in electric shock and lightning strike injuries, 155Abdominal thrusts in foreign-body airway obstruction, 28, 29, 162Acidosis, bicarbonate therapy in, 81– 82in definitions of neonate, infant, and child, 13, 14, 157and recommendations for resuscitation, 13, 14 –15angiotensin-converting enzyme inhibitors in, 102Air bag–related injuries of children, 156automatic transport ventilators in,
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Icnirp.infoINTERNATIONAL COMMISSION ON NON‐IONIZING RADIATION PROTECTION
ON HEALTH ISSUES OF ULTRAVIOLET TANNING
APPLIANCES USED FOR COSMETIC PURPOSES
PUBLISHED IN: HEALTH PHYSICS 84(1):119‐127; 2003
ICNIRP PUBLICATION – 2003
HEALTH ISSUES OF ULTRAVIOLET TANNING APPLIANCES
USED FOR COSMETIC PURPOSES
The International Commission on Non-Ionizing Radiation Protection* l Low-pressure fluorescent tubes, emitting mostly UVA or mostly UVB, with broad-band or narrowband emis- Consumer d e m a n d for a cosmetic tan is the eco- nomic basis of the “suntanning industry,” which devel- l Filtered high pressure and high intensity discharge ops and distributes equipment for commercial suntanning lamps, emitting virtually only UVA or a mixture of and markets suntanning services to consumers.
Tanning appliances are currently the subject of an Exposure from sunbeds and other tanning ap- international standard established by the International pliances has the same potential risks as exposure to the Electrotechnical Commission (IEC 1995), which has UVR in solar radiation. The term “sunbed” is frequently regulatory status in some countries. Four types of appli- used to describe all tanning appliances consisting of ances are recognized in this standard and defined by this either a single UVR-emitting lamp (emitting UVA and/or UVB radiation) as in some facial tanners or a number ofsuch lamps incorporated into a bed, canopy, panel, or any UV type 1 appliances are those that emit UV radiation such that the biological effect is caused by radiation Potential adverse health effects of exposure to UVR having wavelengths longer than 320 nm and charac- are well documented and reasonably well quantified terized by a relatively high irradiance 0.15 W m-2 )’ (WHO 1994). The purpose of this document is to in the range 320 nm to 400 nm. The emission at summarize the potential adverse effects of exposure to wavelengths less than 320 nm is limited to 0.5 mW ultraviolet radiation from tanning appliances and to provide recommendations to minimize the risks of such UV type 2 appliances are those that emit UV radiation effects. Recommendations in this document apply o ly to such that the biological effect is caused by radiation the use of sunbeds for cosmetic purposes.
having wavelengths both shorter and longer than 320nm and characterized by a relatively high irradiance 0.15 W m-2;) in the range 320 nm to 400 nm. The it-radiance at wavelengths less than 320 nm is in the There are two distinctly different categories of UV type 3 appliances are those that emit UV radiation ultraviolet appliances used in tanning applications, each such that the biological effect is caused by radiation with different UVR emission characteristics and different having wavelengths both shorter and longer than 320 requirements for filtering to eliminate undesirable wave- nm and characterized by a limited it-radiance W m - 2 ) in each UV radiation band; andUV type 4 appliances are those that emit UV radiation such that the biological effect is mainly caused by * ICNIRP c/o BfS, Institut fiir Strahlenhygiene, Ingolstaedter radiation having wavelengths shorter than 320 nm (at Landstr. 1, 85764 Oberschleissheim, Germany.
For correspondence or reprints contact: R. Matthes at the above an irradiance greater than 0.15 W m -2, and in the address, or email at [email protected]
wavelength range 320-400 nm, the it-radiance is The International Commission on Illumination (CIE) defines UVR as optical radiation between 100 and 400 nm, and this spectralregion is divided into three photobiological spectral regions: UVC(l00-280 nm), UVB (280-315 nm) and UVA (315-400 nm).
