1. Know Your Responsibilities: Information for Tanning Salon Operators
What You Need to Know to Support Ontario’s Skin Cancer Prevention Act

2. Thank You
This information material was created for tanning salon operators in consultation with the following organizations:
Canadian Dermatology Association
Central West Tobacco Control Area Network
Healthy Environments and Consumer Safety Branch Environmental and Radiation Health Sciences Directorate
Niagara Region Public Health Youth Advisory Committee
This material is adapted with permission from Niagara Region Public Health and Hamilton Public Health Services

3. Overview
This information material has been created for tanning salon staff to explain the Skin Cancer Prevention Act, Radiation Emitting Devices (RED) Act, and the health impacts of tanning bed use. This information material is designed to help you understand:
Your responsibilities under the RED Act
Your responsibilities under the Ontario Skin Cancer Prevention Act
Health inspections
Causes and types of skin cancer
UV exposure reactions
Assessing skin type

4. Tanning Beds and Skin Cancer
Youth under 18 years of age should not use tanning beds
Overexposure to ultraviolet rays (UVR) can cause skin cancer
Skin cancer are growths on the skin that can spread to other parts of the body. It can be caused by spending a lot of time in the sun or from using tanning beds. Most skin cancer is preventable.
The World Health Organization states that youth under the age of 18 should not use tanning beds. Tanning beds give off UVA and UVB rays, which can cause skin cancer.
Skin cancers are growths on the skin that can spread to other parts of the body. It can be caused by spending a lot of time in the sun or from using tanning beds. Most skin cancer is preventable.
The Skin Cancer Prevention Act and RED Act are in place to prevent skin cancer and protect our population from unsafe radiation.

5. Tanning Beds and Skin Cancer
The Skin Cancer Prevention Act and the RED Act are in place to prevent skin cancer and protect people’s exposure to unsafe radiation
The World Health Organization states that youth under the age of 18 should not use tanning beds. Tanning beds give off UVA and UVB rays, which can cause skin cancer.
Skin cancers are growths on the skin that can spread to other parts of the body. It can be caused by spending a lot of time in the sun or from using tanning beds. Most skin cancer is preventable.
The Skin Cancer Prevention Act and RED Act are in place to prevent skin cancer and protect our population from unsafe radiation.

6. Radiation Emitting Devices Act RED Act
In Canada, the Radiation Emitting Devices (RED) Act protects against unsafe radiation emitting devices.
The Act governs:
Sale (including re-sale)
Lease
Importation of radiation emitting devices
Regulations associated with the Act
The RED Act protects Canadians against unsafe radiation emitting devices.
The RED Act governs the sale, resale, lease and importation of radiation emitting devices in Canada, as well as making regulations for carrying out the purposes and provisions of the Act.
The following sections summarize, in part, SOME pieces of the Radiation Emitting Devices Regulations for tanning equipment. The RED Act does not cover medical phototherapy units. More details and legal wording are available online on the Health Canada website.

7. Radiation Emitting Devices Act RED Act
Information and Standards
Must be on every piece of tanning equipment in both English and French
Instructions for use (including directions for determining exposure positions, maximum exposure time, and manufacturer recommendations on minimum time between exposures)
Instructions on replacement and repair
UV radiation warning labels
The following information must come with each piece of tanning equipment in both French and English:
Instruction for its use, including directions for determining the exposure positions, maximum exposure time, and manufacturer recommendations on minimum time between exposures
Instructions for replacement and repairs
A warning to always follow instructions to avoid injury
And the ultraviolet radiation warning label
Every tanning bed must be constructed with the following safety features:
A shut-off control so that the user can easily shut off the machine without unplugging it
An accurate timer
And a Plexiglas barrier between the lamps and the user to prevent contact

8. Radiation Emitting Devices Act RED Act
Construction Standards
Every tanning bed must include the following safety features
Shut-off control
Timer
Plexiglass barrier between the lamps and user to prevent contact
The following information must come with each piece of tanning equipment in both French and English:
Instruction for its use, including directions for determining the exposure positions, maximum exposure time, and manufacturer recommendations on minimum time between exposures
Instructions for replacement and repairs
A warning to always follow instructions to avoid injury
And the ultraviolet radiation warning label
Every tanning bed must be constructed with the following safety features:
A shut-off control so that the user can easily shut off the machine without unplugging it
An accurate timer
And a Plexiglas barrier between the lamps and the user to prevent contact

