Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
The Dangers of Tanning: Protecting Your Skin This Summer
The summer sun beckons with its warm embrace, but that golden tan comes with a hidden cost. Dr. Holly Thacker dives deep into the phenomenon known as "tanorexia" – the addiction to tanning that has serious health implications many don't recognize until it's too late.
This addiction isn't merely psychological. When your skin is exposed to ultraviolet radiation, your body releases endorphins – those feel-good neurochemicals that create a genuine physical dependency. "People can actually get addicted to this," Dr. Thacker explains, drawing parallels between tanorexia and other recognized addictive behaviors.
Whether you're concerned about your own tanning habits or protecting children's delicate skin, this episode delivers practical, science-backed advice for maintaining healthy skin while still enjoying outdoor activities. Because as Dr. Thacker reminds us, all natural complexions are beautiful – it's about being "happy in your own skin" while keeping that skin healthy for years to come.
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, and I'm back in the sunny sunflower house for a new podcast on tanorexia. Tanorexia, you know, we've just passed prom season, it's the summertime. People like that bronze glow. I'll always remember a patient who told me if you can't firm it, then you better bronze it. And, of course, nowadays, with self-tanning products and leg makeup, you don't have to damage your skin and actually tan yourself. But what is tanorexia? Well, I wrote a column about this back in May of 2012, and it was titled Do you have Tanorexia? Because I noticed that when my sons were starting high school, I noticed during prom season how deeply, deeply tan the young ladies were. They had very lovely dresses, but their skin was pretty crispy and I remember thinking I hope that their tans were from spray tans rather than tanning beds.
Holly L. Thacker, MD:And the word tanorexia is a term that dermatologists have used to report people that have a very addictive nature, because actually ultraviolet radiation can release. Radiation can release endorphins, kind of the feel good neurochemical transmitters, and there's people that can actually get addicted to this and that's how that term was coined tanorexia, and it's also sometimes associated with having an altered body image, just like those who suffer from anorexia and there has been a triad scene of tanorexia with anorexia and melanoma. Some people will call themselves tanaholics, saying that their look is fan-tan-tan-sick Is that a fantastic? But it's important to know that all natural complexions are beautiful Dark skin, brown skin, lighter skin, pale skin, various hues and we need to embrace the attitude of being happy in our own skin as well as keeping a healthy organ, the skin, which is the largest organ in the body. So I want to talk about some of the dangers of this indoor tanning, and then I also want to talk about protecting the skin. Protecting the skin. So in 2024, last year, there was almost 20,000 tanning salons in the United States, but this number is declining. There was a decrease of 8.8% from the year before, according to IbisWorld, and this brings the estimated number of salons this year, in 2025, to 18,219.
Holly L. Thacker, MD:Now we know that indoor tanning with ultraviolet radiation is a proven human carcinogen, and the International Agency for Research on Cancer, an affiliate of the World Health Organization, includes UV tanning devices in its group 1, a list of agents known to cause cancer and other things in group 1 include agents like plutonium, cigarettes, as well as solar UV radiation. So ultraviolet tanning devices were reclassified by the FDA from a class one low risk to a class two moderate to high risk as of September of 2014. So 11 years ago, indoor tanning devices can emit ultraviolet radiation in amounts 10 to 15 times higher than the sun at its peak intensity intensity Back in 2024, I had a podcast on this total solar eclipse and how strong the sun is and how you need very protective lenses to protect your eyes. 20 states plus the District of Columbia actually prohibit people under age 18 from going to indoor tanning places Nevada, new Hampshire, new York, north Carolina, oklahoma, rhode Island, texas, vermont, virginia and West Virginia and Oregon and Washington prohibit those from under age 18 from using indoor tanning devices unless a prescription a medical prescription is provided. Now Australia and Brazil and Iran have banned indoor tanning altogether in their countries, and it's important to note that the cost of direct medical care for skin cancer attributed to indoor tanning is over $340 million annually in the United States, and we have almost a half a million cases of skin cancer in the US each year linked to tanning indoor tanning, including about 250,000 basal cell cancers and almost 170 squamous cell cancers, and over 6,000 melanomas, and melanomas really are potentially deadly, although there's been great improvements made in immunotherapy. Potentially deadly, although there's been great improvements made in immunotherapy.