All it-radiances are erythemally weighted. In their international (Manuscript received 1 May 2002; accepted 23 July 2002) standard, the International Electrotechnical Commission (IEC), has used the wave length ranges from 320-400 nm and <320 nm to The emission characteristics and the health risks Delayed tanning (neo-melanogenesis). The visible
associated with the use of each type of appliance are pigmentation takes at least 3 d to develop and results different (Gies et al. 1986). Type 4 appliances, associated from exposure to UVA but is more effectively produced with high levels of emission of UVB (280-3 15 nm), are by UVB (Parrish et al. 1982; Gange et al. 1985).
intended to be used following medical advice and should UVR-induced neo-melanogenesis is strongly dependent not be used for tanning purposes, mainly because of the on cellular responses arising from UVR-induced DNA publicized association between UVB and skin cancer.
damage in cellular nuclei (Eller et al. 1996; Gilchrest et Most of the appliances that are in use today are UVA- al. 1996). Delayed tanning is more persistent than IPD emitting (315-400 nm) appliances, UV types 1, 2, and 3.
and results from an increase in the number, size, and The term “sunbeds” in this document refers to UV- pigmentation of melanin granules (Bech-Thomsen et al.
emitting appliances of UV type 1, 2, and 3, although UV 1994). Exposure to UVB results also in an increase in the type 4 appliances are still marketed to commercial thickness and scattering properties of the epidermis (outer layer of the skin) (Bech-Thomsen and Wulf 1995).
During the last decade, increasing evidence of long Due, at least in part, to these processes, the tan obtained term UVA-induced risks for the skin and the eye has led from a pure UVA appliance, while perhaps cosmetically the sun-tanning industry to increase the UVB content in acceptable, is not as effective in protecting against the emission spectrum of tanning lamps in order to more further exposure to solar UVR as the equivalent pigmen- closely simulate natural sun exposure. This change has tation induced by exposure to solar radiation.
also permitted shorter tanning exposures. It is known that The degree to which an individual successfully tans the ratio of UVA to UVB in the solar spectrum changes as the result of exposure on a sunbed depends critically during the day and undergoes large variations according on his/her skin phototype as judged by his/her ability to to season and latitude. It is also important to recognize tan and the susceptibility to sunburn as a result of that there is no firm scientific evidence to indicate that exposure to solar UVR. Different skin phototypes (clas- tanning with either UVA-dominated or a UVB- sified as phototypes I through VI) are presented in Table dominated sources poses less risk; and, likewise, the use 1. In principle, the reaction of a person to UVR with of a simulated solar spectrum is not necessarily “safer” respect to tanning or sunburning is similar whether the exposure is on a sunbed or to solar radiation.
Among users of artificial suntanning devices, persons EFFECTS ON SKIN
of skin phototypes I and II, who do not tan well and/or whosunburn easily, are likely to be disappointed with the cosmetic results of using a sunbed. It has also been When skin is exposed to UVR, two distinct tanning recognized that many users experience minor adverse cuta- neous effects such as mild erythema, itching, and skin Immediate pigment darkening (IPD). IPD begins
dryness (Diffey 1986; Rivers et al. 1989; Diffey et al. 1990).
immediately on exposure to UVR and is caused by the Individual users of tanning appliances and attendants at darkening of the pigment melanin that is already present tanning salons may incorrectly evaluate individual skin in the skin; it is normally seen only in people who have sensitivity to UVR and underestimate the user’s sensitivity.
at least a moderate constitutive tan. Such pigmentation begins to fade within a few minutes after cessation of exposure. Radiation between 320 and 400 nm is regarded Minor sunburn is a skin reddening (actinic ery- as being most effective for IPD (Irwin et al. 1993).
thema) that appears up to 12 h after UVR exposure.
Table 1. Classification of skin phototypes based on their susceptibility to sunburn in sunlight and their ability to tan
(Fitzpatrick et al. 1995).
phototype Sun sensitivity Sunburn susceptibility” Tanning ability Classes of individuals I Very sensitive Always sunburn (<2 SED) No tan Melano-compromizedbIT Moderately sensitive High (2-3 SED) Light tan III Moderately insensitive Moderate (3-5 SED) Medium tan Melano-competentIV Moderately resistant Low (5-7 SED) Dark tan Melano-competentV Resistant Very low (7-10 SED) Natural brown skin Melano-protectedVI Very resistant Extremely low (> 10 SED) Natural black skin Melano-protected a The ranges of SEDs in parentheses are only indicative.
b Melano-compromized individuals have a greater risk of developing skin cancers than melano-competent individuals.
