November 16, 2021
If you go to the beach during the summer, you’re guaranteed to find people tanning and basking in the sun. Even though countless health campaigns have told us that there is no safe way to tan, this advice usually goes ignored. But why?
There are several reasons that researchers have proposed. The first reason is that some people have an actual addiction to the sun. A recent study by Marianna Sanna and colleagues suggests that the desire to spend time in the sun can stem from an addiction, and that the genes related to this behavior can be passed down in families.[Sanna 2020] This is because ultraviolet (UV) exposure, or the harmful radiation that comes from the sun and other sources like tanning beds, causes the body to produce “feel-good chemicals” called beta-endorphins.[Labbe 2014] These chemicals are opioids that many people can become addicted to because they reduce the feeling of pain—and this positive feeling encourages the brain to want more. In addition, the genes associated with sun-seeking behavior are likely to be associated with anxiety, alcohol use, and other risky behaviors.[Sanna 2020]
Second, tanning is considered attractive and a marker of good health in the western countries. According to multiple studies, the desire to tan is influenced heavily by American and European culture. One study by Chen and colleagues compared Chinese attitudes to Euro-American attitudes about tanning and found that the Chinese Americans who had Euro-American influences were more likely to view tanned skin as attractive and “healthy.”[Chen 2020] Another study showed that people with fair skin are more likely to tan than those with darker skin.[Sanna 2020] Tanning has also been associated with higher socioeconomic status, as those who can afford to travel to areas with hot climates spend more time tanning.[Sanna 2020]
Third, people are happier when they spend time outside and live active lifestyles. Spending time outdoors is highly encouraged by healthcare providers. Not only do we benefit physically from outdoor exercise, but many people also experience improved mental health benefits from spending time in the sun. Seasonal affective disorder (SAD), a form of seasonal depression often experienced in the winter months, is caused by the decrease in exposure to sunlight during the winter months. For this reason, many people seek sunlight to improve their mood and overall well-being.[Mayo Clinic 2017] A study by White and colleagues also showed that two hours in nature each week can provide overall health benefits.[White 2019]
Finally, another reason people may seek the sun is misinformation about the importance of the sun for producing vitamin D. It is true that the sun is involved with converted vitamin precursors in our skin to vitamin D. Indeed, one study by Kemény and colleagues suggests that a vitamin D deficiency could play a role in addiction to sun exposure.[Kemény 2021] However, contrary to popular belief, the amount of vitamin D generated from sunlight is inconsistent. Trying to meet your vitamin D requirements through sun exposure could increase your risk of skin cancer. Experts from the American Academy of Dermatology Association (AAD) recommend getting vitamin D from a healthy diet, including food and beverages rich in this vitamin. For those who require it, supplements are a much safer way to meet vitamin D requirements than trying to rely on sun exposure.[AAD 2021]
With increases in the number of people diagnosed with skin cancer each year, spending time in the sun can also be dangerous for our health. So how do we balance our need for time outdoors and our risk for skin cancer?
The first step starts with each person recognizing risky sun-seeking behavior. Could you have an addiction to the sun or tanning? It’s important to look at your own behaviors and assess whether there is a problem. Alternatives for those who have a sun-seeking addiction include exercise, which releases similar “feel-good” endorphins that may reduce the desire to tan. And of course, its important to address any underlying anxiety or other emotional issues that might be contributing to the problem.
On a societal level, it is important to recognize the harmful impacts of tanning. AIM at Melanoma, our sister organization, has started a campaign called Natural Skin Rocks, which emphasizes loving the skin you are in and protecting your skin from the sun’s rays. Other campaigns continue to stress the dangers of indoor tanning and taking care of your skin. Social media influencers have also recently urged people to add sunscreen to their skincare routines to preserve their natural beauty as they age. All these campaigns focus on natural beauty, and as a community, we should encourage taking care of our skin, while still spending time outdoors. According to Sam Guild, President of AIM at Melanoma Foundation, “We are pleased to see that society is shifting to a focus on the beauty and health of natural skin. People are recognizing the dangers of tanning. Changing the beauty standards and making people aware of the importance of sun safety has required a big push from a number of groups. While advocacy groups like ours and the medical societies have been instrumental in supporting indoor tanning legislation and primary prevention, the beauty industry and social media influencers have also helped by linking sun protection with prevention of the damaging effects of the sun in terms of wrinkles, drooping skin, and dark spots (known as photoaging).”