Holly L. Thacker, MD:It's been estimated that more people develop skin cancer because of indoor tanning than develop lung cancer because of smoking. And we know how strong the causal association of lung cancer and smoking is. If you've ever tanned indoors, you have about an 83% increased risk of developing squamous cell cancer and a 29% increased risk of developing basal cell cancer. And any history of indoor tanning increases that risk of developing basal cancer before age 40 by almost 70%. And women who've ever gone tanning indoors are six times more likely to be diagnosed with melanoma in their twenties than those who have never tanned indoors. And at all ages, the more women tan indoors, the higher the risk of melanoma. And one study observing 63 women diagnosed with melanoma before age 30 found that 97% of them had in fact used tanning beds. And if you use a tanning bed before the age of 35, that risk of melanoma is increased by 75%. So indoor tanning amongst US high school students has decreased by 53% between 2009 and 2015.
Holly L. Thacker, MD:And I would say that when I was out seeing the young people getting their prom pictures one weekend was Derby, the Kentucky Derby weekend, I did notice that it looked like the students had more of their own you know natural skin color, without that excessive, overly tanned look. So maybe it's fading in popularity, and I think that tanning, indoor tanning booths, are fading in popularity too, because of increased knowledge. And I would say, though, that ultraviolet light is used therapeutically, it's used to sterilize things, it's sometimes used medicinally. In fact, when I was in medical school, I developed a skin condition called pitoriasis rosea, and the differential diagnosis was syphilis, which I assure you I didn't have. I remember being mortified when the dermatologist said oh, I know you don't have syphilis, this is classic pitoriasis rosea. With the first target lesion that you had here, go to an indoor tanning place and that will fade the rash, and it did. And then, interestingly, I developed uh the same rash with my third um when I was pregnant, with my third son, and uh the dermatologist chuckled and said you're still really young, cause it's usually just young people that get um pitoriasis rosea, um.
Holly L. Thacker, MD:So there can be some medical reasons, and a lot of people say that just natural ultraviolet light exposure uh not only elevates their mood, but can sometimes help acne. Um. Certainly, being exposed to natural light uh helps your circadian rhythm and um. Exposure to ultraviolet light naturally can also increase vitamin D levels, although once you're over 40, it doesn't seem to make it that much. I think it's bad to avoid all sun exposure and have a low vitamin D, because that in and of itself can also increase cancer. But the wavelengths that they use in some of these indoor tanning booths makes the skin damaged and dark but really doesn't even increase vitamin D. But it does stimulate the release of endorphins, which is like kind of the body's natural opiates, and and that's why you have the term addiction, because people get that hit Um, and sometimes the addiction hides other conditions like OCD or depression or an anxiety disorder, um, and it can be somewhat challenging, uh, to treat.
Holly L. Thacker, MD:It's fine to have a healthy glow and to enjoy being outside, but once you get tanning it is a sign of skin damage and it is evidence of some DNA damage to your skin. It does also visibly speed up the signs of aging and it can lead to cancer, some of which can be deadly, like melanoma, and over time you'll definitely have an increased risk of basal cell, squamous cell and melanoma. So what happens is the ultraviolet light causes genetic damage to the cells on the outside surface of the skin, and the skin is trying to protect itself by making more melanin to give it more of a natural type of sunscreen, and that's why, depending on what your classification for your skin is based on how fair you are or how dark skinned you are generally speaking, the darker skin you are, the stronger the skin is in terms of resisting the damage and it takes more time to damage the skin. And those that are very fair, who don't tan, it takes the least amount of time to damage their skin. So most of us in the sunflower house who want to be strong, be healthy and be in charge, don't want excessive aging, and the wrinkles and dark spots and weathered skin is not particularly attractive, and to do something that you think might improve your appearance but really increases the risk of disease is not a good thing, and each time you get tanned, the damage builds up and it creates more genetic mutations.