9. Radiation Emitting Devices Act RED Act
All Pieces of Tanning Equipment Must:
Meet RED Act standards
Use lamps that meet standards
Have an accurate timer (that allows for preset times and does not exceed maximum exposure recommendation times)
Be used with acceptable eyewear
All pieces of tanning equipment must:
Meet all the functioning standards in the RED Act
Use lamps that meet the standards
Have an accurate timer that allows for preset times and does not exceed maximum exposure recommendation times
And be used with eyewear that meets the standards

10. Radiation Emitting Devices Act RED Act
Labelling Standards
This label must be on each piece of tanning equipment at the time of sale, lease or import. It must be provided in French and English.
This label must be on each piece of tanning equipment at the time of sale, lease or import. It must be provided in French and English.
The following information must always be affixed to the outside surface of the tanning bed, where it can be easily viewed and read by a user before tanning:
The manufacturer’s name and address
The model, serial number, and month/year of manufacture
Detailed directions for determining the exposure positions and a warning that the use of any other position may result in overexposure
Recommended exposure time in minutes
Minimum interval between exposure
Maximum number of minutes of exposure per year (as recommended by the manufacturer)
Model for each type of lamp used in equipment
And the ultraviolet radiation warning labels

11. Radiation Emitting Devices Act RED Act
The following information must always be affixed to the outside surface of the tanning bed, where it can be easily viewed and read by a user before tanning:
Manufacturer’s name and address
Model, serial number, and month/year of manufacture
Detailed directions for determining the exposure positions and a warning that the use of any other position may result in overexposure

12. Radiation Emitting Devices Act RED Act
Recommended exposure time in minutes
Minimum interval between exposure
Maximum number of minutes of exposure per year (as recommended by the manufacturer)
Model for each type of lamp used in equipment
Ultraviolet radiation warning labels

13. Skin Cancer Prevention Act
As of May 1, 2014, the Skin Cancer Prevention Act bans the sale, advertising, marketing and/or provision of tanning bed services to youth under 18 of years in Ontario.
Effective May 1, 2014, the Skin Cancer Prevention Act makes selling, advertising, marketing and/or providing tanning bed services to youth under 18 against the law in Ontario.
What are your responsibilities?
Register your salon with your local public health department before July 1st, 2014 or before operating a new salon
Check identification if a customer appears under 25 years of age
Refuse tanning bed services to youth under 18, or those who cannot show adequate ID proving they are over 18
Make sure all tanning bed users have adequate eye protection
Cooperate with public health inspectors
And do not advertise tanning services to youth under 18

14. Skin Cancer Prevention Act
What are Your Responsibilities?
Register your salon with your local public health unit
Check identification (ID) of customers every time they use a tanning bed
Refuse tanning bed services to youth under 18 years of age
Make sure all tanning bed users have adequate eye protection
Cooperate with Public Health Inspectors
Do not direct marketing or advertising to youth under 18 years of age
Effective May 1, 2014, the Skin Cancer Prevention Act makes selling, advertising, marketing and/or providing tanning bed services to youth under 18 against the law in Ontario.
What are your responsibilities?
Register your salon with your local public health department before July 1st, 2014 or before operating a new salon
Check identification if a customer appears under 25 years of age
Refuse tanning bed services to youth under 18, or those who cannot show adequate ID proving they are over 18
Make sure all tanning bed users have adequate eye protection
Cooperate with public health inspectors
And do not advertise tanning services to youth under 18

15. Marketing and Advertising
Under the Act, you CANNOT market or advertise tanning bed services to youth under 18 years of age
Examples of unacceptable marketing or advertising include: targeting materials to youth under 18 years of age, marketing in or at locations frequented by youth (including schools), or using images targeted at youth under 18 years of age
Under the Act, you may NOT direct marketing or advertising to youth under 18 years old.
Examples of unacceptable advertising and marketing include:
Marketing in or at locations primarily intended for use by youth under 18 years old, such at schools or youth sports locations
Targeting your materials towards youth under 18, such as those attending school formals, prom or graduations
Using images that are targeted at people under 18