Health issues of ultraviolet tanning appliances ICNIRP 121 Erythema gradually fades after a few days, replaced by been limited to non-melanoma skin cancer, and such some tanning in individuals with tanning capability.
estimates necessarily require a number of assumptions Severe sunburn is painful and results in inflammation, such as the dose-response function, the use of ecological blistering, and peeling of the skin. Aside from photoim- rather than individual-based data to estimate the relation munological effects (discussed later), systemic effects of between UV exposure and risk, the extent of natural severe sunburn are unknown except for transient fever.
exposure, and neglecting its intermittency. For example, Sunburn severity depends critically on skin phototype estimates of the risk of incidence of NMSC due to the use (Table 1) and UV dose. For fair-skinned people (skin of UVA sunbeds suggest a doubling of risk for no more phototypes I and II, melano-compromised), the relative than 20 sessions per year over 30 y in Northern Europe effectiveness of UVR for tanning and for erythema is population (Diffey 1987). Despite these health risks, if approximately the same over the entire range of UVB individuals insist on acquiring a tan, there are conclu- and UVA wavelengths (Parrish et al. 1982). For people sions that can be drawn from the scientific data to who tan well and who rarely sunburn (skin phototypes III minimize risk such as presented in the recommendation.
and IV, melano-competent), the tanning efficacy of UVA Based upon a modeling of human skin-cancer risk is higher than its erythemal efficacy (Gange et al. 1985).
(Diffey 1987), 10 sessions of 30 min per year will For a given sunbed type, there is a range of radiant increase by 5% the risk of skin cancer compared with exposures which can be expressed in terms of Standard non-users of solaria. A “safe” level of solarium use does Erythemal Dose (SED) unit related to the Minimal Cutaneous malignant melanoma (MM), while much effects in people of different skin phototypes.
less frequent than NMSC, is much more serious andaccounts for the majority of deaths from skin cancer.
There are some mammalian data (Ley et al. 1989; Ley The most serious long-term effects attributed to 1997) for MM that indicate a strong UVB melanoma UVR exposure of the skin are the skin cancers (IARC etiology, but these data are not entirely consistent with 1992). Squamous and basal cell carcinomas are common, data from a fish melanoma model that indicate a strong rarely fatal forms of skin cancer, which are often referred implication of UVA in addition to UVB in the induction to collectively as non-melanoma skin cancers (NMSCs).
of fish melanoma (Setlow 1993). The animal models Experimental studies clearly indicate that UVA and UVB demonstrate an increased impact of neonatal exposure on can cause squamous cell carcinomas (SCCs) in mice. The tumor induction including malignancy (Robinson et al.
same effects are likely in humans (Sterenborg 1987; van 2000; Noonan et al. 2001). The evidence for the indict- Weelden et al. 1988). The erythemal potential of a UVR ment of sunlight as a causal agent is limited to epidemi- source is gaining acceptance as a reasonable approxima- ological data. The data indicate that intermittent exposure tion for a quantitative measure of its carcinogenic poten- to high levels of solar UVR, particularly at an early age, tial (Cole et al. 1985). A series of publications (Berg et may be a contributing causal factor (for recent review see al. 1993; de Gruijl et al. 1993; de Gruijl and van der Leun Armstrong and Kricker 1995; Gilchrest et al. 1999). The 1994; de Gruijl and Forbes 1995) has been a source for individual risk of MM is higher in people who have a the proposal of an action spectrum for photocarcinogen- large number of nevi (moles) and who sunburn readily esis by CIE TC 6-32 (CIE 2000). It will be used to and tan poorly with exposure to solar UVR. Some data evaluate the maximal number of authorized yearly ses- suggesting an association between the use of sunbeds and sions as the basis of a recommendation in the next an increased risk of MM have been published, but it is revision of the international standard, IEC 335-2-27.
