Soaking up rays can seem intoxicating — and that may explain why many otherwise health-conscious women keep getting tan.
You probably know a summertime tanorexic. Maybe you are one yourself: The first day the mercury shimmies over 75, you're on the plaza outside your office at lunch, shucking away your cardigan, baring your arms, shutting your eyes to the warmth, absorbing sunshine like the statue you're leaning against. Maybe you wait for the weekend, though — and then make up for lost time, rigging up elaborate wind guards on the beach.
“When I lived in New York, I would strip down to my bikini in Central Park the second there was a glimpse of sun,” says Katie, a 25-year-old now living in Washington, D.C. “On lunch breaks, I'd purposely walk on the sunny side of the street, then come back to the office and immediately check my tan lines. During college in South Carolina, I scheduled my classes around prime sun hours. Oh, and I also paid $50 extra rent a month to live on the sunny side of the building, with a balcony,” she says.
Deep down, of course — beneath those toasty melanin cells — Katie and her fellow summertime tanners know better: They're well aware that this isn't the healthiest habit, that a tan is a sign of damage, that those new freckles aren't “cute.” Sunbathing is just the reward you give yourself for withstanding yet another punishing unflattering-puffer-coated winter and drizzling spring. “Women feel like it's OK to get sun for just a day or two, just on weekends,” says Francesca J. Fusco, assistant clinical professor of dermatology at Mount Sinai School of Medicine in New York City. “In their heads, they're healthy ten months a year, so they think they can have their fun during the summer.”
This seems especially true in colder climates. “Ever since I moved to L.A., I've realized people live in such fear of aging and skin cancer, with their big hats and daily SPF, to a degree that I never saw when I lived in New York,” says Sally, 37, a television producer.
The undulating pattern of sunbathing in the summer, going back to being pale in the winter, and sunbathing again could burn people in more ways than one. “Studies have shown that getting an occasional blistering sunburn can be more dangerous than having a steady tan with regard to the risk of melanoma, the most dangerous kind of skin cancer,” says Jody A. Levine, co-director of Plastic Surgery & Dermatology of NYC. But that's not a rationale for a permatan: The risks of basal-cell and squamous-cell carcinoma “are linked to cumulative UVB radiation — the more exposure, the greater the risk.” Although it has been reported in the Harvard Health Letter that the body tans as a form of protection against UV rays, dermatologists still insist that people use sunscreen. “A tan has an SPF of eight at best,” Levine says. “That's not even close to the 30 or 45 we recommend.”
Which brings up another excuse tanners deploy: Sunbathing, sitting by the pool — it's a group event, maybe even a long-standing family tradition. For Jennifer, lying in the sun is inextricably linked to happy, sense-specific memories of sitting on the beach in South Carolina with “my mom and the ya-yas, gossiping, passing around magazines, and eating Cheez-Its and Pringles.”
Thus, tell an inveterate tanner that she can't bronze herself anymore, and she may well think she also can't spend time with the people she cares about. “As with smoking, tanning can be hard to give up because it can be a big social experience,” says Steven Feldman, professor of dermatology and public health at Wake Forest University in Winston-Salem, North Carolina. Like nicotine, in fact, ultraviolet rays have been shown to be addictive, which isn't altogether surprising, since they've also been found to improve one's mood and sense of calm. A by-product of the chemical reaction that occurs when UV rays irradiate skin cells is the pleasurable release of endorphins in the brain, Feldman explains.
To prove that people become addicted to UV light, Feldman conducted a 2004 study in which, for one week, participants variously had sessions in two identical-looking, warm tanning beds: one that exposed them to UV rays and one that had a UV-blocking filter. The volunteers' moods were evaluated before and after each session, and they reported feeling more relaxed and at ease following the UV exposure. Moreover, at the end of the week, when given the choice of doing the session in just one of the beds, virtually all of the study subjects chose the one with UV, even though they weren't aware of the difference.
In a follow-up study, before exposure to the beds, participants took a low dose of a narcotic-blocking drug, Naltrexone — “what they use in emergency rooms if someone overdoses on heroin or morphine,” Feldman explains. Not only did frequent tanners show less interest in tanning, but half of them also exhibited common signs of withdrawal. “Nothing happened to the infrequent tanners,” Feldman says. “But the others got jittery and nauseated.”
