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Epidemiologic Notes and Reports Injuries Associated with Ultraviolet Tanning Devices -- Wisconsin

In 1986 and 1987, the Radiation Protection Section, Wisconsin Division of Health, surveyed dermatologists, ophthalmologists, and emergency room personnel to better understand the occurrence of injuries caused by ultraviolet (UV) tanning devices in Wisconsin. Questionnaires were distributed to 43 of 106 practicing dermatologists in the state who were attending the annual meeting of the Wisconsin Dermatological Society in October 1986; 31 (72%) questionnaires were completed and returned. Thirteen (42%) dermatologists had treated a total of 65 patients for cutaneous burns resulting from suntanning devices during the preceding 12 months; the degree of the burns was not specified. Forty-two (65%) patients used bed/booth devices, and 23 (35%) used reflector lamps.

Of questionnaires sent to 132 Wisconsin ophthalmologists (of 260 patient-care ophthalmologists in the state) from a list provided by the state Ophthalmologic Society, 115 (87%) were completed and returned; 48 (42%) ophthalmologists completing the questionnaire had treated a total of 152 patients during the preceding 12-month period for eye injuries related to tanning devices. Injuries included corneal injuries (129 (85%) patients), both corneal and retinal injuries (four (3%)), and unspecified ocular injuries (19 (13%)). Thirty-seven (24%) patients reportedly wore safety goggles during their tanning sessions. The UV sources used by the patients were bed/booth devices (80 (53%) patients), reflector bulb lamps (26 (17%)), and mercury vapor lamps (16 (11%)); for 30 (20%), no source was indicated.

One hundred forty-one (47%) responses were received from questionnaires mailed to 301 emergency physicians and emergency rooms listed with the Wisconsin Division of the American College of Emergency Room Physicians. Forty-one (29%) respondents reported that in a 12-month period they had treated 155 patients for skin burns, including 105 (68%) first-degree burns and 39 (25%) second-degree burns; severity of burn was not indicated for 11 (7%) patients. The UV sources were bed/booth devices (94 (61%)) patients), reflector lamp devices (54 (35%)), and natural light (two (1%)); sources were not indicated for five (3%) patients. Ninety (58%) patients were injured at commercial tanning facilities, and 58 (37%) were injured at home; for seven (5%), location was not indicated. Ninety-one (59%) patients were treated for eye injuries, and 57 (63%) of these were referred to ophthalmologists. Adapted from the Wisconsin Epidemiology Bulletin (vol. 10, no. 1) by M Bunge, HA Anderson, MD, State Epidemiologist for Environmental and Chronic Diseases, JP Davis, MD, State Epidemiologist for Acute and Communicable Diseases, Wisconsin Dept of Health and Social Svcs. Div of Field Svcs, Epidemiology Program Office; Epidemiology Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Artificial suntanning with UV light has become increasingly popular in Wisconsin and nationwide. Types of equipment range from small, single-bulb sunlamps used in the home to elaborate bed/booth equipment used in commercial tanning facilities. Although the number of suntanning devices used in Wisconsin is unknown, sales estimates from three major suppliers indicate that approximately 850 commercial tanning beds/booths were shipped there during 1980-1987. Estimates of the number of persons using these devices are not available; however, an estimated 2 million persons nationwide used 10,000 commercial tanning facilities in 1985. The National Electronic Injury Surveillance System, which is based on emergency room data, estimates that in 1986 approximately 700 U.S. burn injuries were related to suntan booths, and approximately 2600 burn injuries were related to sunlamps.*

Tanning is an adaptive response by the skin to protect the body from the damaging effects of UV radiation. UV radiation is composed of three spectra--UV-A (320-400 nanometers (nm)), the least energetic; UV-B (280-320 nm); and UV-C (less than 280 nm), the most energetic. Natural sunlight that penetrates the atmosphere is composed of UV-A and UV-B (1). Most tanning devices producing UV-A radiation also emit some UV-B radiation (2). Although UV-A radiation is less likely than UV-B to cause erythema, it can cause other adverse health effects to the skin, eyes, blood vessels, and immune system (1,2).

The eyes are highly susceptible to injury from UV radiation. Photokeratitis and conjunctivitis can occur within hours after exposure unless protective goggles are properly worn. UV radiation, in addition to promoting aging of the skin, is thought to promote the formation of cataracts (3).

A retrospective study conducted in Michigan demonstrated a changing trend in the causes of corneal burns (4). During the study period (July 1, 1985-July 1, 1986), 62 patients seen in two emergency rooms were treated for UV-light-induced corneal burns; 25 (40%) of these patients had been exposed at a commercial tanning facility. In previous years, burns associated with exposure to UV radiation from commercial tanning facilities were rare, but in this study the number of corneal burns increased concurrently with an increase in the number of these facilities in the area.

Exposure to UV radiation is associated with an increased risk of skin cancer. More than 500,000 cases of basal and squamous cell carcinoma of the skin occur each year in the United States (5). These skin cancers occur most often on sun-exposed areas of the body and are believed to be caused by exposure to UV radiation. Other evidence suggests that malignant melanoma also may be associated with sun exposure (1).

Because of the manner in which the surveys in Wisconsin were constructed, recall bias and multiple reporting of cases by different practitioners are probable. Questionnaires to emergency rooms and emergency physicians were designed to separate eye injuries from skin injuries. Because a person may have sustained both kinds of injuries, each of which would have been reported separately, overlap may also exist. Although the surveys do not reflect the total number of residents who have been acutely injured by using UV tanning devices in 1986-1987 or the risk factors associated with the use of these devices, survey results indicate that injuries associated with UV tanning devices can be severe enough to require medical attention. The extent of acute injuries associated with UV tanning devices may be underestimated, since medical assistance may not be sought for all injuries.

The long-term effects of UV tanning devices are not known (5); however, these devices have no known health benefits (2,6). Therefore, persons who choose to use these UV tanning devices should be aware of the potential risks and should follow the manufacturer's directions to minimize these risks. Protective goggles should be properly worn. Medications can increase photosensitivity, and persons on medication should consult their physician or pharmacist before using any tanning devices.

References

1.Pierce T, Moss E, Sams WM, Akers JH. Hazards of ultraviolet-radiation . . . particularly artificial suntanning devices. J Environ Health 1986;49:76-80. 2.Food and Drug Administration. The darker side of indoor tanning: skin cancer, eye damage, skin aging, allergic reactions. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1987; HHS publication no. (FDA)87-8270. 3.Pitts DG. Threat of ultraviolet radiation to the eye--how to protect against it. J Am Optom Assoc 1981;52:949-57. 4.Walters BL, Kelly TM. Commercial tanning facilities: a new source of eye injury. Am J Emerg Med 1987;5:386-9. 5.National Cancer Institute. Nonmelanoma skin cancers, basal and squamous cell carcinomas: research report. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1988; NIH publication no. 88-2977. 6.Photobiology Task Force of the American Academy of Dermatology. Risks and benefits from high-intensity ultraviolet A sources used for cosmetic purposes. J Am Acad Dermatol 1985; 12(2 pt 1):380-1. *Estimates are available from the U.S. Consumer Products Safety Commission, National Injury Information Clearinghouse, National Electronic Injury Surveillance System.

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