If the national media is a circus parade, the clown in the ultraviolet spotlight last month was 44-year-old Patricia Krentcil of New Jersey, who was arrested for allegedly bringing her five-year-old daughter to a tanning salon. But far from white-faced, this big-tent star had the dark, leathery visage of a tanning fanatic. The little girl, who sustained a burn, was much younger than New Jersey's legal tanning-booth age of 14—but the collective conversation soon turned from "What did this woman do to her child?" to, um, wait a minute, "What did she do to herself?" While Krentcil denied the charges and claimed that her daughter was sunburned while playing outside, media watchers gazed in amazement at the mother's unnaturally tropical, prematurely aged complexion—soon the fodder for TV comedians who likened it to a baseball glove in one monologue, a Slim Jim in another. Showered with judgment and catty chatter, the woman that newspapers dubbed the Tanorexic Mom could hardly run for cover.
As beaches and swimming pools open across the country, tanning devotees as well as casual sunshine enthusiasts can get their fix for free, almost anywhere. Of course, there's a bright side to sun exposure: It's linked with improved mood, better sleep, and the vitamin D production that's essential to good health. Yet reaping these benefits in excess can have dire consequences. Ultraviolet rays from sunlight carry the carcinogenic effects responsible for the most common form cancer in America today. Skin cancer, affecting some two million people a year, accounts for nearly half of all diagnosed cancers. Most episodes involve the less deadly basal or squamous cell carcinomas, yet melanoma—the most vicious form of skin cancer in the pack—plagued about 75,000 Americans in 2011.
The numbers are rising while the age of patients is dropping. "Typically, I had seen people in their 50s, 60s, and older with skin cancer, but that has shifted," says Dr. Hendrick Uyttendaele [pronounced "Yoo-ten-dale"] of Hudson Dermatology, with offices in Poughkeepsie, Fishkill, and Kingston. "Now it starts earlier. Seeing people in their 40s with skin cancer is becoming routine, and it's creeping into the 30s and 20s. I saw a 24-year-old who thought she had a zit on her upper lip, but no, it was skin cancer. She was going to get married and had to postpone the wedding to get surgery." These days, Uyttendaele tells his immortal-feeling younger patients, "This can happen to people in your age group."
Sunshine, the New Moonshine
Ideas of beauty come and go, set in motion by the tastemakers of the era. It was grand dame Coco Chanel who made the sun-kissed look fashionable in the 1920s, and the notion of a tan's attractiveness remains lodged in the cultural psyche. Yet some people take sun worship too far—and a new wave of research is revealing that there may be more to the story than mere vanity. Ultraviolet (UV) light, whether from the sun or tanning beds, can be addictive, says Dr. Steven Feldman, a dermatologist as well as a professor at Wake Forest Baptist Medical Center in North Carolina. When skin cells in culture are exposed to UV light, says Feldman, "They release a melanocyte-stimulating hormone which can bring on a suntan. But along with this, a larger protein is also made which contains endorphins, the natural opioid known as the feel-good hormone."
With funding from the National Institute on Drug Abuse, Feldman led a series of small studies to explore subjects' responses to UV light. In a 2004 study, 12 frequent and infrequent tanners were offered a session each in two identical-looking tanning beds—but in one bed, unbeknownst to subjects, the UV rays were blocked. Offered a third session in their choice of beds, tanners requested the bed with UV light 95 percent of the time. They invariably told Feldman, "This one relaxes me more." In a 2006 follow-up study with 16 tanners, Feldman's team gave subjects endorphin blockers; as a result, the subjects could no longer tell the difference between the two beds, and several tanners exhibited withdrawal symptoms. Moreover, in an unrelated study at UT Southwestern Medical Center in 2011, researchers scanned tanners' brains and found that the same pleasure centers that light up with an opiate high also light up during tanning.
In his own practice, Feldman has seen many tanners keep up their habit long after a healthy glow has given way to mottled skin, sunspots, and wrinkles—and even after they've developed skin cancer. "Addiction is a complex issue, with different factors at work," says Feldman. "If people think they're going to get a date because they look darker, or they're going to have a better prom experience, then that, combined with the opioids, is going to drive the behavior."
What's That Bump?
Human skin is a petri dish for lumps, spots, and bumps—a small city in itself with new denizens appearing with every birthday. While most nevi (moles) form within the first two decades of life, later years can give rise to red dots on the chest, skin tags on the neck or armpits, and keratosis, a thickening of the skin commonly found in the upper body. With such dermal biodiversity, it might be difficult to know which growths are harmless and which are not. "If you're over 40 or you have a lot of moles, it's not a bad idea to have a baseline skin check," says Uyttendaele, whose practice has recently put up new roadside billboards with an image of a leopard and the slogan "Have Your Spots Checked." While Uyttendaele cautions against self-diagnosis ("I can't train people to be dermatologists," he says), he does offer a few tips for those casual, after-the-shower self-exams that can sometimes prompt a call to the doctor's office.
