An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology
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43 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 O R I G I N A L R E S E A R C H access to in-office phototherapy (49% vs. 48% for adults and 8% vs. 10% for minors). Having access to in-office phototherapy does not appear to impact whether a dermatologist recommends tanning beds to their patients for medical reasons (49% with access vs. 48% without access for adults and 8% with access vs. 10% without access for minors). DISCUSSION As with most medical treatments, UV radiation has both harmful and therapeutic properties. Contrary to tanning industry claims, dermatologic diseases are far from purely cosmetic, and, in some cases, the benefit of UV treatment might outweigh the risk. Psoriasis, for example, has major systemic health implications, including erosive inflammatory arthritis and increased risk of cardiovascular disease, metabolic syndrome, diabetes, and obesity. 29–34 While commercial tanning beds and in-office phototherapy units have a similar appearance, they utilize different equipment and emit a vastly different spectrum of UV radiation. For example, narrowband UVB phototherapy devices emit a concentrated dose of 311 to 313nm UVB, while tanning beds emit an average of five-percent broad spectrum UVB (290–320nm) with the remaining 95 percent composed of UVA light (320–400nm). Therefore, tanning beds might be an inefficient source of UV exposure in the treatment of dermatological disease when more ideal options like phototherapy are unavailable due to cost or proximity. 35 Interpretation of results. By our estimation, these results represent approximately 809,369 patient visits per year. Only an estimated 0.057 percent, or 458 (417 adult, 41 pediatric) out of the 809,369 patients were referred to tanning salons for medical treatment. We estimate the rates of dermatologist referral to tanning salons for medical treatment to be extremely low; only one adult out of every 1,940 patients and one child out of every 19,450 patients. In other words, the average dermatologist in our study saw 4,000 to 6,500 patients per year and referred approximately three of them (2.74 adults and 0.27 minors) for medical treatment in tanning salons. Our findings, albeit limited to responses from only 152 physicians, strongly contradict the idea that dermatologists use UV radiation therapy for cosmetic purposes. In our study, none of the 152 physicians who participated in the survey recommended tanning salons for cosmetic reasons to any patient, adult or pediatric. Phototherapy was recommended for cosmetic reasons to two adults, accounting for 0.00025 percent of patients, and zero minors. We suspect the two providers reporting these two patients might have been describing referrals for phototherapy to treat conditions they considered to be cosmetic (e.g., some consider vitiligo treatment to be cosmetic). Additionally, it is important to recognize that the recommendations to use tanning beds for medical reasons were not based on whether the physicians had access to an in-office phototherapy unit. (49% vs. 48% for adults and 8% vs. 10% for minors). This further suggests that referrals by dermatologists are driven by individual patient factors (e.g., insurance coverage, proximity TABLE 1. Conditions treated ADULTS MINORS TANNING BEDS PHOTOTHERAPY TANNING BEDS PHOTOTHERAPY • Psoriasis (67) • Atopic Derm (21) • PR (8) • Pruritus (6) • Vitiligo (3) • GA (2) • Urticaria (2) • CTCL (1) • PMLE (1) • TV (1) • Psoriasis (119) • Atopic Derm (71) • Vitiligo (45) • Pruritus (34) • CTCL (22) • LP (8) • Psoriasis (11) • Atopic Derm (6) • PR (2) • Psoriasis (38) • Vitiligo (30) • Atopic Derm (22) • Morphea (3) • Pruritus (2) • CTCL (2) • PR (2) • LP (1) • GVHD (1) • Urticaria (1) • PN (1) • LDS (1) • LyP (1) Dermatologic conditions recommended for treatment with UV light (number of providers out of 152 who recommended treatment to at least one patient for specified condition within the past year). CD: contact dermatitis; CTCL: cutaneous T cell lymphoma; GA: granuloma annulare; GVHD: graft versus host disease; LDS: lipodermatosclerosis; LP: lichen planus; LyP: lymphomatoid papulosis; NLD: necrobiosis lipoidica diabeticorum; PLC: pityriasis lichenoides chronica; PMLE: polymorphous light eruption; PN: prurigo nodularis; PR: pityriasis rosea; TV: tinea versicolor FIGURE 1. Recommended tanning regimens. Complete regimens recommended to either adults or minors for medical treatment in tanning beds, including: 1) minutes per session (y-axis), 2) sessions per week (x=3, Δ=2.5, =2, =1), and 3) weeks of treatment (x-axis)