The BAD's consensus on sunbeds:

• The British Association of Dermatologists would like the government to restrict sunbed use for under-18s.
• We are also calling for a ban on coin-operated, unmanned sunbeds.
• Many salons do not provide adequate information on the health risks either, but instead advertise somewhat spurious health ‘benefits’. We would therefore also like to see better point of sale information supplied, outlining the health risks so people can make a more informed decision regarding sunbed use.
• Many people do not understand the risks that these machines pose, especially when they can be found at sports centres and places that suggest they are ‘healthy’, which sends conflicting messages. We would therefore like to see the removal of sunbeds from all health facilities such as gyms and sports centres.

The British Association of Dermatologists believes that Scotland’s move to limit sunbed use, as well as informing people as to the risks, is a huge step in the right direction. The perceived health gains from tanning, such as vitamin D production, can be achieved by other means, including diet and supplements.

We would ask the government not only to introduce regulations, but also powers of inspection of sunbed parlours, to ensure compliance.

One option is for local authority regulated licensing scheme, with licences issued only to salons that comply with set criteria and that pass regular inspections. Standards that would have to be met in order to retain a licence include:

• The restriction of sunbeds for under-18s
  
• Full-time supervision of sunbed facilities by trained staff
  
• Compulsory display and provision of customer information regarding the health risks
• A limit on the number of sessions available for adults to prevent over-exposure
• No coin-operated machines

Evidence that the equipment has been properly maintained and complies with British safety standards.

Licences would not be granted to local authority health facilities, such as gyms and health centres, and licences could be revoked at any stage, subject to regular inspections. Premises not in possession of a licence would not be permitted to offer sunbeds.

Some recent studies:

Shocking safety standards in sunbed parlours, research reveals

A high number of tanning parlours have shockingly poor standards of practice and a severe lack of staff training, including the provision of sunbeds designed for medical use only.

332 tanning salons in Northern Ireland took part in a survey over an eight week period in July and August 2007, and the results have raised serious concerns about safety within the sunbed industry.

Types of sunbed and safety

Staggeringly, over a quarter of premises used ‘type 4’ sunbeds which are designed for medical use and not for cosmetic tanning, according to European and international standards*. It is possible that many others are using sunbeds that emit high levels of UV, as almost two thirds (62%) of salons did not know what level of ultraviolet (UV) radiation their sunbeds produced.

39 percent of the premises reported that devices were not regularly tested. The date of the last inspection of fixed electrical installations was unknown in over a third (34%) of premises, while 18 percent of premises did not even know the manufacturer of the sunbeds in their salons. In 71 percent of the tanning salons the operating manual for the sunbeds was unavailable.

This raises serious concerns that improperly maintained or faulty machines could produce high levels of ultraviolet (UV) radiation, cause burning to the skin and potentially lead to skin cancer.

High risk users

Worryingly, the study found little evidence of children being prohibited from using sunbeds. Only half (51%) vetted clients with regard to age. Where premises allowed minors to use sunbeds, almost three quarters (71%) did not require parents or guardians to sign a consent form. Furthermore, over 15 percent of staff received no age awareness training.

In one fifth (20%) of the salons skin type was not even discussed with customers. In the salons where skin type was discussed, it was left to the client to determine their own skin type in 13 percent of cases.

In a recent study, only 40 percent of the indigenous population of Northern Ireland felt they were skin type I and II (naturally fair skinned) with over 30 percent typing themselves as type V or VI (dark Asian or black skinned)¹ whereas in fact Northern Ireland has a predominantly fair-skinned population.

Dr Art O’Hagan, Consultant Dermatologist explained: “Previous studies have shown poor comprehension of personal skin types, and relying on clients to have knowledge of their own skin type is an unsafe mode of skin type vetting.

Furthermore, asking about skin types was a somewhat purposeless exercise, since only 44 percent of customers with skin type 1 (people with very pale skin who are at greater risk of burning and skin cancer) were subsequently advised against using the sunbeds. More shockingly, only 31 percent of cases advised patients not to use a sunbed if they had a history of skin cancer.”

Hygiene, facilities and staff training

In a quarter (24%) of salons, the staff were offered no training at all on the risks of UV exposure.

39 percent of salons had coin operated devices, allowing the use of devices without staff supervision.

Basic hygiene standards in many of the salons that took part in the survey were particularly low. Only three quarters (75%) of salons reported that staff cleaned the sunbeds after usage, with others expecting clients to clean the sunbeds themselves, while almost a quarter (22%) failed to sanitise their eye protection wear after usage.

Worryingly, there was a charge for eye protection in 38 percent of cases. Furthermore, over 30 percent of the goggles were not CE marked therefore did not conform to a mandatory marking in the European Economic area and did not offer sufficient protection.

Interestingly over three quarters (79%) of premises were not members of the Sunbed Association, which shows that any code of conduct applied by the association does not apply to the majority of salons.

Local councils in Northern Ireland have prohibited the use of sunbeds in local council premises however the survey’s results have shown that private parlours continue to run with worryingly poor standards of operation.

The tanning industry in Northern Ireland continues to grow despite most of the population having a predominant skin type that increases their risks of skin cancer. In particular, the use of sunbeds seems to be prevalent in younger girls.³

Rebecca Freeman at the British Association of Dermatologists said: “This survey has shown that there is a serious lack of regulation within the sunbed industry, and self regulation is clearly not working. Children are able to access sunbeds in a shockingly high number of salons, which is a real worry.

