An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology
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44 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 to phototherapy, cost to patient), rather than financial gain. Recommended treatment regimen. Interestingly, we observed an unexpected level of variability among the treatment regimens recommended to patients for medical treatment in tanning salons (Figure 3). Of the 38 complete treatment regimens, 90 percent of treatments for adults and 86 percent of treatments for minors were unique between providers. Consistent with these findings, there are few published recommendations and no widely accepted standardized treatment protocols for medical use of tanning beds. Future studies to investigate optimal treatment regimens are needed, but the movement toward standardization of dermatologic disease treatment presents several challenges. In addition to physiologic differences between disease conditions, treatment with tanning beds is complicated by individual variability in skin type, dose- response, and exposure history. Perhaps more importantly, inter- and intra-device variability in UV emission, imprecise spectral targeting, and administration by the patient or non- medical staff all have potential to lead to unpredictable variations in dosing. The composite average of the recommended treatment regimens in this study was 2.5 sessions per week for 6.1 minutes per session for 8.3 weeks. Other publications have suggested 3 to 7 sessions per week starting at a low dose of 2 to 3 minutes per session, with small incremental increases ranging from 15 seconds to one minute per session until the desired effect is achieved, and subsequent clinical follow up 4 to 6 weeks after initiation of treatment. 34,36,37 It is suggested that a combination of these techniques in conjunction with patient education to monitor for signs of treatment efficacy (e.g., mild erythema, disease improvement) or overdose (e.g., pain, sunburn, blistering) is the most prudent approach to minimize damage to the skin while optimizing treatment. Additionally, patients should be encouraged to have explicit conversations with tanning salon employees regarding goals (e.g., disease treatment rather than tanning) and methods to minimize dosing variability (e.g., using a specific tanning bed, requesting notification of any bulb or equipment changes). Limitations. Potential limitations are those inherent to survey studies, including nonresponse bias, sampling bias, and recall bias. Further limitations include the small sample size and regionalized, but limited, distribution of this survey. Due to an inability to discern the specific number of dermatologists who accepted the survey or were in attendance at the surveyed sessions from the total number of registered attendees, which included some non-physician staff and students who were not invited to complete the survey, we were forced to use the entire meeting registry, 350 (IDS=60, CDS=185, PAD=105) in calculating response rate. By assuming all 350 registrants were dermatologists who received the survey, we were able to calculate the minimum possible response rate. However, this method almost certainly resulted in an artificially deflated overall response rate of 43.4 percent. Additionally, time constraints at PAD limited verbal introduction to only the CDS and IDS meetings, where minimum response rates were 52 percent and 53 percent, respectively. We suspect that the brevity and anonymity of the survey, as well as distribution and collection methods, might have limited nonresponse bias despite moderate response rates. TABLE 2. Counseling of specific patient populations on the risks of UV tanning. COUNSELING ON UV TANNING DEVICES TOTAL PROVIDER SEX P-VALUE MALE FEMALE Girls younger than 18 years of age 82.1 (124) 82.2 (60) 82.1 (64) 0.98 Women aged 18–40 88.1 (133) 83.6 (61) 92.3 (72) 0.1 Women older than 40 58.3 (88) 58.9 (43) 57.7 (45) 0.06 Boys younger than 18 years of age 37.1 (56) 47.9 (35) 26.9 (21) 0.008 Men aged 18–40 42.4 (64) 52.1 (38) 33.3 (26) 0.02 Men older than 40 37.7 (57) 46.6 (34) 29.5 (23) 0.03 Parents of minors 55.6 (84) 54.8 (40) 56.4 (44) 0.84 Patients with skin cancer history 59.6 (90) 60.3 (44) 59.0 (46) 0.87 Patients with obvious UV damage 64.2 (97) 61.6 (45) 66.7 (52) 0.52 Cosmetic patients 46.4 (70) 45.2 (33) 47.4 (37) 0.78 FIGURE 2. Physician concern for pediatric patients: Comparison of the average level of concern providers have for pediatric patients' wellbeing with regards several health-related issues. Data presented as mean with error bars representing standard error