Chapter 7
Determining an Exposure Schedule

· Exposure time
· Skin typing

Accurate control of exposure times is necessary to decrease the risk of overexposure to ultraviolet radiation. Another factor involved in optimal tanning sessions is being able to accurately identify the various skin types of those clients that frequent indoor tanning facilities.

Determining Exposure Time:
Where To Look
FDA standards require that the manufacturer provide an exposure schedule with the product warning label. The exposure schedule allows a user to gradually build up a tan and maintain it while controlling the risk of acute injury and delayed adverse effects. Because the UV dose that causes a barely discernible pink coloration of the skin (MED or minimal erythema dose) is not the same for everyone, the exposure schedule for the first time user will depend on the skin type of the user. Sub-erythema doses of UV received at 24-hour intervals initially lead to a reduction of the erythema thresholds. Therefore, the exposure schedule and maximum recommended exposure time limits the potential for erythema and monitors the dose of radiation necessary to achieve and maintain a tan.

The amount of UV required to achieve a tan is different for each person. The exposure schedule is designed to allow a client to gradually build a tan, while minimizing the risk of erythema. The schedule is based on the skin type of the individual client and the output of lamps in the tanning unit. It takes into account a client�s recent exposure, then increases the session time gradually.

Maximum timer intervals depend upon the intensity and spectral distribution of ultraviolet emission from the equipment and must not exceed the maximum recommended exposure time provided on the manufacturer�s label. Equipment manufacturers are required to develop an exposure schedule and to establish the recommended exposure time. Therefore, the maximum timer interval based on the characteristics of their particular products.

According to the FDA, the purpose of a sunlamp product timer is to provide for reliable control of exposures and to limit acute (and delayed) damage from unintentionally long exposures.

It is the tanning salon operator�s responsibility to determine the amount of time a client can tan. This time is determined by referring to the manufacturer�s printed label for suggested tanning time. In order to properly utilize the label the operator must accurately determine the client�s skin type and skin sensitivity (see below). Also, a thorough evaluation must done to determine factors that could eliminate or reduce tanning time (checking for photosensitizing substances and unit past the maximum conditions). Regardless of skin type, a client should never be allowed to exceed the time allowed on the manufacturer�s label.

Skin-Typing
The most important factor involved in determining a client�s tanning time is his or her skin type. In order to understand and implement exposure schedules, salon operators consistently must be able to skin type clients with accuracy.

In some states, salon operators are required to use a state-approved skin typing form. The most common skin typing charts used today are based on the Fitzpatrick system, which evolved from Dr. Thomas B. Fitzpatrick�s earlier biological work. The system originally was developed to determine appropriate exposure schedules for patients with psoriasis who were being treated with PUVA therapy. It takes into account an individual�s reaction to sunlight exposure lasting 45 to 60 minutes with unexposed (untanned) skin, as well as his or her coloring: hair, eyes, skin (phenotype).

Charts based on the Fitzpatrick system categorize humans into six different skin types, arranged from lightest to darkest coloring. Below is a typical skin typing chart. Skin type is determined by a person�s initial response to sun exposure after a long period of no exposure (winter). It remains the same, regardless of tan developing due to further exposures.

Skin Type 1 tans little or not at all; burns easily and severely; then peels. Skin reaction samples include most often fair skin, blue eyes, freckles, and white, unexposed skin. The skin of Type 1 individuals does not have the ability to create natural protection from ultraviolet exposure, and it is particularly susceptible to burning and damage from UV rays. These people should avoid UV exposure, and must not be allowed to go into a tanning bed. Skin typing should eliminate the possibility of a Skin Type 1 individual tanning in a bed. Sunless tanning options would be a good solution for these clients.

Skin Type 2 usually burns easily and severely (painful burn); tans minimally and lightly. Skin reaction samples include: fair skin, blue or hazel eyes, blonde or red hair, and white, unexposed skin.

Skin Type 3 burns moderately; gains average tan. Skin reaction samples include: average Caucasian, with white unexposed skin.