unclear as to the relative importance of UVB, UVA, and Efforts to estimate the increased risk of a series of other factors (especially, general sun-seeking behavior) tanning sessions have been made; however, these have in causing this association (Swerdlow et al. 1988; Walteret al. 1990; Autier et al. 199 1; Higgins and du Vivier A minimum erythemal dose (MED) is defined as the UVR 1992; Westerdahl et al. 1994; Autier et al. 1994; Spencer exposure that will produce a “just noticeable” erythema on previously and Amonette 1995; Stem et al. 1997; Miller et al. 1998; unexposed skin of an individual. If the exposure is spectrally weightedby the CIE erythemal action spectrum, the MED corresponds to an Swerdlow and Weinstock 1998; Westerdahl et al. 2000).
effective radiant exposure expressed in Standard Erythemal Dose (SED) Taken collectively, both experimental and epidemi- units, depending on individual skin phototype (Table 1). Erythemally ological data on skin cancer all indicate that cumulative effective it-radiances (W m - 2 eff.), expressed in SEDs per hour, can becalculated for any source of UVR using spectral k-radiance data for the exposure increases the risk for skin cancers. This in- source, at the point of interest, and the relative spectral weighting factors cludes childhood exposures. Therefore, the added expo- for erythema, promulgated by the CIE (McKinlay and Diffey 1987;CIE/ISO 1999). One SED (Diffey et al. 1997) is a CIE/ISO official unit, sure from UV tanning appliances is likely to add to the and effective radiant exposure of 100 J m -2.
detrimental consequences of natural solar exposure.
Premature skin aging
Other skin effects
There is considerable evidence that cumulative People who have excessively used UVA sunbeds have UVR (UVA and UVB) exposure results in premature exhibited increased skin fragility and blistering (Farr- et al.
skin aging characterized by a dry, coarse, leathery, and 1988; Murphy et al. 1989) and atypical melanocytic lesions wrinkled appearance. It has been clearly demonstrated (Jones et al. 1987; Williams et al. 1988; Roth et al. 1989; that UVA causes skin damage in mice (Kligman et al.
Salisbury et al. 1989; Kadunce et al. 1990).
1987; Bissett et al. 1989). Similar effects might be expected in humans as a result of excessive use of Photodermatosis and photosensitivity
Polymorphic light eruption (PLE) is a common Daily exposures to suberythemogenic purely UVA photodermatosis readily produced in some people by within the spectral region 320-400 nm for 8 d or exposure to UV sunbed radiation (Rivers et al. 1989).
exposure to longer UVA wavelengths between 340-400 Other photoaggravated dermatoses such as systemic nm for 2 mo result in cumulative morphological skin lupus erythematosus are also exacerbated by the use of alterations, which are indicative of tissue injury (Lavker UV sunbeds (Stern and Docken 1986). Certain medicines et al. 1995; Lowe et al. 1995; Seité et al. 1998). In a and chemical and topical products (Table 2) such as 5-year longitudinal study of women who used or did not perfumes and lotions may cause skin photosensitization use tanning salons (Piérard 1998), serious modifications of skin elasticity and extensibility were found in thetanning salon user group. In that group, the severity of PHOTOIMMUNOLOGICAL EFFECTS
skin disorders was inversely correlated with their natural UVR exposure causes localized skin and systemic pigment capacities. It has been concluded from the study modifications due to photoimmunological reactions that the unremitting use of sunbeds induces a functional (Noonan and De Fabo 1990), also a particular concern decline of the dermis resembling premature aging.
with UVA sunbed radiation (Hersey et al. 1988; Rivers et Table 2. Agents producing photosensitivity.
Agents producing photosensitivity at local administration Sulphonamides and related chemicals n.a.a Disinfectants (salicylanilide compounds n.a. phototoxic and Phenothiazines (creams, dyes and n.a.
Coal tar and derivatives (phenolic n.a. phototoxic Essential oils (perfumes and colognes) n.a. phototoxic Furocoumarines compounds (psoralens) n.a. phototoxic Cadmium sulphide (tattoos) n.a. phototoxic Agents producing photosensitivity after oral or parenteral administration Non steroid anti-inflammatory drugs Health issues of ultraviolet tanning appliances ICNIRP 123 al. 1989). The clinical improvement of atopic dermatitis The retina
with sub-erythemal UVA exposure indicates that UVR is At least for the chronic effects of exposure to solar able to modify substantially normal and pathological radiation and to radiation from conventional light immunological reactions. UVB radiation can promote the sources, the most important retinal damage mechanism is development of skin cancer, perhaps by suppressing the immune system allowing the tumor to escape immune (Sliney and Wolbarsht 1980). The gradual brunescence surveillance (Duthie et al. 1999). The action spectra in of the lens as it ages results in its decreased transmission the UVB for mixed lymphocyte reaction and mixed of blue-light and of UVR thereby affording increased epidermal cell lymphocyte reaction were found to be protection to the retina. Young children and people who similar to the induction of thymine dimers upon DNA have had a lens surgically removed (aphakes) are at a higher risk of retinal damage from UVR and blue-light.