16. Enforcement and Fines Inspection: Fines:
Public Health Unit will inspect your premises to ensure compliance
Looking for signage, cleanliness and proper procedures
Fines:
Up to $25,000 for a corporation and/or $5,000 for an individual
Individual staff members can be fined even if the corporation is not fined
Public Health is mandated to inspect your salon to ensure compliance with health guidelines and the Skin Cancer Prevention Act. Inspectors will be looking for things such as signage, cleanliness, and proper procedures.
If anyone at your salon sells, provides, or advertises tanning services to youth under 18, the salon owner could face charges up to $25,000 for a corporation and/or $5,000 for an individual. And individual staff member can be fined even if the business or corporation is not fined.

17. Signage
The Skin Cancer Prevention Act and RED Act regulations outline what signs you need to post, what labels are required on tanning equipment, and where they need to go. If these become damaged or missing, please contact your public health unit for assistance getting replacements.
The Skin Cancer Prevention Act and RED Act regulations outline what signs you need to post, what labels are required on tanning equipment, and where they need to go. If these become damaged or missing, please contact your health unit for assistance getting replacements.
The Point of Sale Warning Sign is the principle health warning sign that warns potential users of the dangers associated with tanning bed use, advises of the requirement to use protective eyewear, and advises on the restriction of youth under 18 years old. It must be clearly displayed within one metre of each cash register where tanning services or ultraviolet light treatments for tanning are sold.

18. Signage Point of Sale Warning Sign: Main warning sign
Lists dangers associated with tanning bed use, requirement to wear protective eyewear and notes restriction of youth under 18 years of age using tanning beds
Must be clearly displayed within 1 metre of each cash register
The Skin Cancer Prevention Act and RED Act regulations outline what signs you need to post, what labels are required on tanning equipment, and where they need to go. If these become damaged or missing, please contact your health unit for assistance getting replacements.
The Point of Sale Warning Sign is the principle health warning sign that warns potential users of the dangers associated with tanning bed use, advises of the requirement to use protective eyewear, and advises on the restriction of youth under 18 years old. It must be clearly displayed within one metre of each cash register where tanning services or ultraviolet light treatments for tanning are sold.

19. Signage Health Warning Sign
Must be displayed in rooms where tanning beds are located
Warns potential users of the dangers associated with tanning bed use
Also advises of the requirement to use protective eyewear

20. Signage Age Restriction and Identification Decal
Must pose decal on all entrance doors to tanning facility
Sticker indicates anyone under 18 years of age is banned from using tanning beds AND anyone under 25 years of age must show identification
Retailers must post Age Restriction and Identification decals on all entrance doors of the tanning facility where there is UV tanning equipment on the premises. The sticker indicates that anyone under 18 years old is not allowed to use tanning beds and that anyone under 25 years old will be expected to show identification.
The Employee Reminder Decal is to be stuck to the counter top at the cash register or service desk. From the counter top, the sign is to face the employee, not the patron. This sign reminds employees that individuals under 18 are restricted from tanning bed use and that they must ask for identification from anyone who appears to be under 25 years of age.

21. Signage Employee Reminder Decal
Decal must be stuck to countertop at cash register or service desk
Decal must face employee
Reminds employees that anyone under 18 years of age is restricted from using a tanning bed AND anyone under 25 years of age must show identification
Retailers must post Age Restriction and Identification decals on all entrance doors of the tanning facility where there is UV tanning equipment on the premises. The sticker indicates that anyone under 18 years old is not allowed to use tanning beds and that anyone under 25 years old will be expected to show identification.
The Employee Reminder Decal is to be stuck to the counter top at the cash register or service desk. From the counter top, the sign is to face the employee, not the patron. This sign reminds employees that individuals under 18 are restricted from tanning bed use and that they must ask for identification from anyone who appears to be under 25 years of age.

