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When did tanning become such a trend? It seems that more and more people are willing to do anything to get a golden sun-kissed look. Should they?
Throughout much of history, pale skin was associated with wealth and royalty, and tanned skin was associated with lower social economic status and manual labor outdoors. Therefore, pale skin was desired, and the use of bleaching creams or white facial makeup, sometimes with toxic ingredients, was not uncommon. It all changed in 1923, when French designer Coco Chanel, one of the most influential women at the time, walked off her yacht with a golden tan after a Mediterranean cruise on the French Riviera. Unintentionally, she started a trend of tanning, which began to be associated with health and leisure, and made it a beauty aspiration.
Following that, surfing and beach culture gained popularity in the 1950s and 1960s. By the 1960s, having a tan indicated leisure, money to travel to warm locations, and physical fitness resulting from outdoor activities. Tanning beds then arrived in the United States in 1978, allowing people to have a tan look even during winter months.
With increased unprotected exposure to solar radiation, came an increase in the incidence of skin cancer. Since the early 1970s, the diagnosis of malignant melanoma, the deadliest skin cancer, has significantly increased. Although many people are aware of the risks of sun tanning, the desire for a tanned look, in a country where indoor tanning is a nearly $5 billion per year industry, is obviously still strong.
Dermatologists, the medical specialists who diagnose almost 10,000 new skin cancers every day in the US, have tirelessly brought attention to the risks of tanning beds and excessive sun exposure. Now, there is a new trend in social media that is making dermatologists worried. It is called nasal tanning spray.
Wait a minute. What? Yes, you heard it right. Nasal tanning spray. It is exactly what you are imagining. A nasal spray that promises to give you a tan.
What Exactly Is in Nasal Tanning Spray, and How Does It Work?
Nasal tanning spray, as it’s called, contains a lab-made ingredient called Melanotan II, sometimes known as “the Barbie drug.” The drug has easy access to your bloodstream since it is applied on the nasal mucosa, and it causes your skin to tan more easily. Social media went into a frenzy over this drug since it seems so easy and harmless. But there are more risks than one can imagine.
To understand how it works, it is important to understand how our skin darkens when stimulated by ultraviolet light. In other words, why do we tan?
Ultraviolet radiation (from the sun or from artificial sources such as tanning beds) causes DNA damage in skin cells (which are called keratinocytes). This stimulates the production of a number of “alert” proteins, one of them called alpha melanocyte stimulating hormone, or α-MSH. This molecule will then go to the neighbor pigment-producing skin cell (called melanocyte) and ask for help. The way that melanocytes help is by the production of a dark pigment that is transferred to keratinocytes and forms a cap around the nucleus, like an umbrella, in hopes to protect their DNA from further damage and mutations. From that, we can see that all tanning is a mechanism of protection against further DNA damage. There is, therefore, no safe tan. To get a tan, you must damage your keratinocytes’ DNA first.
The key substance in increasing skin pigmentation is the α-MSH. Super potent α-MSH analogues were first synthesized in the 1980s for photoprotective effects. The first α-MSH analogue, afamelanotide, is a regulated and tested product. It has the commercial name Scenesse, and it is indicated to increase pain-free light exposure in adult patients with a history of phototoxic reactions from a disease called erythropoietic protoporphyria (EPP).
It was only a matter of time until α-MSH was felt to be used as a way to increase skin pigmentation for aesthetic reasons. There are unregulated α-MSH analogues available to the public, including Melanotan I and Melanotan II. Melanotan I and II are greater than 1000 times more potent than your body’s own α-MSH because of resistance to enzymatic breakdown. They are also nonselective drugs, which means that they not only act on melanocytes, increasing pigment production, but also in other cells involved in sexual function, energy homeostasis, immune function, and cardiovascular function. Melanotan II is the least selective of the two, and it is the drug on nasal tanning sprays.
Despite warnings from the FDA and several European countries, Melanotan I and II have become increasingly popular. Illicit manufacturing has made it relatively easy for the public to buy α -MSH analogues through the Internet in a nasal spray form, and its popularity is further increased by all the attention it gets on social media.
What Are The Risks of Nasal Tanning Spray?