"Any new growth, or a spot that bleeds spontaneously upon minimal pressure, a spot that is painful, or one that doesn't want to heal—those are some of the signs of basal cell cancers," says Uyttendaele. When looking for melanoma, he advises applying the educational acronym "ABCDE" to the brown spots we already have. "A" stands for asymmetrical ("If you have a mole that's the shape of Italy, and that's no good," says Uyttendaele). "B" is for borders, which are clear and sharp in healthy nevi, but might be jagged, fuzzy, or irregular in suspect moles. "C" is color, which you want to be uniform, not multi-hued. "D" is for diameter, which should be no larger than a pencil eraser, and "E" is evolving, as a change in shape and color can signal melanoma. While most melanoma in women form on the legs, the majority in men develop on the back, where they can evade discovery. "That may be why the prognosis for melanoma tends to be worse in men, because they're detected later," says Uyttendaele.
Sunny Good News
With the ravages of UV exposure laid out in vivid, medical-journal detail, it's no surprise that we're seeing more heliophobia (fear of the sun) in our culture—along with helicopter moms and dads who can't let their children walk two feet without slathering them in a whitewash of sunscreen. But there is danger, too, in avoiding the sun completely, and even dermatologists endorse some sun exposure to promote general health. It's common practice among psychiatrists to recommend that depressed individuals spend 30 minutes a day outdoors in the sunshine—and a protective coating of sunscreen won't offset the feel-good effects. Another boon to health is better sleep, since natural sunlight helps shut off the body's production of melatonin, the sleepy hormone. Going outside for 15 minutes at the same time each day, sans sunglasses (so sunlight reaches the pineal gland that produces melatonin), can help the sleep-challenged establish a normal circadian rhythm.
Perhaps most important, sunlight is crucial for the body's synthesis of vitamin D, which is vital not only for bone health but also as a protector against cancer, heart disease, stroke, depression, and an array of autoimmune diseases. Some studies show that as many as three out of four Americans are vitamin D deficient; for these individuals, a vitamin D supplement is recommended. For those who do not take a supplement, skin must be unprotected by sunscreen to do its important work of vitamin D production, which relies on the same UV rays that in excess cause damage. "Sunlight in moderation is not going to be harmful," says Uyttendaele. "People who go overboard with sun protection may do themselves a disservice." Still, his sunlight prescription is a modest one. For Caucasians, Uyttendaele recommends 10 minutes of unprotected sun exposure three times a week to the arms and legs only; for darker-skinned individuals, more time in the sun is necessary for adequate vitamin D. Most doctors agree that the face should be protected in all weather conditions with a broad spectrum SPF 30 to safeguard against wrinkles, sunspots, and other effects of photoaging.
Smarter Sunscreen
Not all sunscreens are created equal—and in fact many have come under fire from environmental and health groups for containing potentially harmful ingredients. Every year, the Environmental Working Group (EWG.com) releases its online list of safe sunscreens and its "hall of shame" of unsafe brands, which in the past has included trusted companies like Coppertone and Banana Boat. EWG's panel of scientists has named two chemical ingredients of particular concern—oxybenzone, which has been shown to have endocrine-disrupting properties, especially in children, and retinol palmitate (or vitamin A), which when exposed to UV light can actually hasten the growth of skin lesions and tumors. "Consumers need to know that ingredients in personal care products are very minimally regulated," says Leann Brown, a spokesperson for EWG. "The FDA does not require sunscreen companies to prove that their products are safe or even effective before coming to market."
Although EWG had not yet released its 2012 safe sunscreen list at press time for this article, in the past the group has given a thumb's up to the chemical ingredient avobenzone, and to mineral-based sunscreens containing zinc and titanium dioxide. However, the mineral nanoparticle ingredients have lately come under the scrutiny of toxicologists, and the jury is out on their effects. For those wary of lathering, both Uyttendaele and Feldman recommend wide-brimmed hats and UV-protective clothing available from companies like Sunprecautions.com and Coolibar.com. Meanwhile, the future of sunscreen could hold some surprises: Dr. Mingjun Zhang, a researcher and professor at the University of Tennessee, is busily isolating safe, sun-absorbing nanoparticles from English ivy. Though his work is not yet ready for commercial application, we may one day see sunscreen growing from vines. But don't wait that long to protect yourself. "There's one sunscreen that works better than all the others," says Feldman. "It's the one you don't mind putting on. Some people want something oily; others want something that disappears. Little girls want it in a pink bottle; little boys like blue. The one you're most likely to put on—that's the one you want."
