Tanning Beds and Base Tans: What a Dermatologist Wants You to Know

This time of year, patients start telling me about their tanning plans. A few tanning bed sessions before a holiday cruise. A base tan before a winter beach trip so they won't burn. As long as they don't burn, they figure it's fine. I understand the appeal. I also spend my days removing the skin cancers that follow. Here is what tanning actually does to your skin.

Tanning Myths vs. Facts at a Glance

Are Tanning Beds Safer Than the Sun?

No. The World Health Organization's cancer agency classifies tanning beds as a Group 1 carcinogen, the same category as tobacco and the sun itself. People who start using tanning beds before age 35 raise their melanoma risk by about 75%.

Tanning beds deliver mostly UVA, often far more intense than midday summer sun. The controlled setting does not make that dose safe. It makes it worse, because it makes it so easy to repeat, week after week, all winter long.

Do Dermatologists Use Tanning Beds?

No. Not for tanning. Many dermatology offices offer phototherapy, a medical treatment that uses specific wavelengths of UV light, most often narrowband UVB, to treat conditions like psoriasis, eczema, and vitiligo. Narrowband UVB burns easily if it is not carefully dosed. When a dermatologist does suggest a tanning bed for psoriasis, it is a rare recommendation for patients who cannot get to the medical light units in a dermatology office.

Whether UVB or UVA, phototherapy looks nothing like a tanning session. Phototherapy is prescribed for a diagnosed disease. Doses are measured and increased gradually, eyes are protected, and cumulative exposure is tracked over time. As with any treatment, dermatologists use the lowest effective dose. A tanning bed delivers mostly UVA for a cosmetic result, with none of the health oversight.

Every medical treatment is a risk versus benefit decision. For a patient with severe psoriasis, cutaneous lymphoma, vitiligo, or atopic dermatitis (eczema), the benefit can justify the risk. For a tan, it never, never, never does.

Does a Base Tan Protect You on a Winter Beach Trip?

Barely, and not even close to anything you should count as protection. That's like using a spaghetti noodle as a seat belt in a 60 mph head-on collision. A base tan provides protection roughly equal to SPF 3 or 4. That is nowhere near enough to prevent a burn on a tropical beach, where the sun can be as intense in January as it is at home in July, and it is no reason to keep tanning. Getting the base tan is itself UV damage. You are not preparing your skin for the sun. You are front-loading the injury and lulling yourself into a false sense of security.

If you want to avoid burning on vacation, start with an SPF 50 sunscreen like SolRX and apply it generously 15 minutes before you go out. Reapply at least every 2 hours, and sooner after swimming or sweating as the label directs. Add a hat, sunglasses, and shade during midday hours. For vacation days in the water, the SolRX Waterblock SPF 50 lotion is built with 8-hour water resistance to stay on through water and sweat. It's a game changer for long days at the beach, on the boat, or wherever you spend the day outside.

Is Tanning OK as Long as You Don't Burn?

No. A tan is your skin's response to injury. When UV damages the DNA in your skin cells, your skin produces more melanin to shield itself from further harm. That darker color is evidence the damage already happened. It is your body screaming for you to stop.

It's funny (not ha-ha funny) that the beauty of a tan overrides our worry that it is slowly killing us. If a tan were ugly, of course, we wouldn't do it. But so many people consider it beautiful, so we do it and hope we'll be okay. That sounds a little like Russian roulette for the skin. Bad Idea Jeans all over it, for the '90s SNL fans.

It cannot be overstated: burning is not the only problem. UV exposure that never turns into a burn can still cause cancer, because it adds up over a lifetime. It can cause basal cell carcinoma, squamous cell carcinoma, and melanoma, the most feared and deadly of the three, along with the wrinkles, sun spots, and loss of firmness people later blame on age.

What most people don't realize is that much of what they call aging is really accumulated time in the sun. Age does affect the appearance and texture of skin. But after 20 years of skin exams on older patients, the contrast between the covered skin on the back, chest, abdomen, and buttocks and the exposed skin on the face, neck, upper chest, and arms is remarkable. The unfreckled, unwrinkled skin that stayed covered is just as old as the mottled, creased, sun-damaged skin. Age alone doesn't explain the difference.

If you have tanned for years, learn how to check your skin for changes, including the ABCDEs of melanoma and sores that won't heal.

Is a Self-Tanner a Safe Alternative?

Yes, with one catch. Sunless tanners use dihydroxyacetone (DHA), an ingredient the FDA has approved for external use. It reacts with the outermost layer of skin to create color without any UV. In a spray booth, protect your eyes, lips, and nose, and avoid inhaling the mist.

The catch is that a self-tanner tan provides no sun protection. If the label lists an SPF, that refers to sunscreen mixed into the product. The tan itself does not protect you, and the sunscreen in it still needs reapplying at least every 2 hours. You still need sunscreen and sun-protective clothing on top of it. For the full picture on what sunscreen can and can't do, read the sunscreen myths I hear every week.

Are Tanning Pills, Injections, and Nasal Sprays Safe?

There is no safe shortcut. Some people take high doses of beta-carotene to turn their skin a darker shade. The result, called carotenemia, is harmless, but the orange color is a poor imitation of a tan.

The one that concerns me is melanotan peptide injections and nasal sprays. They work by stimulating melanocytes to make a real tan. The problem is that they are not approved by the FDA, they are sold illegally and unregulated, and no one knows their long-term safety. When we protect skin from the sun, we are trying not to stimulate melanocytes, because those are the cells that can turn into melanoma. Stimulating them directly raises the concern that these products could contribute to melanoma. That is not proven, but it is a real theoretical risk, and it seems reckless when we just don't know what they do long term. I steer everyone I can away from them.

One related drug is FDA approved, but only for a rare, high-risk condition called erythropoietic protoporphyria. It is extremely expensive, it must be prescribed for that condition by a specially certified provider, and the system can't be fudged to get it for someone who just wants a tan. Even if it could, I'd rather put that money toward a new Porsche every year.

Dr. Lindsay D. Sewell, MD MBA Board-Certified Dermatologist, Mohs Micrographic Surgeon

Dr. Sewell is a board-certified dermatologist and fellowship-trained Mohs micrographic surgeon at High Valley Dermatology in Idaho Falls, where his practice focuses on skin cancer treatment and prevention. A father of eight and lifelong outdoorsman, he writes Clinical Perspectives to bring the sun protection guidance he gives patients in the exam room to everyone else. Learn more about Dr. Sewell