There is also evidence that exposure to UVR can Until the last decade, many implanted artificial lens did activate and accelerate the growth of human viruses not effectively absorb UVA. Macular injuries to two (Otani and Mori 1987; Perna et al. 1987), including tanning booth users were mentioned in one study but not human immunodeficiency virus (HIV) (Zmudzka and confirmed (Walters and Kelley 1987).
Beer 1990), and have effects on infectious disease The crystalline lens and cornea serve in considerable (Halliday and Norval 1997). At present, the significance measure to protect the retina from most UV tanning of these observations with respect to human health is booth radiation, even without protective goggles. As unclear. The effects of UVA exposure on the immune discussed previously, the crystalline lens blocks UVR system are even more uncertain (Schwarz 1998; Vermeer below 400 nm and the cornea blocks UVR below 300 nm, but trace amounts of UV-B radiation between 300and 315 nm may reach the retina (Boettner and Wolter OCULAR EFFECTS
The principal adverse effect of the absorption of Protective eyewear
The use of protective eyewear (goggles) will prevent UVR (UVC and UVB) by the cornea is termed photo- exposure of the eyes to harmful levels of UVR and keratitis (“welder’s flash” or “snow-blindness”), and blue-light. This represents a very important issue for damage is generally limited to the epithelial (front sunbed exposures since an individual is normally pro- surface) cells of the cornea (Sliney and Wolbarsht 1980).
tected from most of the overhead solar UVR by geomet- After a 6- to 12-h latent period that depends inversely on rical shading by the brow ridge and upper lids. The the severity of the exposure, there is severe cornea1 pain, exposure from sunbeds is geometrically greatly different.
Furthermore, oblique rays can be focused into the nasal symptoms are terribly distressing (with incapacitation), equatorial region of the lens (Coroneo et al. 1991). UVR but typically resolve in 24 h. There is some evidence of can only reach the critically important germinative re- possible long-term effects of UVR absorption by the gion of the lens by the focusing of oblique rays. Eyewear cornea (Taylor et al. 1989) and evidence of endothelial that does not incorporate side protection is not suitable to Transmission of UVA to the lens is much greater CONCLUSION AND RECOMMENDATIONS
than that of UVB. Animal data indicate that thresholdlenticular damage is limited mainly to UVR exposure in A review of scientific evidence shows that solar the 295 to 325 nm wavelength band. Experimental UVR is a cause of squamous cell cancer, basal cell spectral efficiency for acute cataracts in laboratory ani- cancer, and cutaneous melanoma as well as causing mals has been measured only in this spectral region.
accelerated skin aging and other adverse health effects.
Although UVA sunbeds produce limited 295-325 nm Because of this strong evidence on the adverse health radiation, it should not be inferred that UVA is safe with effects of UVR, even though there is not conclusive respect to lens exposure. Crystalline lens aging is char- direct evidence that sunbed exposure causes skin cancer, acterized in part by loss of elasticity and browning it is ICNIRP’s view that any use of suntanning appli- (brunescence), both of which may be caused partly by ances is likely to raise the risk of cancer. This risk is UVA. Certain medicines may act as UVA photosensitiz- particularly high for people having skin phototypes I and 124 Health Physics January 2003, Volume 84, Number 1 ICNIRP, therefore, recommends against the use of W-emitting appliances for tanning or other non-medical A. Swerdlow (UK), since 2000L. Szabo (Hungary), until 2000 purposes. The following groups are at particularly high risk of incurring adverse health effects from UVR, and therefore should be particularly counseled against the R. Matthes, Scientific Secretary (Germany)M.H. Repacholi, Chairman Emeritus (Switzerland) People who have skin phototypes I or II;Children (i.e., less than 18 y of age);People who have large numbers of nevi (moles); During the preparation of this document, the composition of the ICNIRP Standing Committee IV and task group was: D.H. Sliney (USA), Chairman Individuals who have a history of frequent childhood J-P. Césarini (France) F. R. de Gruijl (The Netherlands) B.L. Diffey (U.K.)M. Hietanen (Finland) M.A. Mainster (USA) T. Okuno (Japan) B.E. Stuck People who have premalignant or malignant skinlesions; REFERENCES
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US National Institutes of Health. Program and abstract book- Parrish JA, Jaenicke KF, Anderson RR. Erythema and mela- Research workshop on risks and benefits of exposure to nogenesis action spectra of normal human skin. Photochem ultraviolet and tanning. Bethesda: National Institutes of Perna JJ, Mannix ML, Ronney JF, Notkins AL, Straus SE.
