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U.S. Food and Drug Administration |
This article originally appeared in the July-August 1993 FDA Consumer and contains revisions made in April 1995. The article is no longer being updated. |
This article is part of a series with important health information for teenagers.
Some months after a bad sunburn, Susan, 14, went to a dermatologist (skin doctor) for an unrelated problem. During the visit, the doctor recalled that burn and how Susan's skin had blistered and peeled. The doctor remarked that Susan's skin was now clear, her glowing complexion a picture of perfect skin health. But, he warned, the skin and tissue damage from the sunburn might not show up for years to come. Stop sunbathing, the doctor urged her. Avoid the sun.
But Susan continued to sunbathe for several more summers. Today, 12 years later, she wears sunscreen and avoids sunbathing altogether. What made Susan change her mind about the sun?
"There is no such thing as a safe tan," says Darrel Rigel, M.D., clinical associate professor of dermatology at New York University, Manhattan. "Why does the body tan? Because the body is being injured by ultraviolet [UV] radiation that hits it. This causes the body to make melanin, a natural sun screen. So to get tan, you must get injured first."
Melanin is the dark pigment that skin cells make to block out damaging rays in response to injury from UV radiation.
UV radiation comes in two wavelengths--UVA and UVB--and causes skin damage. According to Arthur Sober, M.D., associate professor of dermatology at Harvard University Medical School, the damage is potentially serious whether it is caused by direct sunlight or tanning devices or by light reflected off snow or water or passing through clouds. "On a cloudy day, a person feels cooler, but is still getting a good amount of UV exposure," he says.
Janusz Beer, Ph.D., D.Sc., senior scientist in the radiation biology branch of FDA's Center for Devices and Radiological Health, explains that in natural light, and depending on the time of day, most UV radiation comes from UVA. Both UVA and UVB can cause damage but most of the damage to DNA (genetic material) in skin cells comes from UVB. This could lead to cell and tissue damage and possibly to skin cancer. In addition, he says, scientists know that UVB impairs the body's immune system, which normally defends against disease.
Both UVA and UVB are present year-round, but UVB is more intense in the summer, at higher altitudes, and near the equator, according to the American Academy of Dermatology.
UVA speeds up skin aging by causing changes in the skin's collagen, the protein in the skin's connective tissue. "Just look at pictures of people who work outside, like farmers and fishermen. They all have wrinkly faces," says Beer. "The more exposure, the more wrinkles."
Sunburns and blistering are the most obvious--and painful--results of short-term sun damage. The long-term damage, such as wrinkling, can be disfiguring and in the case of skin cancer, possibly life-threatening.
Barbara Gilchrest, M.D., chairman of the department of dermatology, Boston University School of Medicine, explains that you can think of the skin damage as happening along parallel tracks that intertwine. Freckling and wrinkling are at one end of the tracks, and skin cancer looms at the other end.
The cosmetic changes--wrinkling, coarseness, and irregular pigmentation--occur on one track. The more sinister changes, such as actinic keratosis--scaly, rough, and red, tan, brownish, or grayish spots on the skin that can lead to cancerous tumors--occur on the other. These changes occur as a person is exposed to UV light, even in infancy, she says. The age when you first can see these changes depends on your complexion, how much and how often you're exposed to the sun, and other factors.
John A. Kenney Jr., M.D., professor of dermatology at Howard University College of Medicine, Washington, D.C., notes that black skin seems to have more protection against UV rays than white skin, due to melanin and perhaps other factors. However, warns Kenney, blacks can sunburn to some degree. And UVA does cause some aging changes in black skin as well.
Gilchrest worries that teens are tanning younger and spending more time in the sun than ever before. The unseen damage that occurs at the age of 16 has 60 years to turn into cancer, she says, but shows up as early as age 30 as wrinkling, uneven skin color, and coarsening of the skin.
"Most skin cancer is a result of exposure to sun when people are young. Children and teens are particularly susceptible," says Jeanne Rippere, an FDA microbiologist who evaluates over-the-counter drugs, including sunscreens.
Cancer Rates Climbing
There are three main types of skin cancer: malignant melanoma, basal cell carcinoma, and squamous cell carcinoma. The least common, but the deadliest, of these is malignant melanoma. Regardless of skin color, all people are vulnerable to skin cancer, although among African Americans, for example, the incidence is very low. For this population, squamous cell carcinoma--which can also be fatal--is the most common.
According to the American Cancer Society, in 1995 there will be 800,000 new cases of all skin cancers, up from 700,000 in 1993 and 400,000 in 1980. The society predicts there will be 34,100 new cases of malignant melanoma--15,400 in women and 18,700 in men, with 7,200 deaths from melanomas: 4,500 for men and 2,700 for women. According to a 1990 study released by Brown University, about 2 percent of malignant melanomas are in people younger than 20.
