The psychology of tanning

By Rodney S. W. Basler, M.D. In 1978, as I was finishing my tenure on the academic faculty of the University of Arizona and preparing to return to Lincoln, I published a paper in a medical journal entitled “Damaging Effects of Sunlight on Human Skin.” To my surprise, this seemingly innocuous review article, covering the handful of preliminary studies on the subject that were starting to appear in the medical literature, ignited a mini-firestorm of controversy and considerable interest. I was interviewed by a number of newspapers, including The New York Times and answered questions on talk radio. “Who was this medical renegade suggesting that the deep, dark, attractive tan, the goal of much of the white population, was anything short of healthy?” Obviously, over the ensuing 30 years, the general population has been unevenly enlightened, although clearly not to an adequate level, and behavior has certainly not followed information. It is a rare strip mall, of any respectable size, that opens in Lincoln without the obligatory tanning salon. With apparent disregard for the efforts of this country’s cancer societies and dermatologists, many Americans, especially in the younger age groups, still equate a summer tan with attractiveness and health. Unfortunately, medical data point to the unequivocal conclusion that long-term indiscriminate exposure to sunlight is the primary cause of premature aging of the skin and of all forms of skin cancer. A casual relationship between ultraviolet exposure and lethal malignant melanoma has also been established. Just as a callous represents a compensatory attempt by the skin to respond to chronic friction injury, increased pigmentation, in the form of the oft-envied dark tan, represents the skin’s response to ultraviolet injury. Given this medical fact, why do large portions of the white population continue to strive to present to the world the maximum amount of injury they can possibly attain? What is the basis for the ill-conceived, self-contradictory description of a “healthy tan”? The answer lies in attitudes not grounded in scientific fact but based on incorrect, intuitive perceptions deeply ingrained in the collective psyche of modern-day humanity. Historically, society has exhibited views toward the desirability of pigmented skin which have been incongruous from one period to the next. The pre-Columbian Mayas ascribed deity to the light-skinned individuals and every description of their man-god, Kukulcan, includes some allusion to his white skin. In accordance with this concept, the Spanish invaders were accepted and worshiped rather than appropriately feared and resisted, greatly contributing to the ease of the European conquest. Similarly, in 18th-century France, porcelain paleness was sought with such fervor that, analogous to present attitudes, significant health risks were accepted merely to achieve desired coloration. In this period, stylish women of high bearing would apply lead-based, opaque makeup to their skin, occasionally resulting in lead poisoning with attendant loss of hair and even teeth! The cosmetic intent during this period was obviously socioeconomic, albeit to draw opposite conclusions from today. Because peasants worked in the fields, their skins were perpetually tanned, while those born to the high families of the court were not reduced to outdoor labor, and wore their sallow countenances as a badge of elite distinction. With the industrial revolution, manual labor, relegated, as always, to the working class, moved from the fields to the factory. As a reversal of the previous mentality, the members of the highest socioeconomic classes soon began sporting tans in order to achieve the same desired result—to be distinguished from the working class. Today, in an age of flexible working hours and maximized recreation time, nearly anyone who wishes can attain a tan during the months of sunshine. Now the mark of distinction is the manifestation of a deep, dark (damaging) tan during the winter months, suggesting the means to travel to exotic, sunny destinations. To fill the need to produce the color, while eliminating the travel, artificial tanning salons have become ubiquitous. The deleterious effects of exposure of the skin to ultraviolet light is now an unquestioned point of medical knowledge. Ultraviolet light originating from the sun within the spectrum of wave lengths which reaches the earth is responsible for alterations in the skin that result in the acceleration of the aging process. Artificial light effectively produces wrinkles and premalignant keratoses and can stimulate malignant transformation of normal skin tissue into flesh-colored skin cancers and even malignant melanomas. The evidence linking exposure of the skin to ultraviolet sources, both natural and artificial, with premature aging, premalignant keratoses and actual skin cancer, including potentially fatal melanomas, is incontrovertible. The attitudes of the white population toward the attractiveness and perception of upper-class lifestyle from additional pigment, for the present, seem deeply ingrained, although moving in a somewhat more intelligent direction. Public information campaigns would appear to be the bridge between these two realities. In a free society, I do not believe legislation is necessary to protect individuals from themselves. We don’t need laws that tell us we can’t put beans in our noses, although some age restriction for tanning beds similar to those enforced for smoking might be defensible on the same grounds, that we have an obligation to protect underage adolescents from harming themselves before they can make their own rational decisions. Unless the general population suddenly and seriously heeds our educational efforts, dermatological care will continue to be a major “growth industry” of the future.