Skin Type 4 burns minimally; tans easily and above average with each exposure; exhibits IPD. Skin reaction samples include: people with light or brown skin, dark-brown hair, and dark eyes, and whose unexposed skin is white or light brown (Asians, Hispanics and Mediterraneans.).

SKIN TYPE SKIN REACTION EXAMPLES

Skin Type 5 rarely burns; tans easily and substantially; always exhibits IPD. Skin reaction samples include: brown-skinned persons whose unexposed skin is brown (East Indians, Hispanics, etc.)

The last category, Skin Type 6, tans profusely, never burns; exhibits IPD. Skin reaction samples include: persons with black skin (Africans and African Americans, Austrlians and South Indian Aborigines).

Because people with higher skin types have more pigmentation, thus more natural protection, their exposure schedules can progress more rapidly than those with lower skin types. It is extremely important to note that regardless of skin type, the maximum exposure time in a tanning unit should never be exceeded.

Although it is much harder for a person of Skin Type 4, 5 or 6 to burn, it is possible. It is a common belief that indoor-tanning equipment is designed to produce a quick tan without burning, and that tanning for longer periods will bring quicker results. This is not correct. Following the maximum recommended exposure time of the tanning unit will produce the best results.

Ask Questions
When determining the appropriate exposure schedule for a client, it is important to note that a salon operator can�t base skin type simply by what he or she sees. Because of the prevalence of hair dyes, colored contacts and sunless tanners, it is nearly impossible to accurately determine a client�s natural coloring and a salon operator easily could incorrectly skin type the client. Also, a client can walk in with what appears to be an all-over tan but is only tanned on the arms, legs and face. If operators use the exposure schedule based on what they see, a client easily could incur a burn on previously unexposed skin. It is important for the operator to have an open dialogue with the client.

In addition to skin typing and looking at recent tanning history, other factors should be used to properly utilize the exposure schedule. A salon operator needs to ask a clients about possible photosensitizing medications and medical conditions that could affect recommended tanning times. A questionnaire inquiring about sun sensitivity, natural coloring, recent tanning history, medications and medical history should be used, and is required by certain states. (A questionnaire of this type is listed on the next page. Each response is given a numerical value, after the tanning operator reviews the questions with the client the answers are tallied up and an individual�s sun sensitivity is determined. This level of sun sensitivity can then be used when utilizing the manufacturer�s printed label for suggested tanning time.)

Tanning Takes Time
Clients need to be educated on the tanning process and made aware that it takes some time. It takes six to 10 sessions following the exposure schedule for a previously unexposed individual to develop a base tan. Because we live in a society that is used to immediate gratification, it would be a smart idea for salons to carry self tanners and bronzers for clients who want immediate color while beginning their tanning regime.

The tanning process occurs in two phases. The color seen immediately after getting out of a tanning unit is due to immediate pigment darkening (IPD). IPD results from the rapid darkening of already existing melanin and is induced mainly by UVA. It is most obvious in skin where high levels of pigmentation already exist. IPD can fade within minutes or last up to several days after longer exposures and blend into the delayed tanning phase.

The delayed tanning phase first becomes visible 72 hours after exposure. It is induced mainly by UVB and is the result of increased melanin. By creating an excited condition in the melanocytes which then release more melanin, both UVA and UVB contribute to the delayed tanning phase.

Because the length of IPD is primarily determined by skin type, certain individuals will experience IPD for only a few minutes. It is important to educate these clients on the tanning process, otherwise they may incorrectly perceive that they did not receive adequate color from their tanning session and try to tan again within a 24-hour period. This could lead to unintentional overexposure. Supplementing sunless tanning options along with UV tanning will allow these clients to have immediate color while they develop their base tans.

Satisfied Customers
Clients rely on salon operators to maximize their tanning processes while reducing their risks for overexposure. By appropriately determining exposure schedules based on skin type, salon operators can ensure continued business success. Clients who achieve beautiful, golden tans without incurring sunburn will be satisfied, repeat clientele.