Why My Patient Will Not Stop Tanning

UV radiation (UVR) is a known carcinogen, yet many people seek out additional exposure and even pay for it. An economic utility model breaks down the decision to tan as a cost-benefit argument whereby the guaranteed benefit of relaxing today and having the desired tan tomorrow can outweigh the dis­tant possible cost of developing skin cancer and photoaging. Additionally, some individuals actually may develop a substance-related disorder (SRD) on UVR that drives their need to tan. Modification of the CAGE (cut down, annoyed, guilty, eye-opener) questionnaire and Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision)(DSM-IV-TR) criteria for substance abuse finds that a number of patients meet criteria for a possible UVR SRD. Although the dependency may primarily be psychological, it also is possible that a physiological dependency develops with chronic exposure to UVR. Administration of naltrexone to select frequent tanners blunted their preference for UVR versus non-UVR light beds and even induced withdrawal-like symptoms in some individuals. By looking deeper into the reasons that people tan, it may be possible to develop a more effective prevention campaign.