Van Weelden H, de Gruijl FR, van der Putte SCJ, Toonstra J, Reactivation of latent herpes simplex virus infection by van der Leun JC. The carcinogenic risks of modem tanning ultraviolet light: A human model. J Am Acad Dermatol equipment: Is UV-A safer than UV-B? Arch Dermatol Pierard GE. Ageing in the sun parlor. Int J Cos Sci 20:25 l-259; Vermeer BJ, Winstzen M, Claas FHJ, Schothorst AA, Hurks HMH. UV-induced immunosuppression. The critical role of Pitts DG, Bergmanson JPG, Chu LWF, Waxler M, Hitchins wavelength. In: Rougier A, Schaefer H, eds. Protection of VM. Ultrastructural analysis of cornea1 exposure to UV the skin against ultraviolet radiations. Paris: John Libbey radiation. Acta Ophthalmol (Copenh) 65:263-273; 1987.
Rivers JK, Norris PG, Murphy GM, Chu AC, Midgley G, Walter SD, Marrett LD, From L, Hertzman C, Shannon HS, Morris J, Morris RW, Young AR, Hawk JLM. UVA Roy P. The association of cutaneous malignant melanoma sunbeds: Tanning, photoprotection, acute adverse effects with the use of sunbeds and sunlamps. Am J Epidemiol and immunological changes. Br J Dermatol 120:767-777; Walters BL, Kelley TM. Commercial tanning facilities: a new Robinson ES, Hill RH Jr, Kripke ML, Setlow RB. The source of eye injury. Am J Emerg Med 5:386-389; 1987.
Monodelphis melanoma model: initial report on large ultra- Westerdahl J, Olsson H, Masback A, Ingvar C, Jonsson N, violet A exposures of suckling young. Photochem Photobiol Brandt L, Jonsson PE, Moller T. Use of sunbeds or sunlamps and malignant melanoma in southern Sweden.
Roth DE, Hodge S, Callen JP. Possible ultraviolet A-induced lentigines: a side effect of chronic tanning salon usage.
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Risks of cutaneous malignant melanoma in relation to use of Salisbury JR, Williams H, du Vivier AWP. Tanning-bed sunbeds: futher evidence for UV-A carcinogenicity. Br J lentigines: Ultrastructural and histopathologic features.
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Williams HC, Salisbury J, Brett J, du Vivier A. Sunbed Schwarz T. Effects of UVA light on the immune system. A lentigines. Br Med J 296:1097; 1988.
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Setlow R, Grist E, Thompson K, Woodhead AD. Wavelengths APPENDIX A
effective in induction of malignant melanoma. Proc Nat1Acad Sci USA 90:6666 - 6670; 1993.
If tanning devices are used, then the following Sliney DH, Wolbarsht ML. Safety with lasers and other optical specific recommendations from past workshops should sources, a comprehensive handbook. New York: PlenumPress; 1980.
Sliney DH. Defining biologic exposures to light. In: Cronly- Dillon J, Rosen ES, Marshall J, eds. Hazards of light. New Claims of beneficial medical effects should not be made. Any therapeutic use of tanning devices should Spencer JM, Amonette RA. Indoor tanning: Risks, benefits and future trends. J Am Acad Dermatol 33:288-298; 1995.