22. Acceptable ID
Ask for ID from anyone who looks 25 years of age or younger.
You must ID every time
Acceptable ID must be:
Government-issued
Have a photo
Include date of birth
Ontario photo health cards are acceptable, but you may NOT request one
Tanning bed use is illegal for youth under 18, so you must ask for ID from anyone who looks 25 years of age or younger. You must ID every time.
Acceptable photo ID must be government-issued and have a date of birth. Ontario photo health cards are acceptable but you may NOT request one.

23. Ontario Driver’s Licence
Ontario Driver’s License is an acceptable form of identification
Should match year of birth
Should match day of birth
Should match person in front of you
Should match month of birth for a male person
(month + 50 for female)
The Ontario Driver’s License is an acceptable form of identification.
The photo should look like the person in front of you
The date of birth format is: year, month then day
The date at the bottom will identify when the cardholder will turn 19. For tanning salons, you can subtract 1 year to determine when the cardholder will turn 18. In this example, John will turn 18 in 2013.
If the ID does not look acceptable then ask more questions:
Can the customer answer questions about date of birth and spelling of name?
Does the customer have another form of ID available?
If the ID is not acceptable, stay calm and advise the customer of the law. Be clear and firm.
Year, month, and day of birth
Identifies when cardholder will turn 19

24. Ontario Photo Health Card
Ontario Health Cards with a photo may be accepted, but you may NOT ask for one
Ontario Health cards with a photo may be accepted, but you may NOT ask for one.
Year, month, and day of birth
Tells you (M)ale or (F)emale

25. Keep it Clean What is the health concern? Protect yourself!
Tanning beds may become tainted with blood or body fluids such as Hepatitis B, Hepatitis C or HIV
Tanning beds must be cleaned and disinfected after each use
You do not have to see blood or body fluids for an infection to occur
Protect yourself!
Wash your hands thoroughly
Use gloves or other proper personal protection when required
Follow manufacturers instructions when cleaning and disinfecting tanning beds or booths
Public Health will inspect your salon to ensure compliance with health guidelines and the Skin Cancer Prevention Act.
The health concern is that tanning beds may become contaminated with blood or body fluids carrying diseases such as hepatitis B, hepatitis C or HIV. Tanning beds must be cleaned and disinfected after each client to prevent the transmission of blood-borne diseases. You do not have to see blood or body fluids for an infection to occur.
Protect yourself by thoroughly washing your hands before and after cleaning or disinfecting client contact surfaces. Use gloves or other personal protection and follow the manufacturer’s instructions when cleaning and disinfecting tanning beds or booths.

26. Protect Your Clients’ Health
Clients’ skin should be free of cuts, wounds, irritations and rashes
Protective eyewear is required. Single use eyewear is recommended
If using reusable protective eye wear, ensure it is properly cleaned and then disinfected after each client
Cleaning and disinfecting chemicals should be properly labeled
In order to protect the client’s health, it is important that clients’ skin is free of cuts, wounds, irritations, and rashes to reduce the risk of infection.
Protective eyewear is required. Single use eyewear is highly recommended.
Reusable protective eye wear must be cleaned and then disinfected using an intermediate level disinfectant after each client. Contact your public health inspectors for specific disinfectants that can be used or refer to the disinfection chart.
Cleaning and disinfecting chemicals provided for client use should be properly labeled with name of the product and directions for use. Products must be approved for use in Canada and have a drug identification number or natural product number.
Garbage receptacles should be provided in each tanning room.
Used towels, robes, and linens must be laundered after each client.
Washrooms must be maintained in clean condition and supplied with liquid soap and single use towels.

27. Protect Your Clients’ Health
Garbage receptacles should be provided in each tanning room
Used towels, robes and linens must be laundered after each client
Washrooms must be maintained in clean condition and supplied with liquid soap and single use towels
In order to protect the client’s health, it is important that clients’ skin is free of cuts, wounds, irritations, and rashes to reduce the risk of infection.
Protective eyewear is required. Single use eyewear is highly recommended.
Reusable protective eye wear must be cleaned and then disinfected using an intermediate level disinfectant after each client. Contact your public health inspectors for specific disinfectants that can be used or refer to the disinfection chart.
Cleaning and disinfecting chemicals provided for client use should be properly labeled with name of the product and directions for use. Products must be approved for use in Canada and have a drug identification number or natural product number.
Garbage receptacles should be provided in each tanning room.
Used towels, robes, and linens must be laundered after each client.
Washrooms must be maintained in clean condition and supplied with liquid soap and single use towels.