One in five salons do not consider the client’s skin type, yet people with skin type 1, which is pale and burns easily, are particularly at risk of serious and permanent skin damage from sunbed use. Likewise, less than a third of salons advise people against using a sunbed if they have a history of skin cancer. This survey implies salons are not protecting their clients sufficiently. There is a great need for improved public education and strong regulation of sunbed salons to ensure that those who do choose to use sunbeds are fully aware of the risks.”

Possible effects of sunbed use include premature skin ageing, increased skin fragility, cataracts and skin cancer.^4,5

References:

“Public at risk – a survey of sunbed parlour operating practices in Northern Ireland”. AH O’Hagan1, C Devereux1, A Devlin2, G O’Callaghan2, B Furey2, G McElwee2,4, G McEvoy2, J Caughey2, L McPeak2, L Fitzsimmons2, L Smart2, N McMahon2, P Loan2, S Martin2, S Gordon2,4, T Crossan2,  A Gavin3.

1Craigavon Area Hospital, 2Sun Bed Working Group (NIMSIG), 3Northern Ireland Cancer Registry, 4Ulster Cancer Foundation.

Other references:

* The French regulations for ultraviolet radiation sunbeds; J. P. Cesarini, Radiation Protection Dosimetry
Vol 91, Nos 1-3, pp 205-207, 2000.

1. Gavin A. Personal Communication, Sept 2008
2. Northern Ireland Statistics and Research Agency. NI Census 2001, Key Statistics. www.nisra.gov.uk/census/census2001output/keystatistics/keystatrepl.html 
3. ing W, Schultz K, Cac NN, Peterson M, Walling HW. Tanning bed exposure increases the risk of malignant melanoma. Int J Dermatol. 2007; 46:1253-57
4. Sunbeds; Hawk JLM, Radiat Prot Dosimetry, 2000; 91:143–5.
5. Epidemiology of chronic disease risks in relation to ultraviolet radiation exposure; Swerdlow AJ, Radiat Prot Dosimetry 2000; 91:19–23

Shocking sunbed study shows increased cancer risk

A study published in the August 2007 British Journal of Dermatology uncovered worrying new findings about sunbeds, including a rise in ‘high power’ sunbeds and a lack of knowledge by users of the cancer risks involved.

Scientists at the Ninewells Hospital & Medical School in Dundee compared current sunbed usage to a 1998 survey of sunbeds in the Dundee, Perth and Kinross areas, and also surveyed the habits and opinions of sunbed users.

Their study revealed a 30 percent increase in the number of privately operated sunbeds since 1998, despite increased warnings over the cancer dangers involved in sunbed use.

The team also measured the levels of cancer-causing UV radiation created by each sunbed, and found that a shocking 83 percent produced UVB radiation levels that exceed the European standard. UVB is generally considered to be particularly dangerous and is closely linked to induction of skin cancer.

Equally worrying is the emergence of stronger, high power sunbeds. Dr Harry Moseley, Consultant Clinical Scientist and one of the study’s authors, said: “In an earlier study we found that sunbeds carried a cancer risk similar to that of UK summer sun. However, since our initial study, there have been technological developments leading to new, high power ‘fast tan’ units. These have become increasingly popular, along with the emergence of unmanned sun parlours.

“People sometimes use sunbeds in the mistaken belief that they are a safe alternative to conventional tanning, but this is simply not the case – the average sunbed now carries the same cancer risk as the midday southern European sun.”

The researchers then conducted a survey of sunbed users, discovering that a staggering 15 percent do not believe that sunbeds carry a health risk. Of those who did feel sunbeds carry risks, only 56 percent mentioned cancer.

Other findings of concern are as follows:

• Half of respondents started using sunbeds early in life, between the ages of 16 and 24
• Almost a quarter have been using sunbeds for more than 10 years
• Over a third have had between 29 and 40 sunbed sessions in the past year, and over a quarter more than 50 sessions
• A quarter never use goggles to protect their eyes
• Only seven percent had actually been advised to wear goggles

Dr Moseley said: “In comparing these results with those obtained in the earlier study, a number of key differences should be highlighted. We have found a 30 percent increase in the number of privately operated sunbeds. This is particularly disturbing because in the earlier study, in which we looked at environmental health factors, we found that many privately operated sunbeds had major faults; for example, 89 percent did not attempt to impose a limit on the number of sessions, 81 percent provided inadequate information, 59 percent maintained no customer records and 33 percent failed to display guidance. Therefore, it is a cause for concern that the number of sunbeds provided by the private sector is increasing.

“Another factor that has emerged is that the mean cancer risk for all machines is now comparable to that from Mediterranean sun, whereas in the previous study this only applied to stand-up booths. This increase in carcinogenic potential is directly related to the widespread use of high power sunlamps, both in stand-up booths and lie-down sunbeds.

“Also, for the first time, we identified premises with unmanned sunbeds. These have no supervision and anyone, including children, may use the facilities. There is no limit imposed on the dose per session nor the number of sessions.

“The majority of sunbeds do not comply with the British and European standard for cosmetic tanning units. 83 per cent of sunbeds produced UVB irradiances that exceeded the limit specified in the standard. Product standards are intended to protect the public but, clearly, sunbed manufacturers are ignoring the standard and there is no effective control on the suppliers or operators.

Notes:

1. If using this study in the media, please ensure you mention that the study is being released in the British Journal of Dermatology, the publication of the British Association of Dermatologists (August 2007 edition)
2. The study is titled ‘Qualitative risk assessment of sunbeds: impact of new high power lamps’. Authors: Harry Moseley, James Ferguson, Hannah Oliver – The Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
3. BJD is published by Blackwells.

For more information or further statistics, please contact: Nina Goad, BAD Communications Manager, Phone: 0207 391 6355, Email: nina@bad.org.uk