Tanning devices should comply with the requirements Sterenborg HJCM. Investigations on the action spectrum of tumor genesis by ultraviolet radiation. Utrecht: State Uni- of the IEC standard (1995) and be limited to UV type versity of Utrecht; 1987. Dissertation.
Stern RS, Docken W. An exacerbation of SLE after visiting a Appropriate health warnings should be provided to the Stern RS, Nichols KT, Väkeva LH. For the PUVA follow-up Appropriate UV-protective goggles should be pro- study. N Engl J Med 336:1041-1045; 1997.
Swerdlow AJ, English JSC, MacKie RM, O’Doherty CJ, Hunter JAA, Clark J, Mole DJ. Fluorescent lights, ultravi- Operator staff should be provided with appropriate olet lamps, and risk of cutaneous melanoma. Br Med J approved training (receive appropriate certification); Professional operators are responsible for providing Swerdlow AJ, Weinstock MA. Do tanning lamps cause mela- noma? An epidemiologic assessment. J Am Acad Dermatol client information and guidance on the safe use of Health issues of ultraviolet tanning appliances ICNIRP 127 Minimize the number of sessions. For example, the APPENDIX B
French Regulations (J. 0. Republique Francaise, An- Further readings
nexe 2, 1997) require that regular exposure, for pho-totypes III and IV, melano-competent skin, should not l American Academy of Dermatology. Position State- exceed two sessions per week with a maximum of 30 ment on Indoor Tanning. Dermatology World; March sessions per year (erythemally effective exposure of l EUROSKIN Towards the Promotion and Harmoniza- 500 J m -2 per session). An occasional break from the tion of Skin Cancer Prevention; Session VI: WHO Workshop-UVR Tanning Devices, 2 - 5 May 2000, Manufacturers or dealers must supply exposure sched- ules based on the tanning device lamp characteristics; l Finnish Center for Radiation and Nuclear Safety: Because the sensitivities of individuals vary greatly, it is advisable to limit the duration of the first session to l IRPA/INIRC Guidelines. Health issues of ultraviolet “A” sunbeds used for cosmetic purposes. Health Phys about one-half of a regular session in order to establish the user’s skin response. If following the first session l J. 0. Republique Francaise: Decret Nos. 97-6 17, Mai any adverse reaction occurs, further use of the sunbed 1997 relatif a la vente et a la mise a disposition du public de certains appareils de bronzage utilisant des Products designed to enhance or accelerate tanning l Norwegian Radiation Protection Authority: Code of Any modifications, such as the replacement of lamps, practice (modification of #2 & 5 of the Royal Resolu-tion concerning the use of x rays, 1983); 1992.
filters or reflectors should not change the IEC classi- l NRPB Board statement on effects of ultraviolet radi- fication of the device. Tanning devices should have an ation on human health and health effects from ultravi- Tanning devices in hotels or in recreational facilities l NRPB Use of Sunbeds and cosmetic tanning. State- should be subject to the same controls as noted above ment by NRPB Advisory Group on Non-Ionising radiation. Radiological Protection Bulletin No. 2 18, Because of their possible misuse, unattended or coin- l Senat de Belgique (May 1998): Proposition de loi operated tanning devices should not be used; reglementant l’exploitation des centres de bronzage, By the nature of their use, sunlamps in the home are not subject to the same degree of control as those used under proper supervision in commercial outlets, so l Swedish Radiation Protection Institute: Regulatory additional safety information should be provided by code concerning sunbeds (SSI FS 1998: 2).
the vendor or supplier of the tanning device. In these l U.S. Food and Drug Administration. Policy on maxi- circumstances only IEC type 3 tanning devices should mum timer intervals and exposure schedule for sun-lamps. August 1986; FDA Rockville MD, USA.
l Radiation Protection Dosimetry-Ultraviolet Radia- Recognizing that different countries will have different tion Exposure, Measurement and Protection. ways of implementing and determining compliance lay AF, Repacholi MH, eds. Proceedings of an Inter- with these recommendations, the tanning facilities national Workshop St Catherine’s College, Oxford, should comply with these recommendations, and that England, October 18 -20; 1999. Radiation Protection compliance should be checked by the appropriate
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