Holly L. Thacker, MD:And, in particular, indoor tanning is dangerous because it's not natural sunlight and Tanning does damage all types of skin, even people that are darker skinned, and you can still enjoy outdoor activities and being out in the Sun, but it is important to be smart about this. So tanning beds. Are they as harmful as the sun? The answer is yes. Whether indoors or outdoors, the UVA rays used in tanning beds can increase cancer risk. Is going to an indoor tanning booth a good way to get vitamin D? No, the truth is that ultraviolet B radiation is what helps with vitamin D, and most indoor tanning is just the UVA rays. So you don't even get the vitamin D benefits. So it's much better to get vitamin D with food or with supplements D3K2, or exposure 10-15 minutes a day of the exposed arms or legs without sunscreen.
Holly L. Thacker, MD:A lot of women ask me should I get a base tan indoors before I go to a tropical vacation so I don't get a bad sunburn? No, tanning does not protect against sunburn, it just exposes you to more harmful rays. So shade protective clothing, a nice wide brimmed hat, big sun umbrellas and UV blocking sunglasses, and after age six months you know, a mineral based zinc oxide uh sunscreen um can be applied. A lot of women will ask me you know I feel so much better when it's sunny out. Does tanning help with seasonal affective disorder? And the answer is no, the tanning does not help treat seasonal affective disorder. Um, there are lights that have 10,000 lux of light that you can purchase and plug in, and from September to April in the Northern Hemisphere, when the days are shorter, 30 minutes of that light exposed in the morning does elevate the mood.
Holly L. Thacker, MD:So how can you protect yourself and look great? And you are listening to the Speaking of Women's Health podcast. I'm in the Sunflower host, I'm your executive director and host, dr Holly Thacker, and we are talking about tanorexia, the skin, vitamin D, and we have several podcasts on caring for your skin, interviews with skincare estheticians, and my third podcast of season one is all about vitamin D, which is a mood elevator and does help to reduce cancer and other conditions. And how can you protect yourself and look great? So avoid tanning, avoid damaging your skin and fake don't bake is the term. So if you want that golden glow, there's sunless tanning products and there's a lot of different options to give you kind of that sun-kissed bronze look, but you still need sun protection. Bronze look, but you still need sun protection.
Holly L. Thacker, MD:And even though I had that patient who told me if you can't tone, just tan it or bronze it, it's much better to try to tone your skin and tone your muscles and get radiant skin by doing aerobic high intensity exercise, working out feels good. It boosts your mood. You stronger. Staying hydrated helps your skin having a good skincare routine as well. It's so important to hydrate, particularly in the hot weather, and choose whole, unprocessed foods and get foods rich in vitamin A. The yellow, red, orange colored fruits and vegetables are good for vitamin A and vitamin C, which helps your skin. So making healthy skin a way of your general lifestyle is important. The Skin Cancer Foundation talks about playing in the shade, knowing all about sunscreen, and we did do a prior podcast on sunscreen Covering up exposed skin.
Holly L. Thacker, MD:Watch out for windows, because the ultraviolet light comes through windows. I don't know if you've noticed in your house areas that get a lot of sun. You can see how strong the sun is, how it can bleach out your carpet and your draperies and your furniture. Definitely say no to tanning beds. Early detection of skin cancer is important and the clothing can give you a barrier and it doesn't wear off like sunscreen. New fabrics can be high-tech and breathable. A hat with a wide brim is helpful. A hat with a wide brim is helpful where you be blocking. Sunglasses to protect your eyes. That's very important. What does upf mean? Well, that stands for the ultraviolet protection factor and you'll see that label on clothing, hats and some fabrics. So the number indicates what fraction of the sun's ultraviolet light penetrate the fabric. So a shirt that's UPF 50, for example, only allows 1, 50th of the radiation to reach your skin, as if you didn't have that shirt on. The pitfall is clothing leaves some skin exposed the face, you know, the forearms, the décollet area.
Holly L. Thacker, MD:Playing in the shade is a good idea, especially between 10 am and 3 pm, peak hours of sun intensity. When I go outside at lunch to walk, I'm trying to walk on the shady side of the street. I usually try to grab a visor, even if I'm going outside to get the mail, to protect my face. But ultraviolet light passes through leaves and branches and even in the wintertime you can, even with makeup on and being in your car with the window up, and it's the reason why in America more people have left-sided skin cancers whereas, say, in the United Kingdom, where they drive on the other side of the road, they have more right-sided skin cancers. So shade's not a perfect shield and ultraviolet light can be reflected off of water, sand, glass, concrete.
