Posted : 09/01/2001
Special Report: Coming Of Age
by Donald L. Smith
An emerging entity like the indoor tanning industry must participate in meetings conducted by prestigious scientific organizations because doing so helps us "come of age" and gain recognition as a professional group.
At the July 7-12, 2001, American Society of Photobiology Annual Meeting in Chicago, four individuals from the industry made well-received scientific presentations.
Those making presentations were Michael Stepp, Wolff System Technology Corporation; Joe Schuster, Wolff System Technology Corporation and the Suntanning Association for Education; Barbara Grant, UV Research Institute; and, myself representing the North American Alliance of Tanning Salon Owners.
Michael Holick, M.D., Ph.D., of the Boston University School of Medicine, also gave a presentation covering his work on the development of facultative pigmentation (better known as a "tan") and the incontrovertible benefits of maintaining optimal levels of vitamin D. His research was partially supported by a grant from the Indoor Tanning Association.
Food and Drug Administration (FDA) representatives, dermatologists and photobiologists from around the world also made presentations. Unfortunately, most of them either were critical of, or against, tanning.
Highlights
Saturday, July 7
Overview
The topic of this symposium, which was Chaired by Januscz Z. Beer, Ph.D., of the FDA, was "Burning, Tanning and Typing" and 15 papers were presented by attendees from the United States, Korea, France, Germany, England, Brazil and the Netherlands.
The universal "theme" of the comment from the photobiologists and dermatologists making presentations was the difficulty they encountered trying to utilize either a questionnaire, a physician interview or phototesting in order to determine their patients' or research subjects' tolerance and sensitivity to UVR (and also lasers in one fascinating presentation!).
It was very enlightening to learn of this difficulty, given the fact that they (as opposed to tanning salon owners) have the well-defined "endpoint" of "UVR-induced erythema (sunburning)" that persists for at least 24 hours.
(Author's Note: In both my Saturday and Sunday presentations, I pointed out the fact that tanning salon owners must determine the tolerance/sensitivity of their clients through the use of a standardized questionnaire and their experience in order to prevent the unwanted endpoint of UVR-induced erythema (sunburning) which is a much more difficult task.)
First Industry Paper
Joe Schuster, representing both Wolff System Technology Corporation and the Suntanning Association for Education, presented a paper titled "Skin Typing Methods in Use in Indoor Tanning Salons" that provided the attendees with a comprehensive look at how a tanning salon owner determines a client's skin type.
Schuster pointed out that there was both an "art" and a "science" to the determination of a client's sensitivity to UVR and that individuals with darker natural skin color and/or acquired tan could tolerate more UVR than an individual with lighter natural skin color and no tan.
Second Industry Paper
I represented both the UVR Research Institute and the North American Alliance of Tanning Salon Owners, presenting a paper titled "The Evolutionary Development of an Indoor Tanning Industry-Specific Skin Typing (Subtyping) System.
I showed how the definition of the baseline group of "the most sensitive Skin Type 2" mandates the use of "subtypes" because if there is a "most sensitive" segment of the population, there must be a "least sensitive" segment; and, if there are both "most" and "least" sensitive segments, there must be a "mean" sensitive segment in the middle.
Thus, 2A is the most sensitive; 2B is the mean sensitive; and, 2C is the least sensitive. I pointed out that the FDA either must "mandate" subtyping to conform to the logic presented above or change the definition of the baseline group to "the mean sensitive Skin Type 2" in order to be scientifically correct. I also provided updated statistics on the skin type/subtype demographics of 10,000 clients of tanning salons in the United States that are listed below. These statistics are probably the only "real world" statistics available.
| Skin Type/Subtype: | 2A | 2B | 2C | 3A | 3B | 4 | 5 | 6 |
| Estimated % | 2 | 3 | 5 | 20 | 35 | 17 | 8 | 8 |
| Actual (n=10,000) | 0.8 | 5.4 | 16.6 | 30.4 | 26.2 | 17.6 | 2.1 | 0.05 |
Sunday, July 8
Overview
The introductory statement from the ASP Program stated "Indoor tanning, both at commercial facilities and in the home, has become increasingly popular over the past few decades. Though 48-hour intervals between exposures often are recommended, some individuals choose to tan daily. Such exposure patterns can result in a very substantial UV burden, which may contribute to skin cancer and photoaging. This symposium reviewed the possibilities of reducing UV exposure needed to produce a cosmetically-desirable tan by the use of optimal schedules and appropriately selected UV sources."
Interestingly, Dr. Cyr's introduction stated that FDA is unable to find the documents that led to the existing exposure schedules. Moreover, he said that a letter explaining why the CDRH-EAS (erythemal action spectrum) is different from the European-EAS is "missing" and cannot be found.
First Industry Paper
Michael Stepp, president of Wolff System Technology, presented some historical information showing how the sunlamps used by the indoor tanning industry have evolved from the high UVB percentage "FS Series" sunlamps used in the early days of the industry (and still are being used by the research community) to the sunlamps used today that more closely mimic sunlight.
He pointed out that the judicious selection of quality phosphors by sunlamp manufacturers make it possible to create a sunlamp that tans well, lasts longer and is more gentle to the skin.
Second Industry Paper
I presented a paper titled "Calculating Initial Session Exposure Times That Neither Overexpose, Nor Underexpose Clients Of Indoor Tanning Salons to Ultraviolet Radiation" that showed how once three factors are known, the calculation of ISTs (initial session times) is simple and accurate.
Those three factors are knowing the skin type/subtype of the individual; establishing tolerance to UV levels for each skin type/subtype; and, determining the MED/minute of the sunlamp being utilized as the irradiance source.
