Background: Recommendations to restrict summer sunlight exposure to prevent skin cancer apparently conflict with requirements to protect bone health through adequate 25-hydroxyvitamin D (25[OH]D) levels, as provided by cutaneous ultraviolet (UV)B exposure. Furthermore, sunlight exposure promotes a feeling of euphoria that is felt to drive further sun-seeking behaviour. Objectives: My principal objective was to examine health risk (DNA damage) and health benefits (25[OH]D gain, and potential cutaneous photoprotection) following low-level summer sunlight exposures in people of light (phototype II) and darker (phototype V) skin. A further objective was to evaluate serum endocannabinoid levels, potential drivers of mood elevation, following these exposures, and to assess for evidence of tanning addiction in a cross-section of psoriasis patients who had received similar low dose UV exposures, as medical phototherapy. Methods: During wintertime, 10 white Caucasians and 6 South Asians aged 18 to 60 years, from Greater Manchester, UK, received a simulated summer's sunlight exposures, specifically 1.3 standard erythemal dose, thrice weekly for 6 weeks, whilst casually dressed. Serum and urine samples and skin colour measurements were taken at baseline, Monday, Wednesday and Friday of week 1 and then weekly, and buttock skin that had received differential UVR exposures was biopsied for immunohistochemical analysis. Phototype II individuals, who are at higher risk of sunburn, were subsequently challenged with 2X minimal erythema dose (MED) UVB on small areas of simulated summer-exposed and photoprotected skin. Separately, a link to an online tanning questionnaire survey was sent to all members of the National Psoriasis Foundation (USA) during my USA field trip. Results: The simulated summer resulted in 50% gain in 25(OH)D for both phototype groups, but significantly more cutaneous DNA damage (cyclobutane pyrimidine dimers, CPD) in phototype II than V (p<0.0001). There was no accumulation of cutaneous CPD after 6 weeks compared with a single UVR exposure in either group, while phototype V individuals had repaired a greater proportion of their CPD 24 hours after final UVR exposure (p<0.0001). Urinary oxidative DNA damage was higher in phototype II throughout the simulated summer (p=0.002) and unaffected by UVR. All individuals had significant skin darkening, and in phototype II, stratum corneum thickness increased significantly (p<0.05). This tanning response provided significant photoprotection against a pro-inflammatory UVB (2X MED) challenge, as shown by reduced erythema and neutrophil influx in skin exposed to the simulated summer than in photoprotected skin (p<0.05 for both). Serum endocannabinoid (2-arachidonoyl glycerol) levels increased significantly during the simulated summer in both phototype groups (p<0.01), peaking at week 2-3. The cross-sectional study of 1,832 psoriasis patients revealed 34% had used sunbeds; 11% of current users fulfilled diagnostic criteria for addictive-like tanning behaviour: female sex, younger age, younger age at psoriasis diagnosis, severe disease and prior phototherapy were significant risk factors for addiction. Discussion: These findings should assist public health guidance on safe sunlight exposure and highlight the need for distinct guidance targeted to different phototype groups. Furthermore, individuals with psoriasis, in particular those who previously received regular UVR exposure, are at high risk of tanning addiction that may be driven by the endocannabinoid system.

Millions of Americans engage in tanning each year, defined as intentional ultraviolet radiation (UVR) exposure in the form of sunbathing or the use of indoor tanning beds. An emerging body of research suggests that UVR has addictive properties and some tanners engage in excessive tanning. This article provides an overview of the evidence of tanning addiction and a systematic review of existing tanning interventions with the goal of evaluating their potential to impact addicted tanners. Our search identified 24 intervention studies that were summarized and discussed according to 3 primary themes. First, there is a dearth of tanning interventions that target excessive tanning or are designed as treatments for tanning addiction. Second, tanning interventions are primarily educational interventions designed to increase knowledge of the risks of tanning. Third, there are notable aspects of existing tanning interventions that are relevant to addiction science, including the use of brief motivational and cognitive-behavioral-based interventions. Future directions are considered including recommendations for utilizing the existing evidence base to formulate interventions targeting excessive tanners.

Recent research shows that 7.7% of individuals who use indoor tanning beds do so in private homes,1 but little is known about this group. This study evaluated the tanning practices, reasons for tanning, and association with tanning addiction of adults who use tanning beds in private residences.