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Burns 1992 Apr;18(2):103-6
Pronto Socorro Para Queimaduras, Goiania, Brasil.
A retrospective study has analyzed 562 sun-related burns out of 19,643 patients treated at our institution from 1 March 1988 to 28 February 1991. These patients were analysed according to sex, age, burn area, mode and length of treatment and outcome. Females, mainly adults, represented 60.8 per cent of all patients presenting burned due to sun bathing. There is a marked seasonal incidence, proportionally constant throughout these 3 years. The main causes of injury were sun only (36.7 per cent), sun plus fig leaf 'tea' tanning lotion (17.7 per cent) and lemon juice (17.7 per cent). Healing to normal skin appearance was achieved in 99.1 per cent, 0.7 per cent healed with scarring and one patient died due to massive sepsis. The effect of sunlight on skin and the process of 'sunburn' when using homemade plant-derived tanning lotions containing substances which can induce a photodermatitis reaction is also discussed.
PMID: 1590921, UI: 92272951
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World J Surg 1992 Mar-Apr;16(2):157-65
Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand.
The evidence relating cutaneous malignant melanoma to previous sun exposure is now very strong. Major northern hemisphere studies consistently show increases in melanoma in association with recreational and vacation activities related to intermittent sun exposure. These studies have also recorded amounts of sun exposure from such activities. Several studies suggest an increased risk related to short periods of intensive exposure in early adult life. In contrast, regular outdoor occupation confers a decreased risk in these same studies. Australian studies, in populations with much higher levels of total sun exposure, do not show such a clear distinction between intermittent and chronic exposure. The evidence is consistent with a complex relationship of melanoma risk to sun exposure, the risk being increased by intermittent exposure to levels of sun which are higher than normal for that individual, but no increased risk or even a decreased risk related to long term chronic exposure. Possible biological mechanisms for this complex relationship are discussed. In the Western Canada Melanoma Study the effects of occupational and recreational exposure are different in form and are independent. The increased risks seen with various measures of sun exposure do not appear to be systematically different for individuals who have a good tanning response as compared to individuals who do not.
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PMID: 1561794, UI: 92221638
Health Psychol 1992;11(6):371-6
Prevention Research Center (M/C 275), University of Illinois, Chicago 60607.
We examined knowledge, attitudes, and behaviors related to skin cancer, sun exposure, sunscreen use, and use of tanning booths in 903 female and 800 male adolescents. The effectiveness of a brief, school-based intervention designed to increase teens' knowledge and preventive attitudes about skin cancer was also evaluated. Females, older students, and those with high-risk skin types were most likely to use sunscreen and to take precautions. However, overall level of protection was low. Intentions to take precautions were associated with levels of perceived susceptibility to skin cancer, attitudes about the benefits of sun exposure, skin type, and sex. Beyond intentions, sunscreen use was associated with perceived susceptibility and skin type. The one-session, school-based intervention significantly increased knowledge and perceived susceptibility to skin cancer but not behavioral intentions.
PMID: 1286656, UI: 93162032
J Am Acad Dermatol 1991 Aug;25(2 Pt 1):336-7
Quad City Skin Clinic, Moline, IL 61265.
PMID: 1918477, UI: 92012353
Melanoma Res 1991 Apr-May;1(1):69-74
Jules Bordet Institute, Brussels, Belgium.
Two recently published case-control studies have highlighted the possibility of an association between the development of cutaneous malignant melanoma and exposure to sunlamps and sunbeds. Little is known about the behaviour patterns with regard to exposure to sunlamps and sunbeds in Western Europe. This descriptive study compares usage patterns of sunlamps and sunbeds of melanoma patients with the general population in Belgium. Evidence is given that melanoma patients are greater users of artificial ultraviolet sources than the general population, and that the incidence of melanoma in different geographical areas increases proportional to the percentage of people using tanning devices. Although this descriptive study may well be biased or refuted, it does advocate the need for further epidemiological research addressing specifically the issue of melanoma and exposure to artificial sources of ultraviolet radiation.
PMID: 1822772, UI: 92353655
J Am Acad Dermatol 1991 Feb;24(2 Pt 1):277-82
Department of Medicine, College of Human Medicine, Michigan State University, East Lansing 48824-1315.