28. Health Inspections
Side of Bed: all required labels should be on beds and throughout tanning salon
Tanning Beds: Must be cleaned/disinfected after each client to prevent infections such as HIV and hepatitis
Pillow Area: All pillows/towels should be made of easily washable surface and cleaned or laundered after each use
Floor: Should be made of easily washable surface, cleaned daily, and be in good repair
Chairs: Any surface that bare skin may have touched should be cleaned and disinfected
Garbage: Should be provided in each tanning room
Squirt Bottle: Cleaning/disinfecting chemicals provided for client use should be properly labeled with the name of product & directions for use
Towel Dispensers: Single-use towels recommended for cleaning and disinfecting purposes

29. Ultraviolet Rays (UVR) and Skin Cancer
Over exposure to Ultraviolet Rays (UVR) can cause skin cancer
Most skin cancer is preventable
Earlier in this course we discussed that exposure to UVR can cause skin cancer. The following slides will discuss the effects of UVR on our skin, what skin cancer can look like and skin reactions to UVR.

30. UVR and Skin UVB Rays: Penetrate outer skin layer
Main cause of sunburn
Any tan or change in skin colour is sign of skin damage (“there is no such thing as a healthy tan”)
UVA Rays:
Go deeper into skin
Can cause permanent damage to skin’s collagen and elastin
This type of damage causes aging skin (including wrinkles, saggy skin and sun spots)
May cause skin cancer (three most common types are: melanoma, basal cell skin cancer and squamous cell skin cancer
There are two types of UV light that penetrate the skin: UVA rays and UVB rays.
UVB rays penetrate the outer layer of the skin. These rays are the main cause of sunburn. Typical signs of sunburn include redness, burning and stinging. Any tan or change in skin colour is a sign of skin damage. The reality is there is no such thing as a safe or healthy tan. A “base tan” provides the skin with an SPF of only 2-4. This give little to no protection against sunburn.
UVA rays go deeper into the skin. These rays can cause permanent damage to the skin’s collagen and elastin. These proteins are responsible for the skin’s structure. This type of damage causes early aging of the skin which includes: wrinkles, saggy skin, and sun spots. UVA rays also cause skin cancer.
Within hours of exposing your skin to the sun or to tanning beds, new skin begins to replace the damaged skin. This is where normal skin cells can change into cancer cells.
The three most common skin cancers are: melanoma, basal cell skin cancer, and squamous cell skin cancer. Each of these refers to the type of skin cell from which it forms.

31. Melanoma Rates of melanoma are increasing in Ontario
Can be cured if found early
Can spread to other parts of the body and cause death
Fourth most common form of cancer in Canadians 15 to 49 years of age
Melanoma is a less common but highly dangerous form of skin cancer. The rates of melanoma are increasing in Ontario. In 2013, there was an estimated 2,950 new cases of melanoma in Ontario.
When melanoma is found early it can be cured. If melanoma is not treated, it can spread deeper into the skin layers. Melanoma can spread to other parts of the body when it reaches the blood and lymph nodes. Once melanoma spreads, it often causes death.
Melanoma is the fourth most common type of cancer diagnosed in Canadians aged 15 to 49.
About 65 percent of melanomas are caused from being exposed to UV rays. 90 percent of melanoma victims are Caucasian.

32. Melanoma Canadian Dermatology Association (2014).
It is a good idea to recommend regular skin checks to your clients. They can use the ABCDE of malignant melanoma to determine if their moles are a concern.
A: Asymmetry (the shape on one side is different than the other side)
B: Border (the border is irregular)
C: Colour (there are colour variations within the lesion)
D: Diameter (it is more than 6 millimetres long)
E: Evolution (the colour, size, shape or feel changes)
Canadian Dermatology Association (2014).
Modified with permission