The good news is that you can still safely enjoy an active lifestyle that gets you out in nature while protecting your skin! According to Krista Rubin, NP at the Center for Melanoma, Massachusetts General Hospital Cancer Center, “We want to protect our skin going forward, but it doesn’t mean that you can’t be out in the world and you can’t be outside.” She recommends UV protection in the form of broad-spectrum sunscreens, or sunscreen that protects against both UVA and UVB exposure. She also recommends wearing sun-protective clothing; using umbrellas, hats, and sunglasses; minimizing direct sun exposure; seeking shade; and avoiding sunlight from 10:00 a.m. – 2:00 p.m., when the sun’s rays are at their strongest.
Research on the benefits of spending time in nature showed that health benefits began with only two hours in nature per week, and that this could be broken up into small amounts throughout the week.[White 2019] Splitting up the time that you spend outdoors while using sun safety techniques, rather than tanning for long periods of time, helps to decrease your risk of skin cancer. The use of a light therapy box, which filters out harmful ultraviolet rays, has also been helpful in improving the mood of people with SAD by mimicking sunlight.[Mayo Clinic 2017] According to Praschak-Rieder and colleagues, bright-light therapy (BLT) is a safe and effective treatment option for SAD.[Praschak-Rieder 2003] With these recommendations in mind, it is possible to spend a healthy amount of time outdoors while still protecting yourself from the sun’s harmful rays.
American Academy of Dermatology. Vitamin D stats and facts. Rosemont, IL: American Academy of Dermatology Association; 2021. https://www.aad.org/media/stats-vitamin-d Accessed November 8, 2021.
Centers for Disease Control and Prevention, Division of Cancer Prevention and Control. Are there benefits to spending time outdoors? Atlanta, GA: Centers for Disease Control and Prevention; 2021. https://www.cdc.gov/cancer/skin/basic_info/outdoors.htm Accessed November 8, 2021.
Chen HY, Robinson JK, Jablonski NG. A cross-cultural exploration on the psychological aspects of skin color aesthetics: implications for sun-related behavior. Transl Behav Med. 2020;10:234-243.
Harvard Health. Vitamin D and your health: breaking old rules, raising new hopes. Cambridge, MA: Harvard Health Publishing; 2021. https://www.health.harvard.edu/staying-healthy/vitamin-d-and-your-health-breaking-old-rules-raising-new-hopes Accessed November 8, 2021.
Kemény LV, Robinson KC, Hermann AL, et al. Vitamin D deficiency exacerbates UV/endorphin and opioid addiction. Sci Adv. 2021;7(24):eabe4577. doi: 10.1126/sciadv.abe4577
Labbe C. Chronic UV exposure induces opioid response that is associated with tanning addiction. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases; 2014. https://www.niams.nih.gov/newsroom/spotlight-on-research/chronic-uv-exposure-induces-opioid-response Accessed November 8, 2021.
Mayo Clinic. Light therapy. Rochester, MN: Mayo Foundation for Medical Education and Research; 2021. https://www.mayoclinic.org/tests-procedures/light-therapy/about/pac-20384604 Accessed November 8, 2021.
Mayo Clinic. Seasonal affective disorder (SAD): symptoms & causes. Rochester, MN: Mayo Foundation for Medical Education and Research; 2017. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651 Accessed October 18, 2021.
Sanna M, Li X, Visconti A, et al. Looking for sunshine: genetic predisposition to sun-seeking in 265,000 individuals of European ancestry. J Invest Dermatol. 2021;141:779-786.
White MP, Alcock I, Grellier J, et al. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Sci Rep. 2019;9:7730. https://doi.org/10.1038/s41598-019-44097-3