Sunless Tanners

Later that year, Sheehan and Lesher reported on their anonymous survey of 121 adults (107 women and 14 men) who received spray-on sunless-tanning treatments between February and May 2004. Most reported that sunless tanning had not or would not affect their use of sunscreen or time spent outdoors. Interestingly, though, 73% of the respondents who had used tanning beds indicated that they had reduced or would reduce their use of indoor tanning. The researchers concluded that practitioners should recommend sunless tanning to their patients who use conventional tanning beds as a way to lower their solar exposure and risk of skin cancer (South. Med. J. 2005;98:1192-5).

In 2006, Brooks et al. reported on their July 2004, greater Boston, cross-sectional survey of 448 nonrandomly selected people aged 18-30 years on the subjects of artificial tanning products, recent history of sunburns, and tanning-bed use. During the preceding year, 22% of respondents had used sunless-tanning products and the same percentage hadn’t but would consider using them in the next year. Users of these lotions were more likely to have been severe burners and, after controlling for skin type, the investigators found that previous and potential users were more likely to have experienced sunburns during the summer and to have used tanning beds than were respondents who had neither used nor planned to use sunless tanners. The researchers concluded that the option of sunless tanning did not seem to lower the incidence of sunburn or the use of tanning beds. Further, they urged caution in offering broad support for artificial tanning products, even though looking for alternatives to UV exposure is to be encouraged (J. Am. Acad. Dermatol. 2006;54:1060-6).

A 2007 study using data from 5,491 completed interviews as part of the National Cancer Institute’s HINTS (Health Information National Trends Survey) 2005 set out to determine the prevalence of sunless-tanning formulation use and to understand the relationship between sunless tanning, indoor tanning, and sun-protective behavior. In so doing, the investigators found that the use of sunless-tanning products was relatively rare, with an estimated 11% of U.S. adults claiming to have used such products in the previous year. Of this group, 13% used sunless tanners more than 25 times; 12% used them 11-24 times; 35% used them 3-10 times; and 40% used them just once or twice. Users and exclusive users were more likely to be women, well educated, and living in the West (J. Am. Acad. Dermatol. 2007;56:387-90).

Recent Cause for Pause

In 2008, Jung et al. used the electron spin resonance spectroscopy–based radical sun protection factor, which measures free-radical reactions in skin biopsies during UV exposure and can determine the protective effect of UV filters and sunscreens, to analyze three different self-tanning agents, including DHA. Noting that the reaction of the reducing sugars in such products and amino acids (Maillard reaction) in the skin layer engendered Amadori products that created free radicals during UV irradiation, the investigators reported that in DHA-treated skin, more than 180% additional radicals were produced during sun exposure, compared with untreated skin. They concluded that the use of self-tanners necessitated reducing solar exposure duration (Spectrochim. Acta A. Mol. Biomol Spectrosc. 2008;69:1423-8). Consequently, DHA users would be well advised to wait at least 24 hours before solar exposure following application of sunless lotion or spray (Dermatol. Clin. 2009;27:149-54).

Conclusion

In addition to the need to continually persuade patients to engage in skin-protective behavior – namely, limiting sun exposure, avoiding peak-time exposures, wearing wide-brimmed hats and clothing with SPF value, and using sunscreens (preferably those containing avobenzone, Mexoryl, zinc oxide, or titanium dioxide) every day – it is incumbent upon dermatologists to disabuse our patients of the idea that untanned skin is less attractive or, conversely, that tans should be equated with attractive skin. Although healthy messages (that there is no such thing as a healthy tan, and that a tan indicates skin damage) are slowly spreading, sunless tanners appear to be a medically and cosmetically acceptable intermediary step, far surpassing the patently detrimental effects of indoor tanning. That said, patients should be advised to refrain from solar exposure for a full 24 hours after applying sunless tanners. Furthermore, much more research is necessary to truly establish that DHA delivers even modest protection from UVA or UVB. Accordingly, patients should be counseled that sunless tanners do not suffice as a base, nor do they justify extended solar exposure, and that sunscreens should also be applied.