33. Basal Cell Skin Cancer
Basal cell skin cancer is the most common form of skin cancer in Canada. It is also the least dangerous, but must be treated or it will continue to grow.
Early warning signs:
Reddish bump with a pearly border
Bleeds, crusts over and then comes back
Does not heal within four weeks
Often on the upper body or legs, feet, arms, and hands
Basal cell skin cancer is the most common form of skin cancer in Canada.
This type of skin cancer is the least dangerous but it must be treated since it will continue to grow. It will invade and destroy surrounding skin tissue and can eventually cause scars that disfigure the body.
Basal cell skin cancers usually appear on UV exposed areas. They most commonly appear on the face and neck, but also on the trunk, arms, and legs. The appearance of this type of skin cancer can vary.
The early warning signs of basal cell skin cancer are:
A firm, flesh-coloured or slightly reddish bump
A sore or growth that bleeds, crusts over and then comes back
Any sore that does not heal within four weeks
And a small, red scaling patch seen most often on the upper body or legs, feet, arms, and hands

34. Basal Cell Skin Cancer
Fair-skinned people with blond hair or red hair and skin that usually sunburns are most at risk from this form of skin cancer.
Basal cell skin cancer is most common in:
Men over 50 years of age
People who have already had one basal cell skin cancer
Organ transplant patients whose immune systems are weak
Fair-skinned people with blond hair or red hair and skin that usually sunburns are most at risk.
Although this cancer is now seen in teenagers and people in their early twenties, it is most common in:
Men over 50 years of age
People who have already had one basal cell skin cancer
And organ transplant patients whose immune systems are weak

35. Squamous Cell Skin Cancer
Squamous cell skin cancer is the second most common form of skin cancer in Canada. It can grow quickly over a period of a few weeks, and can spread to other areas of the body. It often appears on the head, neck, arms, and the back of the hands and legs.
Early warning signs:
Thick, red, scaly bumps or growths
Open sore or crusted skin
Grows quickly
Squamous cell skin cancer is the second most common form of skin cancer in Canada.
It must be treated because the lesion may continue to grow in size. It can damage the tissue around it and can spread to other areas of the body.
Squamous cell skin cancers appear as thick, red, scaly bumps or wart-like growths. They may look like an open sore or crusted skin.
This type of skin cancer may grow quickly over a period of a few weeks. It appears on the head, neck, arms and the back of the hands and legs, which are usually exposed to the sun. Check for this cancer on the ear and lips since the cancer can be more aggressive on those areas.
Early warning signs:
Thick, red, scaly bumps or growths
Open sore or crusted skin
Grows quickly

36. Photoaging
Photoaging happens when the skin begins to show early signs of aging due to UV exposure.
Photoaging signs include:
Wrinkles
Frown lines
Spider veins
Freckles, age spots or uneven skin colour
Stretched lips
Skin that looks like leather
Skin that sags
Photoaging happens when the skin begins to show early signs of aging. It is caused by repeated exposure to UVA and UVB rays from the sun and/or tanning beds.
Photoaging is different than normal aging because the UV rays change the normal structure of the skin. It appears on parts of the body that are regularly exposed to UV light such as the face, neck, and back of the hands. Photoaging includes wrinkles, spider veins, freckles, stretched skin, and leathery skin.

37. Skin Reactions
Skin reactions include ‘phototoxicity’ and ‘photoallergy.’
These can be caused by a pre- existing allergy to UV rays reacting with:
Medications
Foods
Skin care products
Lotions
Skin reactions include phototoxicity and photoallergy.
These can be caused by UVA and/or UVB rays reacting with:
Medications
Foods
Skin care products
Lotions

38. Photosensitivity
UV rays can trigger a photosensitivity reaction such as an itchy rash or hives.
UVA and UVB rays can trigger a photosensitivity reaction. People who suffer this type of reaction may get an itchy rash. Hives are a type of photosensitivity reaction which are large, itchy welts or red bumps. They can start after only a few minutes of being exposed to UV rays. Hives can last for minutes or hours.
Sometimes people who have a severe reaction may also get headaches, have trouble breathing, feel dizzy and weak or be sick to their stomach.