An area survey of tanning salon proprietors was conducted in a medium-sized midwestern city. Proprietors reported they were in compliance with federal safety regulations, but not all had age, frequency, or duration restrictions. Similarly, proprietors were not uniformly informing patrons of potential tanning hazards, including the possibility of skin cancer, and were not knowledgeable about the risk and benefits of tanning. Some establishments reported selling psoralens to patrons to enhance tanning. More explicit guidelines regarding the use of tanning equipment and more accurate consumer information are needed.
PMID: 2007675, UI: 91178124
J Photochem Photobiol B 1991 Jan;8(2):219-23
Regional Medical Physics Department, Dryburn Hospital, U.K.
PMID: 1904923, UI: 91268977
BMJ 1990 Oct 6;301(6755):773-4 Published erratum appears in BMJ 1990 Oct 20;301(6757):890
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PMID: 2275730, UI: 91028394
J Natl Cancer Inst 1990 Aug 15;82(16):1361
Department of Microbiology, Clemson University, SC 29634-1911.
PMID: 2380993, UI: 90339513
Dermatol Nurs 1990 Jun;2(3):162-7
The proliferation of indoor tanning facilities is a result of our society's belief that tanning is a symbol of wealth, health, and youth. This article examines the indoor tanning industry, the effects of ultraviolet-A radiation, and public education.
PMID: 2141272, UI: 90283211
Am J Epidemiol 1990 Feb;131(2):232-43
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Data are presented from a large case-control study (583 cases, 608 controls) to estimate the association of melanoma with the use of sunbeds and sunlamps. Odds ratios of 1.88 and 1.45 were found for ever having used a sunbed or sunlamp in males and females, respectively, which was statistically significant in males and of borderline significance in females. These effects persisted when adjustments were made for age and a variety of potential confounders. The effect was slightly stronger for lentigo maligna and for lesions of the face, head, neck, and arms. The risk was greater and significant for both sexes for domestic use of sunbeds/sunlamps, and increased with duration and amount of use. A comparison of 43 cases interviewed before a diagnosis of melanoma had been made with the other 540 cases suggests that recall bias was not responsible for the association. The authors conclude that use of artificial tanning devices appears to be a risk factor for melanoma.
PMID: 2296977, UI: 90119586
J Int Med Res 1990;18 Suppl 3:2C-7C
Allergy Clinic 'City', Vienna, Austria.
A well-tanned skin is currently regarded as a sign of fitness, youth and health, with people increasingly exposing their skin to the sun and using tanning accelerators, such as psoralens, but exposure to ultraviolet B (UVB) radiation from the sun causes extrinsic ageing of the skin. The minimal erythema dose is rarely exceeded but the UVB dose that brings about irrepairable DNA damage leading to photodamage is lower. Growing numbers of patients, therefore, have prematurely aged skin with pigmented spots, dryness, itchiness and wrinkles. These symptoms are more than just of cosmetic concern. It is known that epitheliomas frequently develop in photodamaged skin; consequently, this skin requires medical treatment. Prophylactic measures should be taken from childhood, but an effective treatment for already damaged skin is topically applied tretinoin, which should be used with a mild skin cleansing and skin care programme.
PMID: 2227084, UI: 91032547
J Photochem Photobiol B 1989 Nov;4(2):227-8
PMID: 2512383, UI: 90079675
Int J Dermatol 1989 Oct;28(8):517-23
Department of Dermatology, University Medical Center Steglitz, University of Berlin, West Germany.
The relationship between cutaneous malignant melanoma (MM) and possible risk factors was assessed in a case-controlled study. Two hundred patients and 200 non-melanoma controls of German origin matched for age and sex were interviewed and examined for pigmented moles and pigmentation characteristics. In patients with MM significantly more melanocytic nevi greater than or equal to 2 mm (MCN) were found (mean, 53 MCN) compared to control cases (mean, 18 MCN). For persons with greater than 60 MCN the relative risk (RR) for developing MM increased 15 times compared to less than or equal to 10 MCN. Additional independent markers for an increased risk were presence of atypical MCN (RR = 7 vs. none) found in 45% of patients and in 5% of the control group, moderate to large numbers of actinic lentigines (RR = 6.2 vs. none), and lack of tanning as well as a tendency to sunburn (skin type I; RR = 2.2 vs skin type IV) No significant correlation was found between the relative risk for MM and hair color, eye color, duration of free time sun exposure and number of sunburns. Individuals with permanent outdoor profession and sun exposure, however, showed a clearly increased relative risk for developing MM.