Wrinkle treatments and tanning
Feldman notes that research about substance abuse — whether the substance be drugs, drinking, or ultraviolet exposure — shows that “one way to tell people are addicted is when they know they're doing something bad, can't stop themselves, and lie about it to others.” Think of it as “SPFibbing” — showing up to work on a Monday with skin the color of a pueblo and swearing that you reapplied 45 every hour. “I sometimes attribute my tan to activities like being at an outdoor function or boating — something I never do,” says Stephanie, a 42-year-old researcher in Boston. “All to disguise the fact that I log long hours in the sun to accomplish a tan.” Polly, a 39-year-old investor in New Hampshire, confesses, “I have told my dermatologist that I use a much higher sunscreen than I actually do. And I've scheduled my yearly appointments for February — essentially the only time of the year when I know I'm not going to be tan.”
Overwhelmingly, tanning addicts tend to be women. “I always hear women saying, ‘It's just so relaxing; this is my time to do something for myself,’” Feldman says. A study at the University of Washington in Seattle surveyed 385 students about their tanning habits and also asked four so-called CAGE questions — shorthand for “cut-down, annoyed, guilty, eye-opener” — that are usually used to gauge substance abuse. (For instance, have you been annoyed when someone criticized your tan? Have you thought about tanning as soon as you open your eyes in the morning?) Overall, 76 percent of the women surveyed admitted to tanning deliberately, versus 59 percent of the men, and 22 percent of the women who tanned outdoors had positive CAGE results.
For lead researcher Robin Hornung, a clinical associate professor of dermatology, the study confirmed that tanning can be an addiction, explaining why “dermatologists often see people who repeatedly tan their skin and have difficulty stopping, despite knowing they are damaging their skin.” For women who rely on sunlight as a way to lift their mood, regular exercise can provide an alternative endorphin rush, she says.
Sunbathing is such a die-hard habit that even the fear of skin cancer may not be a deterrent. Hornung found that 77 percent of people with a relative who'd been treated for skin cancer still tanned outside (and a mind-boggling 44 percent used tanning booths).
Since dermatologists' cancer warnings often fall on deaf ears, doctors frequently find themselves appealing to patients' vanity. When women spend their money on cosmetic treatments to prevent or treat wrinkles yet also spend a lot of time in the sun, “it's like three steps forward, two steps back,” Fusco says. Looking good — or thinking you look good, anyway — for a few months of the summer isn't a fair trade for “aging so much more quickly, and looking so much worse when you're 30, 40, or 50,” Levine says.
When Hornung encounters tanning addicts, she says, “I often suggest having them look at examples of prematurely aged skin” — possibly including their own, under a special light that highlights age spots. Polly (of the strategically timed skin checkups) says, “I saw the light — and the freckles and the brown spots — and finally decided to switch to self-tanner.” But for some tanners, Levine says, seeing a friend or relative fall prey to melanoma is the only thing that will get the dangers of the sun through to them.
That was true of Vera, a 31-year-old in Philadelphia. While she was growing up, her whole family tanned — she and her three sisters call their father, who's from Brazil, “Mocha” because that's the color of his skin. Her Anglo mom, meanwhile, “was a warrior about her tan,” Vera says. “All our vacations were to the Outer Banks, and we would sit on the beach all day but take a break from the heat at lunch. Not my mom. She stayed out there the whole time.”
During her junior year of college, Vera endured the Massachusetts winter by indoor-tanning daily. “I was delusional,” she says. “Now, a tan is linked to something awful in my life. I don't ever want to see myself tan again.”
In 2000, her mother was diagnosed with melanoma in a spot on her back. She had it removed and seemed fine until 2003, when her doctor found the melanoma had metastasized to her lung. “It's a nasty, nasty cancer,” Vera says. While she was taking care of her mother every day in a skin-cancer unit, Vera says, “I saw how truly bleak the prognosis is. When it metastasized, it was pretty much over. We just focused on keeping her comfortable and extending her life.” She died in June 2005.
Vera now has a son, whom she will never allow outside without a slathering of sunscreen. As for herself, beyond everyday SPF, “I won't so much as cross the street without putting my black hat on,” she says. “I call it my ‘Pretty Woman’ hat, and it casts enough shade for my entire family.” If, in summers past, there was no such thing as too tan, now there's no such thing as too pale. Despite its wide brim, she started worrying that her hat might not be enough: “That's why I bought my parasol.”