A high number of tanning parlours have shockingly poor standards of practice and a severe lack of staff training, including the provision of sunbeds designed for medical use only, a report due to be released at the British Association of Dermatologists’ annual conference this week will reveal.

332 tanning salons in Northern Ireland took part in a survey over an eight week period in July and August 2007, and the results have raised serious concerns about safety within the sunbed industry.

Types of sunbed and safety

Staggeringly, over a quarter of premises used ‘type 4’ sunbeds which are designed for medical use and not for cosmetic tanning, according to European and international standards*. It is possible that many others are using sunbeds that emit high levels of UV, as almost two thirds (62%) of salons did not know what level of ultraviolet (UV) radiation their sunbeds produced.

39 percent of the premises reported that devices were not regularly tested. The date of the last inspection of fixed electrical installations was unknown in over a third (34%) of premises, while 18 percent of premises did not even know the manufacturer of the sunbeds in their salons. In 71 percent of the tanning salons the operating manual for the sunbeds was unavailable.

This raises serious concerns that improperly maintained or faulty machines could produce high levels of ultraviolet (UV) radiation, cause burning to the skin and potentially lead to skin cancer.

High risk users

Worryingly, the study found little evidence of children being prohibited from using sunbeds. Only half (51%) vetted clients with regard to age. Where premises allowed minors to use sunbeds, almost three quarters (71%) did not require parents or guardians to sign a consent form. Furthermore, over 15 percent of staff received no age awareness training.
In one fifth (20%) of the salons skin type was not even discussed with customers. In the salons where skin type was discussed, it was left to the client to determine their own skin type in 13 percent of cases.

In a recent study, only 40 percent of the indigenous population of Northern Ireland felt they were skin type I and II (naturally fair skinned) with over 30 percent typing themselves as type V or VI (dark Asian or black skinned)1 whereas in fact Northern Ireland has a predominantly fair-skinned population.

Dr Art O’Hagan, Consultant Dermatologist explained: “Previous studies have shown poor comprehension of personal skin types, and relying on clients to have knowledge of their own skin type is an unsafe mode of skin type vetting. Furthermore, asking about skin types was a somewhat purposeless exercise, since only 44 percent of customers with skin type 1 (people with very pale skin who are at greater risk of burning and skin cancer) were subsequently advised against using the sunbeds. More shockingly, only 31 percent of cases advised patients not to use a sunbed if they had a history of skin cancer.”

Hygiene, facilities and staff training

In a quarter (24%) of salons, the staff were offered no training at all on the risks of UV exposure.
39 percent of salons had coin operated devices, allowing the use of devices without staff supervision.

Basic hygiene standards in many of the salons that took part in the survey were particularly low. Only three quarters (75%) of salons reported that staff cleaned the sunbeds after usage, with others expecting clients to clean the sunbeds themselves, while almost a quarter (22%) failed to sanitise their eye protection wear after usage.

Worryingly, there was a charge for eye protection in 38 percent of cases. Furthermore, over 30 percent of the goggles were not CE marked therefore did not conform to a mandatory marking in the European Economic area and did not offer sufficient protection.

Interestingly over three quarters (79%) of premises were not members of the Sunbed Association, which shows that any code of conduct applied by the association does not apply to the majority of salons.

Local councils in Northern Ireland have prohibited the use of sunbeds in local council premises however the survey’s results have shown that private parlours continue to run with worryingly poor standards of operation.

The tanning industry in Northern Ireland continues to grow despite most of the population having a predominant skin type that increases their risks of skin cancer. In particular, the use of sunbeds seems to be prevalent in younger girls.3

Rebecca Freeman at the British Association of Dermatologists said: “This survey has shown that there is a serious lack of regulation within the sunbed industry, and self regulation is clearly not working. Children are able to access sunbeds in a shockingly high number of salons, which is a real worry. One in five salons do not consider the client’s skin type, yet people with skin type 1, which is pale and burns easily, are particularly at risk of serious and permanent skin damage from sunbed use. Likewise, less than a third of salons advise people against using a sunbed if they have a history of skin cancer. This survey implies salons are not protecting their clients sufficiently. There is a great need for improved public education and strong regulation of sunbed salons to ensure that those who do choose to use sunbeds are fully aware of the risks.”

Possible effects of sunbed use include premature skin ageing, increased skin fragility, cataracts and skin
Cancer.4,5

Summary of results

Sunbed and Safety
• 27% of premises used ‘type 4’ sunbeds.
• 62% of salons did not know what level of ultraviolet (UV) radiation their sunbeds produced.
• 39% of the premises reported that devices were not regularly tested.
• 34% of premises did not know the date of their last fixed electrical installations inspection.
• 18% of premises did not know the manufacturer of the sunbeds in their salons.
• In 71% of the tanning salons the operating manual for the sunbeds was unavailable.