PMID: 2583889, UI: 90061507
JAMA 1989 Jul 21;262(3):380-4
Tanning for cosmetic purposes by sunbathing or by using artificial tanning devices is widespread. The hazards associated with exposure to ultraviolet radiation are of concern to the medical profession. Depending on the amount and form of the radiation, as well as on the skin type of the individual exposed, ultraviolet radiation causes erythema, sunburn, photodamage (photoaging), photocarcinogenesis, damage to the eyes, alteration of the immune system of the skin, and chemical hypersensitivity. Skin cancers most commonly produced by ultraviolet radiation are basal and squamous cell carcinomas. There also is much circumstantial evidence that the increase in the incidence of cutaneous malignant melanoma during the past half century is related to increased sun exposure, but this has not been proved. Effective and cosmetically acceptable sunscreen preparations have been developed that can do much to prevent or reduce most harmful effects to ultraviolet radiation if they are applied properly and consistently. Other safety measures include (1) minimizing exposure to ultraviolet radiation, (2) being aware of reflective surfaces while in the sun, (3) wearing protective clothing, (4) avoiding use of artificial tanning devices, and (5) protecting infants and children.
PMID: 2661872, UI: 89294036
Postgrad Med 1989 Jul;86(1):131-6, 141-4
University of California, Irvine, California College of Medicine.
Several pathologic processes of the skin are seen more commonly in the elderly, so these patients need special attention. The skin undergoes physiologic and structural changes as it ages, and knowledge of these changes is essential to accurately interpret the physical signs and symptoms that may be present in the elderly patient. Since cutaneous inflammatory responses and subjective sensations may be diminished in aged skin, a higher degree of vigilance in physical examination is needed to reach a proper diagnosis. Prevention of many of the cutaneous signs of aging and of most skin cancers is dependent upon sun avoidance. Thus, the best advice physicians can offer patients of any age is to limit sun exposure by using a sunscreen with a high sun-protection factor, to avoid being in the sun during the peak tanning hours (between 10:00 AM and 2:00 PM), and to wear protective clothing when exposed to the sun.
PMID: 2662152, UI: 89296659
JAMA 1989 Jun 23-30;261(24):3519-20
PMID: 2724494, UI: 89259249
Br J Dermatol 1989 Jun;120(6):767-77
Institute of Dermatology, St. Thomas' Hospital, London, U.K.
The effects on 31 normal subjects following exposure to sunbeds containing UVA lamps with minimal UVB emission have been compared in a double-blind study with the effects on nine control subjects of a similar exposure course three times weekly for 4 weeks to sunbeds emitting visible light. On previously untanned areas, all those subjects on active treatment developed a mild tan; in tanned areas they all developed a moderate tan, while all control subjects developed a minimal to mild tan. The mean protection factor against later UVB-induced erythema was 3.2 +/- 0.3 after the active course and 1.6 +/- 0.2 among the controls. Significantly more frequent adverse cutaneous effects for active subjects were pruritus, erythema, freckling, burning sensation, dryness and polymorphic light eruption. Cutaneous Langerhans cell numbers, and blood CD3+ (pan T-cell) and CD4+ (helper T-cell) lymphocyte subsets were reduced in both active and control groups. CD8+ (cytotoxic/suppressor T-cell) counts were similarly but not significantly reduced in both groups. Pityrosporum yeast counts were significantly reduced in both groups. The changes found in both groups seem attributable to small amounts of UVB emission from both active and control lamps.
PMID: 2757939, UI: 89335561
MMWR Morb Mortal Wkly Rep 1989 May 19;38(19):333-5
PMID: 2497327, UI: 89238329
Environ Health Perspect 1989 May;81:139-51
Laboratory of Epidemiology and Biostatistics, New York University Medical Center, NY 10010.
