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Little is known about commercial tanning bed use in psoriasis sufferers.1 Given that psoriasis improves with ultraviolet (UV) exposure, it is likely that patients self administer treatment via commercial tanning beds. Our cross-sectional study quantified tanning bed usage and whether tanning behaviors result in addictive-like tanning disorders in psoriasis patients.
An online questionnaire was sent to subscribers of National Psoriasis Foundation email-list serve (February–April 2014; c.14,000 individuals). Questions included demographics, psoriasis history, and UV usage. 1932 respondents were analyzed. Of 1830 that answered queries regarding tanning bed use, 34% (n=617) had used tanning beds consistent with 36% in studies of the general population,2 and 28% (n=512) were current users. Respondents who tanned were younger, diagnosed with psoriasis when younger, and predominantly female (p<0.0001 for all).
Sixty-two percent of 617 tanners started tanning to treat psoriasis; they were more likely to have received medical phototherapy (p<0.0001) and had more severe psoriasis, (previous hospitalization or erythroderma; p<0.01, p<0.0001). Table I displays reasons for tanning.
Ninety-nine percent of 170 current users disclosed their tanning-frequency; 55% tanned ≥once a week (n=93). Tanning in winter was the predominant seasonal pattern (37%; n=119), but 23% (n=73) tanned year-round. The highest-ranking reason for tanning was “preventing sunburn,” followed by “relax, reduce stress or improve mood.” To “prevent psoriasis from coming back” and “treat or improve existing psoriasis” were the least important reasons, even in the majority (55%) of those who previously started tanning for psoriasis self-treatment.
Eleven percent of those who tanned in the last 5 years (322 participants) met modified Diagnostic Statistical Manual (DSM)-IV criteria for addiction-like tanning behaviors,3 of which 79% (n=27) were classified as mild, 18% (n=6) moderate and 3% (n=1) severe. Individuals who started tanning as self-treatment were more likely to exhibit addictive-like tanning behaviors than those who started for alternate reasons (p<0.05). Table II displays modified DSM-IV criteria.
To date, few studies have assessed tanning bed usage in psoriasis patients1 and none have addressed their addictive-like tanning behaviors. In the general public, recreational tanning continues unabated despite skin cancer health campaigns.2 Addictive behavioral patterns of UV self-administration, similar to those of other substance-related disorders, have been reported.4 These so-called “tanorexics” reported symptoms including anxiety if their tan is not maintained, inability to stop tanning, and continued tanning despite adverse consequences (e.g. premature aging, skin cancer).5 Such symptoms were reported by a significant proportion of our respondents.
Our results imply that tanning bed usage among psoriasis sufferers is widespread and linked with tanning addiction. Practitioners should be particularly vigilant to the possibility of tanning bed usage in at-risk patients: younger, female patients diagnosed at early age, those with severe psoriasis and previously-prescribed phototherapy treatment were more likely to exhibit problematic tanning behaviors. Additionally, tanners with psoriasis may be at increased risk for skin cancer and studies assessing skin cancer risk in phototherapy patients may be biased by tanning bed usage. Future research should incorporate similar surveys in European centers where the availability of phototherapy differs.
The authors would like to thank the National Psoriasis Foundation for their generous assistance in disseminating the survey to its members. This study was supported, in part, by the National Institute on Arthritis and Musculoskeletal and Skin Diseases AR063018.
Conflict of Interest: The authors report no conflicts of interest.
IRB: This study was qualified as exempt by the Institutional Review Board at the University of Texas Southwestern Medical Center at Dallas, USA.
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