must wear proper goggles for eye protection and be sure that the beds are properly disinfected after and before each user to prevent certain diseases such as genital warts.

With the continued fascination for tanning, the various methods one tried to accomplish this from sun basking to self applied media of the 70's and then in the late 80's and early 90's, consumers became easily attracted to the tanning pills.

Tanning pills were heavily advertised in fitness magazines with claims that the pills would help prevent skin blistering and peeling or skin cancer because they are non-UVs. However, in the February, 1990 issue of the FDA Consumer, the tanning pill made negative news and consumers were made aware of its potential danger. These pills promoted tinting by ingesting massive doses of a non-FDA approved food additive canthaxanthin which has various side effects such as retinopathy or crystal deposits in the eye. This was later confirmed by Darrell Hulisz, PharmD and pharmacist Ginger Boles in the August, 1993 issue of the American Pharmacy. These conditions rarely show symptoms but results in reduced visual acuity. Canthaxanthin, an orange carotenoid pigment is related to Vitamin A but has no Vitamin A activity. It has also been linked to hepatitis and urticaria. (14, 15, 18)

At FDA's request, U.S. marshals seized 15 cases (24 bottles each) of tanning pills from Alberti's home on June 24, 1988. The pills, valued at more than $4,000, were ordered destroyed in the October 1989 court decision. (11)

Tyrosine, an amino acid, or tyrosine derivatives, found in tanning accelerators, were publicized to penetrate the skin. Claims were made that these helped the increased production of melanin which is responsible in bringing about the tanning of the skin was later found ineffective and may also be dangerous. (17)

When Monica showed off her tanned legs, Ross, also tried it with disappointing results. In any case, after the 10th Season of Friends featured airbrushed/ sprayed on tanning, requests for the "tanning" service multiplied and search engines showed an increase surfing for this new trend. Little did the tanning community know that DHA use was not new to savvy tanners.

DHA (dihydroxyacetone), a food coloring used since the 1960's. Though discovered in the 1920's, DHA was finally approved by the FDA as an approved skin coloring ingredient. (12, 18) and the only one so far found to be effective It has no known toxicity which has been used in the cosmetics industry for over 30 years. There are some towels or towelletes that one can rub on one's skin. However, the most popular application is when it is sprayed or misted. For maintenance, it is recommended that the "tanner" repeat the session every five to seven days. Some facilities offer booths while others have operators spray the client. With an experienced operator, this technique of manual spraying by the operator can provide a more even application. However, for those wanting complete privacy, the tanning spray booth can be a better choice. (12, 18)

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What is DHA and how does it work? One is gently misted with the DHA solution which reacts with the amino acids (proteins) in the outermost layer (dead cells) of your skin. For best results, exfoliate prior to getting air-brushed. The challenge with this application is the evenness After a session, one gradually tans within three to four hours with results that last anywhere from days to about three weeks. Just as with any service, look for a facility that stresses sanitation and users of "airbrushed tanning" must remember that DHA is just a skin stain and does not provide any UV protection.

Proper exfoliation, skin preparation, use of proper moisturizers and care will enhance and help extend your "tan."The future is almost here. Well we're now almost in the middle of 2004. Who would think that testing for libido and an alternative to Viagra can result in better tanning?

University of Arizona have licensed the drug development on the synthetic versions of melanocyte stimulating hormone (MSH) called Melanotan I, and Melanotan II. to make melanin. This increase melanin production will then darken the skin and provide protection against exposure to UV light which will then reduce incidences of skin cancers.

Melanotan is a peptide hormone which must be given by injection. The product is currently investigational and will require FDA approval. Widespread use of the product may be limited unless an oral dosage form can be developed. The complete side effect profile of this new drug is not known.
This "discovery" coined as "Barbie Drug" is supposed to help one lose weight, get a tan and improve their sex life has got to be a winner for a lot of people but like any new inventions, the FDA will look at it with keen eyes while the hopeful tanners are just craving for its availability.

Epitan, an Australian based biotechnology company even established a website in search of volunteers for this drug Melanotan, http://www.epitan.com.au.

Note: This article is presented here for informational purposes only and was based on opinions gathered from various articles, some of which are listed below. Please consult your health provider if you need further information or assistance should you wish to try to use any of the tanning methods mentioned above.

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Resources and References:

1. Holick MF. Vitamin D. In: Shils M, Olson J, Shike M, Ross AC, ed. Modern Nutrition in Health and Disease, 9th ed. Baltimore: Williams and Wilkins, 1999.
2. http://www.cc.nih.gov/ccc/supplements/vitdref.html
3. http://silentladies.com/PBara.html
4. Garland, Cedric F., et al. Could sunscreens increase melanoma risk? American Journal of Public Health, Vol. 82, No. 4, April 1992, pp. 614-15
5. Garland, Cedric F. et al. Effect of sunscreens on UV radiation-induced enhancement of melanoma growth in mice. Journal of the National Cancer Institute, Vol. 86, No. 10, May 18, 1994, pp. 798-801
6. Partial excerpts:Robinson, Julian. The Quest for Human Beauty: An Illustrated History. New York: W.W. Norton and Co., 1998.
7. http://scriptorium.lib.duke.edu/adaccess/cosmetics-history.html
8. http://www.yourhealthbase.com/database/a109l.htm
9. http://www.second-opinions.co.uk/sunlight.html
10. J Natl Cancer Inst 2002 Feb 6;94(3):224-6 Abstract quote
11. http://vm.cfsan.fda.gov/~dms/cos-tan2.html
12. FDA Code of Federal Regulations CITE: 21CFR73.1150
13. http://www.medicinenet.com/script/main/art.asp?articlekey=23898
14. http://www.aad.org/PressReleases/self-tan.html
15. http://ucmclexpert.uc.edu
16. http://www.cnn.com/HEALTH/men/9906/17/viagra.alternative/
17. http://www.cancer.org/docroot/PED/content/ped_7_1x_Dangers_of_Artificial_Tanning
18. http://www.skincancer.org/

Other Sources and Tips:
Visit us for free use of our Skin Scanner

Skin Cancer Foundation at 1-800-SKIN-490
http://www.vh.org/adult/patient/dermatology/suntips/index.html
http://www.skincancer.org/

A condensed version of this three-part article was published in WestCoast Media in July, August and September, 2002. Copyright © July, 2002; © March, 2004

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