I showed how this information can be used to calculate the time to 0.75 MED (the initial session time); 1 MED (the time to sunburn); and 4 MED (the maximum allowable dose).
(Author's Note: A complete article setting forth the exposure schedule information presented in Chicago will be published in a future issue of LOOKING FIT magazine, including the charts and graphs used.)
Low Points
This study is used by FDA to "prove" that the existing exposure schedule "recommendations" posted on sunbeds should be mandated. It is a complete mystery to me why the FDA thinks that data on three Skin Type 3s and six Skin Type 4s (with no Skin Type 2s!) helps in any way to resolve the exposure schedule issue. Moreover, it is obvious to me that Dr. Sayre is a leading member of the anti-tanning establishment.
Sharon A. Miller, M.S., of the FDA presented data from its study that utilized FS Series sunlamps with 65% UVB and 25% UVA2. She stated that the tan produced was "contaminated by erythema (sunburn)" and seemed to imply that this finding was important. In fact, not having a high degree of UVR-induced erythema (sunburning) would have been surprising given the extremely high UVB and UVA2 percentages of the sunlamps they used.
In response to a question from the floor by Joe Schuster, it was disclosed by Miller that the FDA was going to repeat its study this fall using three sunlamps common to the indoor tanning industry. (You can read the letter I sent the FDA last fall protesting the use of these inappropriate sunlamps in the "Regulatory" section in TSO's Web site at www.naatso.org.)
(Author's Note: In my Sunday presentation, I showed that a tanning industry sunlamp reaching 4 MED in 20 minutes has an irradiance value of 0.2 MED/minute (12 MED/hour) while the FS Series sunlamp used by the FDA has an intensity of 1.25 MED/minute (75 MED/hour). Moreover, I showed that the IST (initial session time) of three minutes for the industry lamp was the same as the MAD (maximum allowable dose) for the FS sunlamp. Is it any wonder that their research subjects sunburned?)
In his presentation on Sunday, J.C. van der Leun, Ph.D., of the Netherlands recommended that the United States consider "mandating" the same "annual exposure" limitations that have been adopted by several European countries. There, they have decided that clients of indoor tanning salons cannot be exposed to more than 50 MEDs per year, which means that only approximately 15 tanning sessions per year would be allowed.
Several FDA officials and dermatologists in the audience supported this concept and so the indoor tanning industry must vigilantly watch the effort to "mandate" these annual exposure limits in the United States.
(Author's Note: During the question period, I pointed out that the "annual limits" stem from work conducted by Dr. Brian Diffey in 1987 in Scandinavia, and that his calculations were based upon Skin Type 1 individuals. I asked Dr. van der Leun if European regulators had considered "adjusting" their annual exposure limitations to reflect the increased tolerance to UVR enjoyed by individuals with darker skin types/subtypes because a failure to do so would most certainly cause darker-skinned individuals to become deficient in vitamin D. He seemed shocked by the question and, after a significant delay, answered that they "had only considered skin cancer" in their deliberations.
This exchange proved to me that European regulators are considering only the hazards of overexposure and not the hazards of underexposure. Dr. Holick supported my contention by pointing out to Dr. van der Leun that the African-American population is already at risk of developing diseases associated with sub-optimal levels of vitamin D and "annual limits" would most certainly worsen this situation.)
An Interesting Exchange
Cheryl Rosen, M.D., a dermatologist from the University of Toronto (and no friend of the indoor tanning industry) tried to ask questions designed to discredit Dr. Holick's presentation. Not only did he refute all of her statements, she was sadly unable to consider anything other than the effects of UVR on the skin.
During my Sunday presentation I made a plea to the photobiologists in attendance to give as much consideration to the hazards of underexposure as they currently give to the hazards of overexposure. Dr. Holick kindly referenced my comments in his remarks to Dr. Rosen in an attempt to help her see that the dermatology community must broaden its horizon and help find a level of UVR exposure that reduces the risks of both overexposure and underexposure.
Tuesday, July 10
Overview
This symposium was titled "Environmental Photobiology/Sunscreens," and it included a paper by Barbara G. Grant, M.S. of the UVR Research Institute titled "An Improved System for Evaluating Indoor Tanning Industry UVR Sources" that was very well-received by the attendees.
She showed research comparing the data obtained from a spectroradiometer before and after weighting by the CDRH Erythemal Action Spectrum and from hand-held radiometers. She specifically pointed out the importance of knowing the UVA2 wavelengths in order to better understand the operating characteristics of the sunlamps used as sunlight surrogates.
(Author's Note: On page 94 of this issue is an article by Barbara Grant on the subject of spectroradiometry. In future issues, she will cover the material she presented in Chicago.)
The Bottom Line
Moreover, I found that the friendliness of the discussions that took place at our poster session showed that the attendees of this symposium were very receptive to the information we provided. In particular, almost everyone in attendance was interested in our demographic data and many researchers asked to be kept up to date as this project continues.
On a personal note, I made the most of an opportunity to discuss skin typing with Dr. Thomas B. Fitzpatrick, M.D. who developed the I-VI system named after him. I also was able to get him to autograph my copy of his original paper.
Finally, I found the fact that none of the industry speakers were hit with questions designed to be embarrassing and/or with questions that couldn't be answered was both a testament to the care with which these papers were prepared and to the fact that it was obvious that we know far more about the tanning process than do the researchers and regulators in attendance.
In closing, I remind you that there are two things that tanning salon owners always must keep in mind: First, that the incontrovertible benefits of sensible, moderate and responsible exposure to UVR outweigh the minimal and manageable risks involved; and, second, that the hazards of both underexposure and overexposure must be taken into consideration in order to develop a rational public health policy.
