Medical Experts: Spray Tanning Not Safe

Commentary by Ray Allard Tan Plus/ Essentials Of Life
Since the late 1990's Tan Plus, as well as most tanning salons worldwide, have been solicited by spray tanning equipment and solution distributors to add their "safe UV alternative" as a service at our salon. Due to our concerns about the short and long term potential health affects of the chemical, DHA (dihydroxyacetone) used as the coloring agent, we declined to offer spray tanning. We would not apply this chemical to our own skin so we could not justify doing this to our customers. Your skin is like a sponge. What you put on it will eventually be absorbed into the blood stream. We have been openly critical of dihydroxyacetone used in spray tanning as well as other chemicals used in sunscreen and "tingle factor" lotions.

Needless to say, many tanning salons and even dermatologists jumped on the spray tanning bandwagon as a way to boost revenues. Most disturbing to me was that doctors took their authoritative position to persuade their patients, even pregnant women, to spray tan while providing absolutely no evidence of the safety of the chemical, dihydroxyacetone and without any concern of the potential affects to the fetus.

After thorough review, six medical experts have concluded that the active chemical used in spray tans, dihydroxyacetone (DHA), has the potential to cause genetic alterations and DNA damage. The panel of medical experts reviewed 10 of the most-current publicly available scientific studies on DHA for ABC News, including a federal report ABC News obtained through the Freedom of Information Act.

Are 'Spray-On' Tans Safe? Experts Raise Questions as Industry Puts Out Warnings
By Mark Greenblatt and Gitika Ahuja

Six medical experts in areas ranging across the fields of dermatology, toxicology and pulmonary medicine said they "have concerns" after reviewing the literature and reports about DHA, the main chemical in the popular "spray-on" tan, which has conventionally been referred to as the "safe" alternative to tanning under ultraviolet lights.

None of the reviewed studies tested on actual human subjects, but some found DHA altered genes of multiple types of cells and organisms when tested in different labs by different scientists after the chemical was approved for use in the consumer market. "I have concerns," said Dr. Rey Panettieri, a toxicologist and lung specialist at the University of Pennsylvania's Perelman School of Medicine. "The reason I'm concerned is the deposition of the tanning agents into the lungs could really facilitate or aid systemic absorption -- that is, getting into the bloodstream." Panettieri, like all the experts ABC News consulted with, said more studies should be done. He emphasized the available scientific literature is limited. Still, he said, he has seen enough to say the warning signs of serious health concerns exist.

"These compounds in some cells could actually promote the development of cancers or malignancies," he said, "and if that's the case then we need to be wary of them."

The FDA originally approved DHA for "external" use back in 1977, when it was popular in tanning lotions. Those lotions, previously famous for turning skin orange, were never as popular as current products that produce better tans. In recent years, the use of DHA has exploded in the newer "spray" application of the product, which provides a more even tan for consumers.

The FDA told ABC News it never could have envisioned the chemical's use in spray tan back in the 1970s, and says "DHA should not be inhaled or ingested" today. It tells consumers on its website, "The use of DHA in 'tanning' booths as an all-over spray has not been approved by the FDA, since safety data to support this use has not been submitted to the agency for review and evaluation." The agency advises consumers who spray tan they are "not protected from the unapproved use of this color additive" if they are inhaling the mist or allowing it to get inside their body. The agency recommends, "Consumers should request measures to protect their eyes and mucous membranes and prevent inhalation." However, ABC News found some tanning salons offering consumers advice that directly conflicts with what the Food and Drug Administration has recommended.