Age
• 85% of salons claimed to use questionnaires to tailor their advice to customers.
• All salons who participated were asked about age, however only 51% vetted clients with regard to age
• 71% of the premises that allowed minors to use their sunbeds did not require parents or guardians to sign a consent form.
• Over 15% of staff were offered no age awareness training.

Skin Type
• 20% of the salons skin type was not discussed with customers.
• In the salons where skin type was discussed, it was left to the client to determine their own skin type in 13% of cases.
• Only 44% of customers with skin type 1 (people with very pale skin who are at greater risk of burning and skin cancer) were advised against using the sunbeds.
• Only 31% of cases advised patients not to use a sunbed if they had a history of skin cancer.

Staff Training
• 24% of salons, the staff were offered no training at all on the risks of UV exposure.
• 79% of premises were not members of the Sunbed Association.
• 16% of parlours advertised the health benefits of artificial UV sources.
• 39% had coin operated devices allowing the use of devices without supervision of staff.
• 9% of clients were advised not to use sunbeds within 48 hours of last usage.

Hygiene
• Only 75% of salons reported that staff cleaned the sunbeds after usage.
• Only 78% sanitised their eye protection wear after usage.
• There was a charge for eye protection in 38% of cases.
• Over 30% of the goggles were not CE marked therefore did not conform to a mandatory marking in the European Economic area.

Facts about skin cancer

• There are three main types of skin cancer: malignant melanoma – the deadliest but least common, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).
• BCC and SCC are collectively known as ‘non-melanoma skin cancer’. BCC is the most common skin cancer.
• In the UK, more than 100,000 new cases of skin cancer are diagnosed annually, making it the most common cancer. Of these, more than 10,000 are melanoma.
• There are over 2,300 deaths from skin cancer annually in the UK.
• The annual incidence of melanoma worldwide is increasing faster than that of any other cancer.
• In just 30 years, cases of melanoma across Great Britain have quadrupled in men and tripled in women.
• Melanoma is more common in women than men, but there is a faster rate of increase in men and more men die from the disease, possibly due to late detection.
• In as many as 4 out of 5 cases, skin cancer is preventable, so follow the British Association of Dermatologists’ sun safety tips:
You don’t have to avoid the sun all year, and some sunshine can be good for you as it helps the body to produce vitamin D, but taking a few steps when out and about in the summer sun or when on a sunshine holiday will help to protect you from sunburn and the risk of skin cancer, particularly if you are pale skinned.
• Protect the skin with clothing, including a hat, T shirt and UV protective sunglasses
• Spend time in the shade between 11am and 3pm when it’s sunny
• Use a sunscreen of at least SPF 30 (SPF 50 for children or people with pale skin) which also has high UVA protection
• Keep babies and young children out of direct sunlight
• The British Association of Dermatologists recommends that you tell your doctor about any changes to a mole – if your GP is concerned about your skin, make sure you see a Consultant Dermatologist (on the GMC register of specialists), the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.
Sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at the Scottish Exhibition & Conference Centre, Glasgow from July 7th to 10th 2009, and is attended by UK and worldwide dermatologists and dermatology nurses.

“Public at risk – a survey of sunbed parlour operating practices in Northern Ireland”. AH O’Hagan1, C Devereux1, A Devlin2, G O’Callaghan2, B Furey2, G McElwee2,4, G McEvoy2, J Caughey2, L McPeak2, L Fitzsimmons2, L Smart2, N McMahon2, P Loan2, S Martin2, S Gordon2,4, T Crossan2, A Gavin3.
1Craigavon Area Hospital, 2Sun Bed Working Group (NIMSIG), 3Northern Ireland Cancer Registry, 4Ulster Cancer Foundation.

Other references:
* The French regulations for ultraviolet radiation sunbeds; J. P. Cesarini, Radiation Protection Dosimetry
Vol 91, Nos 1-3, pp 205-207, 2000.
1 Gavin A. Personal Communication, Sept 2008
2 Northern Ireland Statistics and Research Agency. NI Census 2001, Key Statistics.www.nisra.gov.uk/census/census2001output/keystatistics/keystatrepl.html
3 Ting W, Schultz K, Cac NN, Peterson M, Walling HW. Tanning bed exposure increases the risk of malignant melanoma. Int J Dermatol. 2007; 46:1253-57
4 Sunbeds; Hawk JLM, Radiat Prot Dosimetry, 2000; 91:143–5.
5 Epidemiology of chronic disease risks in relation to ultraviolet radiation exposure; Swerdlow AJ, Radiat Prot Dosimetry 2000; 91:19–23

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.