The purpose of this case-control study was to identify susceptible subgroups, primarily based on pigmentary characteristics, at higher risk of developing melanoma when exposed to the sun. The study group, which was interviewed from 1979 to 1982, consisted of 289 consecutive patients with melanoma and 527 randomly selected controls without cancer. In general, the risk of melanoma associated with sun exposure was greater for individuals expected to be susceptible on the basis of poor ability to tan, but not other pigmentary traits. There were, in addition, some noteworthy interactions between age and sun exposure. Among subjects with poor tanning ability, the risk of melanoma associated with outdoor occupation was more than 3-fold [odds ratio (OR) = 3.3] compared to indoor occupation. In contrast, the analogous OR was much less elevated among subjects with a good ability to tan (OR = 1.5). Mixed indoor and outdoor job exposure was protective among good tanners (OR = 0.80), but not among poor tanners (OR = 1.5). A similar pattern was seen for recreational sun exposure and, when applying multiple logistic regression, for the patient's overall subjective assessment of his lifetime sun exposure. However, quantitative assessment of average hours of sun exposure did not prove to be a good indicator of melanoma risk, even among susceptible individuals. A history of severe sunburn with blistering was associated with nearly 3-fold risk among poor tanners (OR = 2.9) but was protective among good tanners (OR = 0.79). A history of nonmelanoma skin cancer or solar keratosis was a very strong risk factor (OR = 7.3), which, however, did not significantly differ in magnitude among susceptibility subgroups.
PMID: 2759056, UI: 89338333
J Am Acad Dermatol 1989 May;20(5 Pt 2):950-4
Division of Dermatology, University of Louisville, School of Medicine, KY 40292.
A patient who developed lentigines after prolonged ultraviolet A (UVA) exposure in a tanning booth is described. The patient had no exposure to psoralens or furocoumarins. Histologic examination of a representative lentigo revealed melanocytic hyperplasia and cytologic atypia. Increased nevocytic activity with histologic dysplasia was present in several junctional nevi excised during the period of UVA exposure. Several studies have revealed significant effects of UVA on melanocytes. Patients should be cautioned to avoid tanning bed use in view of these potentially deleterious effects.
PMID: 2715451, UI: 89234803
J Photochem Photobiol B 1989 Apr;3(2):281-7
TNO Medical Biological Laboratory, Rijswijk, The Netherlands.
PMID: 2498488, UI: 89257900
J Am Acad Dermatol 1988 May;18(5 Pt 1):1030-8
Department of Dermatology, John L. McClellan Memorial Veterans Hospital, Little Rock, AR.
Because so little data are available on practices and procedures used by tanning salons, we studied, as customers, salons in a major city in Arkansas, the state where the practice began. We measured both ultraviolet A (UVA) and ultraviolet B (UVB) output at multiple reference points and found UVB always to be present, but at lower-than-expected levels. The highest irradiance was always at the umbilicus and the lowest was on the face. We evaluated compliance with accepted safety principles and federal guidelines and regulations; too often we found no eye protection and sometimes we found inadequate limits of exposure time. Persons with skin types I and II were sometimes promised a safe, effective UVA tan that would protect against sunburn. From our experience we concluded that if the industry is to continue, there is need for closer supervision and regulation.
PMID: 3385022, UI: 88257629
Nebr Med J 1987 Sep;72(9):303-5
PMID: 3670510, UI: 88039269
Am J Emerg Med 1987 Sep;5(5):386-9
A retrospective review of patients visits to two urban emergency departments was undertaken to ascertain the impact of commercial tanning facilities (CTFs) on the incidence of corneal burns. Ocular injury and/or infection represented 1.9% of the total patient census, with corneal burns being 7.6% of the eye pathology. Prior to the opening of a number of CTFs, corneal burns had three causes in the two emergency departments reported here: ultraviolet (UV) keratitis from electric arc welders, (32.5%) chemical or physical agents (28%), and UV keratitis from home sunlamps or reflected sunlight while sunbathing or boating (10.5%). Within a single year, UV keratitis from CTFs became the second most common source of corneal burns, injuring 29% of all patients. While most corneal burns resolved with symptomatic treatment, an additional two patients received retinal burns from the CTFs. Both patients were left with permanent visual deficits. Treatment and aspects of UV ocular injury are discussed.
PMID: 3620037, UI: 87298785
Cancer Nurs 1987 Apr;10(2):93-9
PMID: 3646919, UI: 87215592
S D J Med 1987 Mar;40(3):31-3
PMID: 3470943, UI: 87177950
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