- You don’t know exactly what you are putting into your body. It is illegal to sell Melanotan II in the US. Since it is not regulated, it is impossible to monitor the actual composition of what is being sold or to ensure that they do not contain unsafe impurities. A study examined samples from several different vendors and found that they contained unknown impurities ranging from 4.1 to 5.9%. They also found that products that were advertised as containing 10 mg of Melanotan II actually had varied amounts from 4.3 to 8.84 mg [Breindahl T, Evans-Brown M, Hindersson P et al. Identification and characterization by LC-UV-MS/MS of Melanotan II skin tanning products sold illegally on the internet. Drug Test Anal. 2015;7(2):164-172].
- This product is inhaled. The inside lining of your nose does not offer the same kind of barrier that skin does, therefore anything that is applied into the nasal mucosa will be absorbed into your bloodstream much more quickly. It is simply never a good idea to snort an illegal, non-regulated, and not FDA-approved product.
- Melanotan II will cause your skin to get tanner than usual and faster than usual, but it still requires you to spend unprotected time in the sun. As noted above, skin tanning is a response of your body to DNA damage caused by ultraviolet radiation. Cumulative damage to keratinocytes’ DNA leads to skin cancer.
- There are several known side effects of Melanotan II including acne, facial flushing, decreased appetite, and gastrointestinal issues, including diarrhea, nausea, and vomiting. There have been reports of other serious adverse events associated with the use of Melanotan II, including priapism (painful, sustained erections, which can lead to scarring and permanent erectile dysfunction), renal infarction (a potentially life-threatening condition that causes reduced blood flow to your kidneys), rhabdomyolysis (death of muscle cells) and acute kidney injury.
- By overstimulating the melanocytes, Melanotan II can cause a sudden increase in moles and freckles on your body and darken pre-existing moles. It has also been associated with melanoma, an invasive skin cancer with a high risk of death. Although the cause and effect between Melanotan II and melanoma are difficult to establish with certainty, there have been reports of chronological associations. Interestingly, Melanotan II products are sometimes marketed as a way to protect you from skin cancer, but the opposite is true. In fact, using it actually increases your exposure to the sun’s effects and risks.
- Psychological comorbidities, such as body dysmorphic disorder, are presumed to be common in Melanotan users.
Is it worth the risks? Absolutely not.
A Safer Way To Get a Tanned Look
Dermatologists want you to know that your skin is beautiful in a natural way. But if you still want a tan, there are safer ways to obtain it in which you can get a bronzed glow without exposing your skin to damaging ultraviolet radiation or inhaling Melanotan II and other untested, unregulated products. Safer options for tanning include bronzers, self-tanners, or spray tans. All these products work by changing the color on just the outer layer of your skin. Dihydroxyacetone (DHA), an ingredient used in many sunless tanning products, darkens the skin by reacting with amino acids on the skin’s surface. In vitro skin absorption studies have found no significant systemic absorption of DHA when applied topically to the skin. DHA is FDA-approved for topical application to the skin (e.g., cream or lotion formulations, but not for use in all-over spray tans). Remember that these products do not protect your skin from ultraviolet radiation. The Skin Cancer Foundation and the American Academy of Dermatology recommend self-tanning with concomitant sunscreen use.
As a board-certified dermatologist and Mohs surgeon, who specializes in the diagnosis and treatment of skin cancer, and who have performed thousands of surgeries on patients of all ages, most of them in the face, it’s easy to see why I feel very strongly about protecting this incredible organ. It is the most beautiful when it is healthy.
The protection of our skin against ultraviolet radiation is a great example of the power of healthy habits. The consistent, everyday protection, compounds into tremendous benefits in future decades. The best product for your skin today is the sunscreen you have used daily for the past 20 years.
Renata Prado, MD is a board-certified dermatologist and a fellowship-trained Mohs surgeon. She specializes in the diagnosis and treatment of skin cancer at Vanguard Skin Specialists. Dr. Prado sees patients in Colorado Springs and Castle Rock.
Vanguard Skin Specialists offers dermatology, plastic surgery, Mohs surgery, dermatopathology, and aesthetics.
