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As reported by The Hartford Courant, May 13, 2009.

In Search of a Tan for Prom, Youths Dismiss Risks

By Kathleen Megan

Pale is out.

Even though girls getting ready for their high school proms have heard about the risks associated with indoor tanning, they're flocking to tanning salons this spring to get that baseline bronze.

"I think it makes you feel better about yourself when you look tanner," says Kayla Adams, a senior at Manchester High School. "Celebrities, everybody, talk about being tanned. It's also really relaxing."

"Tanning does make you look more attractive," says Alissa Ranno, a senior at Rocky Hill High School. "It brings out your features more: your eyes, your face, your hair."

The risks of skin cancer concern her, she says, "but I take life day by day. ... I'm not trying to say I'm careless."

Her parents tell her she should be "careful with all that kind of stuff," but Ranno says she doesn't do it all the time. "It's not healthy to do it month after month after month."

But is it OK to do it for a month or two before their prom?

"We don't know if there is any such thing as a safe use of the sun tanning bed," says Dr. Philip Kerr, an assistant professor of dermatology at the University Connecticut School of Medicine, "but certainly less is better."

Tanning beds have been associated with an increased risk of melanoma and non-melanoma skin cancer, according to the American Academy of Dermatologists. Several studies have shown that tanning-bed use before age 35 is associated with an increased risk of melanoma, while excessive use of tanning beds is linked with skin aging, immune suppression and eye damage.

The association between tanning beds and skin cancer is strong, Kerr says, but stops short of a "proven cause and effect" relationship. He expects that research eventually will confirm a direct relationship between tanning beds and skin cancer — much the way smoking was eventually, definitively linked to cancer.

When he talks to young patients who tend to see themselves as indestructible, Kerr emphasizes that tanning beds definitely cause "premature aging of the skin. ... That's a message that seems to resonate with young women and girls: You don't want to look old before your time."

But it's a message many young people ignore.

"Generally, there is still a perception that people look healthier and better when they are tanned," says Dr. Arielle Kauvar, a dermatologist in New York City. "It's hard to convince young people that this is actually a dangerous behavior."

Kauvar is also concerned that high school kids who just want to get tanned for the prom may wind up becoming regulars.

"The problem is that indoor tanning is actually an addictive behavior," Kauvar says. "Several studies show that just like smoking and alcohol: Once you get started, it's hard to stop."

That's because sunlight is associated with well-being and produces endorphins, she says.

The "it's bad for you" message is also clouded by arguments from the tanning industry that a "base" tan protects you from the ravages of sunburns.

Advocates for indoor tanning also argue that many people are low in Vitamin D, which, they say, can be increased through tanning.

John Overstreet, executive director of the Indoor Tanning Association, says of dermatologists who are critical of tanning beds: "They love to talk about skin cancer, they love to scare everyone to death," but he says controlled indoor tanning helps to avoid the sunburns that have been linked to skin cancer.

Debbie Spada, who, with her husband, Umberto, owns Tropical Sun tanning salon in Middletown, said the staff works closely with clients to ensure that they tan safely.

"It's moderation," she says. "I think everything in life is moderation."

Dermatologists are critical of the "base tan" concept and say comparatively little vitamin D comes from tanning beds.

"A tan, just like a burn, is a sign of damage to the skin," says Kauvar. "Both are forms of damage to the skin; both are risk factors for developing skin cancer."

As for vitamin D, Kerr says that it is ultraviolet B rays that increase vitamin D levels, but tanning lightbulbs give off about 93 percent ultraviolet A rays.

In Connecticut, Debbie Osborn, executive director for the Connecticut Dermatology and Dermatologic Surgery Society, says the group has been trying to tighten regulation of tanning beds.

In the state, children under 16 must have a parental note of permission if they want to indoor tan. Osborn and her colleagues would like to see much stronger regulations, requiring parents to accompany children under the age of 18 to the tanning salon, where they would sign a waiver that details the risks.

"People think [tanning beds are] no big deal, but if we impose on parents to have to go in there and sign, parents will start thinking: 'Why am I signing? What am I doing?'" says Osborn. "Cigarettes — no one paid attention until there was a warning on every pack. That's exactly what we would like to see."

If you must have a tan for prom, dermatologists recommend spray-on or rub-on tanning solutions.

Dr. Lisa M. Donofrio, an associate clinical dermatology professor at Yale University School of Medicine, holds out a little hope that fashions might change:

"There is certainly an image that is perpetuated by models, etc., that tan is healthy. I'm hoping with the popularity of the 'Twilight' vampire series 'pale will be the new tan."