Holly L. Thacker, MD:It's important to know your sunscreen and the number tells you how long it takes for the sun's UVB rays to redden your skin compared to the amount of time without a sunscreen. So if you put SPF 30, exactly as generously and evenly applied and reapplied two hours after sweating or swimming, it would take 30 times longer to burn than if you weren't wearing sunscreen. Broad spectrum indicates blocking A and B rays. Water resistant, some claim to be waterproof for 40 to 80 minutes and you can burn in the water and it's important to reapply even if it says it's waterproof.
Holly L. Thacker, MD:People with sensitive skin and young people might want to just focus on the products that only use zinc oxide and titanium dioxide. They're called mineral or physical formulas. You don't have to worry about absorptions of chemicals. The pitfall is you've got to apply it liberally enough and not miss spots. I'll always remember the time my husband had this S-shaped red sunburn on his chest because he took sunscreen and just rubbed it in an S form and he didn't have all of his skin covered. And people can have pain. They can get blisters, scarring, be uncomfortable, it can ruin your vacation and increase your risk of cancer.
Holly L. Thacker, MD:Seek the seal. The bottom line is you need several types of sun protection to safeguard your skin. It takes a village, so to speak. Many products that meet stringent criteria for safe and effective UV protection have earned the Skin Cancer Foundation seal of recommendation. And be choosy about your hats and sunglasses and sunscreens, as well as your moisturizers and cosmetics. Have nice awnings, umbrellas, window film that carry the seal.
Holly L. Thacker, MD:So what do you do with the wee ones, your young children or grandchildren and I'm getting another grandbaby later this summer it's best to keep infants out of the sun for the first six months rather than put anything on their skin. Using hats, sunglasses, stroller shades is very important. Now, infants do need vitamin D supplementation. Breastfed babies need vitamin D and sometimes even bottle fed, although it's usually um. Added to that, august is breastfeeding awareness month, and last August of 2024, we had a great podcast on breastfeeding and feeding your baby Toddlers. Uh, sometimes it can be a challenge for them to wear a protective hats and clothing. Uh, but if you try to get in that habit early, it's a good one.
Holly L. Thacker, MD:Sometimes there can be unexpected exposure. If you're not planning ahead for your outside trips. You want to talk to caregivers and I think getting some sun exposure is good because of vitamin D, particularly if you're not supplemented. But certainly you do not want to damage the skin. So glass blocks UVB pretty well, but UVA gets in. And the same thing is true of windows in your house your house. Generally speaking, car shields are treated to shield the driver from most UVA rays, but not the side back and sunroofs. Interestingly, when you're in your car, protect yourself and your family, or you can get a UV protective window film applied to your window in your car or at home. The windows on airplanes, trains and buses also allow UVA rays to pass through, which is one reason why airline pilots, crew members and even frequent travelers may get more skin cancers than other people. Isn't that interesting?
Holly L. Thacker, MD:The pitfall is you need to plan ahead before traveling and having summer excursions and having protective clothing on. Most importantly, please say no to tanning booths. You deserve to enjoy yourself in the summer and have fun and get outdoor physical activity and fresh air. But indoor tanning does raise the risk of skin cancer and melanoma. And a pitfall is that, while some states have implemented laws to try to protect minors and prohibit them ages, you know, varying from ages 18 to even down to 14 from using tanning beds or requiring parental consent Many states have not restricted access. So peer pressure to tan can affect people's judgment and you don't want to develop the condition of tanorexia, where you actually become addicted to tanning, to tanning and this may need to actually be medically treated with agents like antidepressants. Potentially, certainly, cognitive behavioral therapy can be employed and that can help people's mood and is a non-medication way. Working with someone to kind of wean down on that, dealing with any kind of body dysmorphia issues because you want to feel good about yourself, can be very important and any women that have any disordered eating or eating disorders need to be evaluated.