There are several reasons for the increase in skin cancer, explains Sydney Hurwitz, M.D., clinical professor of pediatrics and dermatology at Yale University School of Medicine. One is the continuing feeling that a tan is a "badge of affluence, sex appeal, health, and self esteem," he says. Another is the increasing loss of the Earth's ozone layer that blocks the sun's damaging rays.
"There are no figures yet on skin cancers among teens," says Hurwitz. "But I have seen five or six children with melanomas. . . . Ten to 20 percent of those people with melanoma go on to die. There is a 6 to 10 percent rate increase per year. In simple language, each day, maybe 80 to 100 people are diagnosed with melanoma."
According to data presented by NYU's Rigel to the American Cancer Society, there are six risk factors associated with malignant melanoma:
Regardless of your skin color, if you're going to be out in the sun, even for a short time, apply a sunscreen to all skin that will be exposed. Apply the sunscreen generously before going into the sun and reapply it often.
FDA regulates sunscreens as over-the-counter drugs. When used correctly, sunscreens can block UV rays and reduce the chances of serious burns. Read the label of the product to find out whether it blocks UVB or UVA rays or both. Products that block both types of rays are labeled "broad spectrum" sunscreens. The American Academy of Dermatology recommends using such products.
Formulated as a solution, lotion, or cream, sunscreens are rated by sun protection factor (SPF). An SPF of 6, for example, means that you can stay in the sun six times longer before burning than if you were wearing no sunscreen. The American Academy of Dermatology suggests that everyone use a product with at least an SPF 15.
In 1993, FDA proposed requiring:
When buying sunglasses, look at the labeling to help you make the right selection. Most sunglass manufacturers label sunglasses according to standards established by the American National Standards Institute in New York. There are three categories:
Sunlamps
The rays from tanning lamps and larger devices used in "tanning parlors" are no safer than natural sunlight.
Hurwitz says that some device manufacturers and tanning parlor owners tell clientele that their devices use UVA rays, the so-called "tanning rays," but not UVB, or "burning rays."
"We now know that UVA rays do damage and are high intensity," Hurwitz says. Many parlors use UVB rays in combination with UVA, which gives people more color. But, once they do get the color, it only lasts for a few days so they often go back for repeated treatments, which is not healthy for the skin.
Lorraine H. Kligman, Ph.D., of the University of Pennsylvania medical school notes that research shows people who use tanning devices often show signs of suppressed immunity.
Examples of suppressed immunity are more colds or outbreaks of oral herpes (also called cold sores).
Also, faulty timing devices may allow people to get more UV exposure than expected. People who don't wear goggles may suffer eye damage from the long wavelengths that penetrate eyelids, she adds. Closing your eyes does not help.
FDA regulates tanning devices as radiological devices and requires, among other things, that tanning parlor operators give users goggles and that tanning device products bear a warning label that states "Danger--Ultraviolet radiation." FDA also requires manufacturers to provide operators with operation manuals containing instructions on proper use and correct bulb replacement.
'Artificial' Tans
There are four different types of products that produce an "artificial" tan without sunlight, according to Stanley Milstein, Ph.D., associate director for cosmetics at FDA's division of colors and cosmetics. They are: bronzers, extenders, tanning pills, and tanning accelerators. Milstein warns that although the products produce a natural-looking tan, they do not protect from UV rays.
Bronzers are color additives that stain the skin without harming it. Some bronzers, for example, are combinations of synthetic certified colors. Others come from natural sources, such as walnut juice. These can be washed off with soap and water.
Extenders are also color additives, but they work through chemical reaction with the proteins of the skin. The only one currently approved by FDA for use in cosmetics intended to add color to the body is called dihydroxyacetone (DHA).
Tanning pills contain carotenoid color additives derived from substances similar to beta-carotene, which gives carrots their orange color. The additives are distributed throughout the body, especially in the skin, making it orange, too. Although FDA has approved certain of these additives for coloring food, at the high levels in tanning pills these products may be harmful. Oral tanning pills containing carotenoid color additives cannot be marketed legally for cosmetic use in coloring the skin.
Tanning accelerators, such as those formulated with tyrosine or tyrosine derivatives, are unapproved new drugs, which must be proven both safe and effective. Promotors claim they contain a substance that, when applied to the skin, will make melanin form faster than normal in sunlight. But, Milstein says, there is little convincing published evidence to show these currently marketed products actually work.
New Attitudes
If you like to keep up with the latest trends, you've probably noticed that the tanned look is slowly fading from fashion. A 1994 survey by the American Academy of Dermatology showed that one-third of all respondents say they never sunbathe and always use a sunscreen when outdoors.
"I think that the young are getting the message," says Shirley Lord, beauty editor of Vogue magazine. "The American Academy of Dermatology has been savvy about its approach in its work with designers and their use of tan models. Our message is: protection, protection, protection."
Alexandra Greeley is a writer in Reston, Va.
Publication No. (FDA) 95-1212
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