ABC News sent undercover cameras into a dozen randomly selected tanning salons in New York City ranging from a large corporate location to smaller mom-and-pop salons. Every salon ABC News visited said spray tanning was completely "safe" with or without protective gear. When asked, nine out of 12 salons did not have any eye covers in stock. Similarly, nine out of 12 salons did not have nose plugs in stock. Eleven out of 12 failed to have any protective gear for the mouth available. However, even if salons had some of the gear in stock, every salon ABC News visited discouraged using it. "You don't need it. You really don't need it," one salon employee said. Another discouraged eye protection, saying it would impact the appearance of the tan. "We wouldn't recommend for you to wear them because when you spray your face that part is going to be not tan," a salon employee said. A different salon said, "We also have goggles but you don't need them." Yet another salon wrongly told undercover ABC News producers that DHA is so safe, it is used to help treat diabetes and can be injected into the body.

Spray Tans: False Sense of Security Given Online

DHA the FDA tells consumers not to inhale or ingest, also called dihydroxyacetone, is the chemical that turns your skin brown. However, an omega 3 fatty acid called docosahexaenoic acid also shares the same abbreviation "DHA.

ABC News also discovered many tanning salons across the nation wrongly telling consumers on their websites that DHA is so safe that it is "food grade," and, "approved for ingestion by the FDA." One potential source of the inaccurate information was one of the largest manufacturers of spray tan product in America, Norvell Skin Solutions, ABC News found. The company runs what it calls "Norvell University," a detailed educational course designed for tanning salons and technicians who wish to offer spray tans to clients. ABC News found Norvell wrongly training salons online and in its course material by saying that "DHA is a food grade product approved for ingestion by the FDA. In fact, the largest user of DHA in the world is the health supplement industry."

The salons and Norvell may have been confusing two very different kinds of "DHA," each with the same abbreviated name. The type of DHA the FDA tells consumers not to inhale or ingest, also called dihydroxyacetone, is the chemical that turns your skin brown. However, an omega 3 fatty acid called docosahexaenoic acid also shares the same abbreviation "DHA." That type of DHA can be found in salmon or milk. It is approved by the FDA to be eaten and is thought to help reduce the risk of coronary disease. "We were absolutely in error," said Rick Norvell, president of Norvell Skin Solutions, after ABC News contacted him about the discrepancy.

DHA: 'A Potential Health Hazard'?

The FDA recently released a report to ABC News, following a Freedom of Information Act request, in which agency scientists wrote, "New information regarding the genotoxicity and carcinogenicity of DHA has become available since the listing of DHA as a color additive."

In the report, dated 1999, agency scientists cited the "new information" discovered by non-FDA researchers who had tested DHA in laboratory settings and found it had the potential for what they called a "mutagenic" effect on genes. The various studies, conducted mostly by university researchers, tested DHA's effects on different types of cells and organisms, including bacteria, salmonella, ecoli and mice skin cells grown in a lab. None of the tests done at the time tested human cells or humans themselves. Still, the results were enough to prompt the agency in the 1990s to attempt to determine how much DHA might be seeping into the living areas of the body when applied to the skin to tan. Prior to the FDA release this year of its 1999 report to ABC News, the tanning industry and even many in the field of dermatology thought DHA only interacted with proteins in the outer protective layers of human skin, also called the stratum corneum, where the skin cells are already dead and where DHA could pose no health risk. However, in the report released to ABC News, FDA scientists concluded that DHA does not stop at the outer dead layers of skin. They wrote: "The fate of DHA remaining in skin is an important issue, since high DHA skin levels were found." They added that tests they performed revealed that much of the DHA applied to skin actually ended up in the living layers of skin. They concluded: "This leaves about 11 percent of the applied DHA dose absorbed remaining in the [living] epidermis and dermis."

Four years after the report was issued, the FDA wrote a follow-up paper based on the same data, concluding that "probably" only 0.5 percent of each application of DHA becomes "systemically available," meaning distributed throughout the body after reaching the bloodstream. The agency concluded that 0.5 percent of an applied dose of DHA was poor absorption, and no further testing was done to check for actual toxicological impacts on the human body. The thinking was that because only a little bit of DHA entered the bloodstream, the health risk would be very low. However, any absorption into the living areas of the skin could be pose a potential risk, even if none of it made it into the bloodstream, said Dr. Darrell Rigel, an NYU professor of dermatology. The fact that some does potentially get into the bloodstream raised additional red flags for him that he said needed to be further explored. Rigel was especially concerned for repeated users of the product and those in higher-risk groups such as pregnant women or young children.