Holly L. Thacker, MD:Sometimes low dose naltrexone, which in high doses blocks opiates, in low doses helps potentiate your own natural endorphins and opiate receptors and our functional medicine doctors. In fact, we have a column on speaking of women's health on the use of low dose naltrexone for chronic pain and inflammation, if you didn't hear our podcast on anti-aging with Dr Christofides and we have two parts of that. The first part was in May of 2025. And the second one is going to be in May of 2025. And the second one is going to be in mid-July of 2025. She talks about using off-label, of course, rapamycin to affect the mTOR pathway in aging and she's personally found some success in people with chronic pain or some autoimmune conditions. In fact, certain autoimmune conditions, like systemic lupus erythematosus, can get significantly worse with any kind of ultraviolet light exposure, indoor tanning or outside radiation.
Holly L. Thacker, MD:And people that inherit two recessive genes from each parent and have albinism, where they have zero pigment at all in their skin, are at super, super high risk for skin cancer and have to take protective measures of their skin at all times. And if you haven't been a regular subscriber to our podcast, please hit follow or subscribe. And if you go on our website speakingofwomenshealthcom, you can put in different topics. We've done topics on enjoying the summer and protecting yourself from summer hazards not just the sun but bug bites and just preparing for the summer. We have several podcasts on skin and hair topics that perennially women are interested in. In fact, the one with our esthetician, lori Skarsgård, was so good we reprised it with some other skincare tips. In fact, I learned that the blue light that comes off the screens that so many of us work in front of the screens can be very damaging to our skin, and that's one reason to limit screen time and also to protect the skin. And topical vitamin C with iron or ferric acid can also help protect the skin, and so I've certainly incorporated that into my routine.
Holly L. Thacker, MD:I would like to emphasize if you've ever had pre-skin cancer, actinic keratosis or a basal cell cancer or squamous cell cancer or potentially the deadly melanoma, it's very important that you get regular skincare checks and we're talking at least once a year. At least once a year. And if you are someone, or you know someone, who has been afflicted with tanorexia and just cannot stop the obsessive behavior of constantly going to the tanning booths which are, you know, decreasing, like we said, there are less booths out there, I think, because people don't want to be sued for cancer, since they are, you know, known carcinogens please talk to your healthcare team If they particularly can't help you, if it's not within their expertise, they can hopefully refer you to someone who can do cognitive behavioral therapy, who can work with you on an individualized plan to kind of withdraw off of that activity. And, as I mentioned, you know we always really like lifestyle first to improve the mood good sleep we have so many good podcasts on sleep hygiene, on good nutrition. I mean food really affects your mood. Vitamin D elevates the mood. B-complex, omega-3s Unfortunately we have this epidemic of people who are too low in omega-3s and I've done a couple of podcasts related to food and heart healthy oils and olive oil and how to get more omega-3 in your diet. That truly is a mood elevator, and other natural substances like turmeric, saffron have recently been shown to elevate the mood. So don't turn to tobacco or alcohol or tanning booth to boost your mood Sleep, social interaction, exercise, natural, bright light.
Holly L. Thacker, MD:A lot of times people's mood is affected by light and a lot of people don't tolerate LED lights and certainly flickering lights can really irritate the brain, maybe even trigger seizures. We had a podcast on seizures and we do have an excellent podcast on migraine headache, which affects half the population. So the light that affects your eyes and retina affect your brain and there's all different wavelengths of light and we've even talked about laser different wavelengths of light and we've even talked about laser, which is light therapy for various conditions, medically as well as cosmetically. So protect your skin and no method is exactly perfect, but at least one in five people by age 70 will have skin cancer and that number seems to be rising. And you should get used to checking your own skin once a month or so and seeing a physician or someone specially trained in checking your skin once a year and if you have something suspicious, make an appointment and get in and get it checked out.
Holly L. Thacker, MD:Thank you so much for listening to our Speaking of Women's Health podcast. If you enjoyed this show, please give us a five-star rating and if you don't subscribe, hit follow or subscribe. You can find us on Apple, itunes, spotify, amazon Music. Tune in. You can make a donation to our nonprofit at speakingofwomenshealthcom and hit the give button. Don't miss a future episode. So subscribe and I'll look forward to seeing you back in the sunny but protected healthy sunflower house next time. Remember, be strong, be healthy and be in charge.
