# A single-centre, prospective, qualitative analysis of knowledge, attitudes and behaviour of sunbed use among patients attending a pigmented lesion clinic in a tertiary referral centre

## TL;DR

This study explores why people use sunbeds despite health risks, finding that cosmetic reasons and addictive behavior drive continued use, especially among young women.

## Contribution

The study identifies a potential addictive component to sunbed use and highlights regulatory and public health gaps in tanning practices.

## Key findings

- Sunbed users are predominantly young women in urban areas seeking cosmetic benefits and confidence.
- Many tanning salons fail to comply with safety regulations, and users often ignore health risks.
- Use of unregulated tanning agents like Melanotan I and II correlates with increased sunbed frequency.

## Abstract

Indoor tanning through sunbeds is linked to a heightened risk of skin cancers, particularly cutaneous squamous cell carcinoma and basal cell carcinoma, with significant increases in risk for users aged < 35 years. Despite regulations established by the Public Health (Sunbeds) Act 2014 in Ireland, sunbed use persists, primarily for cosmetic reasons.

To analyse the characteristics, attitudes and behaviours of sunbed users attending an Irish dermatology outpatient clinic.

We undertook a prospective qualitative analysis of 104 consecutive patients attending a pigmented lesion clinic in a tertiary referral dermatology department in Ireland. This was done using a self-reported anonymous survey where respondents answered questions relating to their own demographic data, frequency of sunbed use, motivation for sunbed use and use of unregulated tan-enhancing agents (namely Melanotan I and II).

The results showed that patient demographics were consistent with previous studies on sunbeds use, namely younger female patients living in urban areas. Many sunbed premises did not comply with safety regulations; over half lacked protective goggles, and nearly half received no health risk information. The reasons for sunbed use included improving appearance and confidence, with a significant number using tan-enhancing agents. Surprisingly, increased awareness of health risks did not correlate with reduced usage; many users continued tanning practices despite concerns about its adverse effects. Users of tan-enhancing agents also used sunbeds more frequently compared with nonusers.

This study suggests a potential psychopathological aspect of tanning behaviours similar to addictive disorders like smoking and alcohol. Patients may benefit from psychological and behavioural interventions such as cognitive behavioural therapy to address their compulsive behaviour. Furthermore, there was a concerning lack of compliance with regulations in tanning salons, highlighting a public health issue. The rising use of unregulated tanning agents, especially among younger people, poses additional risks, including blood-borne infections. This study underscores the need for targeted educational interventions among younger age groups and stricter enforcement of regulations to mitigate health risks associated with indoor tanning. Understanding the complex motivations behind sunbed use is crucial for developing effective strategies to reduce its prevalence and promote safer alternatives.

Awareness or concerns on adverse effects of sunbed does not correlate with lower usage.

The addictive aspect of sunbed use for achieving a desired cosmetic appearance suggests a compulsive behaviour which needs to be studied in more detail. Lack of strict regulation on sunbed premises and unregulated tan-enhancing agents are important public health concerns, contributing to increasing incidence of skin cancer including melanoma and other adverse health outcomes.