Girls as young as 4 years old who compete in beauty pageants are known to be spray tanned by their moms, who believe the tan to be a completely safe way to give their children a darker glow. Rigel believes the FDA paper, combined with other literature he reviewed, would surprise many of his colleagues in the medical field. He said the papers were enough to make him change what he will tell his patients about spray tanning. "What you showed me certainly leads me to say I have to rethink what I'm doing and what I'm saying because there's ... a real potential problem there," he said. "I feel that I must give my patients the information that you've given to me, because I think it is valid."

Following receipt of the 1999 FDA report, ABC News located nine other studies performed mostly by non-government university researchers on DHA. ABC News asked Rigel and five other medical experts to review the papers and anything else they could find on their own, and to offer their analysis about potential health risks. Before he read all of the papers, Rigel said, he would "tell my patients what every other dermatologist tells them: 'If you want to be tanned, [tanning with DHA] is effective, it's not being absorbed and there's no long-term problems.' After reading these papers, I'm not sure that's true anymore." "A potential problem has been identified and for public safety, more studies should be done," added Rigel, a former president of the three largest dermatological groups in the nation: the American Academy of Dermatology, the American Dermatological Association, and the American Society for Dermatologic Surgery.

"The concern here is we never thought this was getting absorbed," he said. "We thought it's binding to the surface of the skin and that's where the stain is.  So this is ... news that, in fact, it is penetrating beyond that."

ABC News also presented the panel of experts with information about some studies that found no carcinogenic or potential cancer-causing impacts of DHA, such as when it was tested on mice. However, that same FDA report from the 1990s raised questions about whether some of those tests came up negative simply because the DHA never absorbed into the skin of the particular type of mice tested.

Dr. Lynn Goldman, the dean of the School of Public Health and Health Services at George Washington University, reviewed the same group of papers and said that DHA tested positive for mutating genes in far too many different types of studies to reject concerns about its health implications. "The substance seems to have a potential for what they call creating mutations or changing DNA in living cells, which is a serious problem and needs to be further investigated, yet hasn't been," she said.

"What we're concerned about is not so much that reaction that creates the tanning, but reactions that may occur deeper down with living cells that might then change DNA, causing a mutation and what the possible impacts of that might be," she said. "I'd be very concerned for the potential of lung cancer."

Researchers should, however, not just be concerned about cancer, but other health effects such as birth defects, especially if a woman who was pregnant was spray tanning and allowing the mist to get inside her body, Goldman said. One tanning salon employee ABC News visited undercover, the lead trainer for a large corporate chain of salons in New York, told undercover television producers that DHA is "super safe," and, "great for pregnant women," something Goldman disagreed with. Goldman is a pediatrician appointed by President Clinton and approved by the Senate to serve in a top position at the EPA overseeing chemical safety. She has since left the position and gone back to university work. Her experience in both public health science and government gives her an unusual perspective which bridges both health and regulatory issues. "I think a lot of people assume that because things are on the market that it means somebody has very carefully evaluated them and that they're safe," she said. She was concerned about DHA mainly on two fronts -- firstly, because of the new information scientists have learned about DHA since it was approved for use in the 1970s. She believed the information was strong enough to warrant a full review of the product's safety that takes into account all potential health implications. Secondly, she said, the explosion in DHA's use in spray tanning means many more people will be exposed to it in a manner that has never been subject to an FDA safety review. "The use is expanding and it doesn't prompt a re-evaluation," she said, "and I think that's a serious problem."

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Tanning & Natural Health News is a publication of Tan Plus /Essentials Of Life, Barclay Square, 350 Route 108, Somersworth, NH. This publication is designed for educational purposes only and is not intended to be presented as medical advice. Product statements made have not been evaluated by the Food & Drug Administration.

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