39. Photosensitivity Hives: Are large, itchy welts or red bumps
Can start after only a few minutes of being exposed to UV rays
Can last for minutes or hours
Sometimes, people who have a severe reaction may:
Get headaches
Have trouble breathing
Feel dizzy and weak or be sick to their stomach
UVA and UVB rays can trigger a photosensitivity reaction. People who suffer this type of reaction may get an itchy rash. Hives are a type of photosensitivity reaction which are large, itchy welts or red bumps. They can start after only a few minutes of being exposed to UV rays. Hives can last for minutes or hours.
Sometimes people who have a severe reaction may also get headaches, have trouble breathing, feel dizzy and weak or be sick to their stomach.

40. Phototoxic Reactions
A phototoxic reaction can appear a few hours after UV exposure.
Phototoxic reactions can:
Cause pain, redness and swelling
Are similar to a sunburn
Only happen when the person has taken certain drugs
People with these reactions may also have a brown or blue-gray mark in areas of the skin that have been exposed to UV rays.
Phototoxic reactions only happen on areas of the skin that have been exposed to UV rays. This can appear a few hours after exposure. People may have this reaction even if they are exposed for a short period of time.
Phototoxic reactions can cause pain, redness and swelling. These reactions are similar to a sunburn, but they only happen when the person has taken certain drugs (e.g. antibiotics).
Sometimes people with these reactions might also have a brown or blue-gray mark in areas of the skin that have been exposed to UV rays.

41. Photoallergic Reactions
This is an allergic reaction that causes the skin to become red when exposed to UV rays.
This type of reaction happens due to a pre-existing allergy, or when a person has or has used:
Skin care products
Antibiotics
New tattoos
Certain foods, including artificial sweeteners
Photoallergic reactions cause the skin to become red. The skin might start crusting and may also blister. There might be spots that look like hives.
This type of reaction is usually caused by:
Skin care products
Antibiotics
New tattoos
Certain foods, including artificial sweeteners
Photoallergic reactions happen when the person has used these products and are then exposed to UV rays. The reaction usually happens hours after exposure.

42. Erythema (sunburn)
Erythema is a medical term to describe redness and swelling of the skin. Sunburns are caused by UV rays (mostly UVB rays) and symptoms may develop hours after exposure.
Erythema is a medical term to describe redness and swelling of the skin. Sunburn is mostly caused by UVB rays. Symptoms may develop hours after exposure.
Sunburn can range from mild to severe and can occur on a small or large area of the body, depending on which areas were exposed to UV rays.

43. Preventing UV Reactions
At the start of each new tanning session, it’s a good idea to remind clients:
About the risk of a reaction to UV rays
To check the drug labels or speak to a pharmacist when using a new product
If a client complains of rashes or itching during or after a tanning session, tell them to see a doctor.
At the start of each new tanning session, it is a good idea to remind your clients about the risk of a reaction to UV rays.
Remind clients to check the drug labels or speak to a pharmacist when using a new product. Even medications and creams bought off the shelf may cause a reaction.
If a client complains of rashes or itching during or after a tanning session, tell them to see a doctor.

44. Skin Types Genetics and reaction to sun exposure determine skin type.
Determining a client’s skin type will help you understand their risk for skin damage.
TYPE 1: Very pale skin, blond or red hair, blue or green eyes. Burns and never tans. May have many freckles or moles.
TYPE 2: Fair skin, blond or red hair, light coloured eyes. Usually burns, seldom tans.
TYPE 3: Medium-skinned Caucasians who sometimes burns, sometimes tans.
TYPE 4: Darker-skinned Caucasians or Mediterraneans. Tans easily, rarely burns.
TYPE 5: Middle eastern skin tone. Tans easily, seldom burns.
TYPE 6: Dark brown/black skin. Doesn’t burn, but can still suffer from skin and eye damage from exposure to the sun. 2 1 6
The Fitzpatrick Skin Type system is used to determine the skin’s response to UV exposure. Genetics and reaction to sun exposure determine skin type. Skin types range from very fair (Type 1) to very dark (Type 6). Finding out a client’s skin type will help you understand their risk for skin damage.
Most experts agree that those with Type 1 skin should NOT use tanning beds. Their skin is easily damaged by UV exposure and they do not tan.
Scroll over the image to learn more about skin type. When assessing a client’s skin type, remember that it can be difficult to determine skin type by looks due to hair dyes, coloured contacts, and self tanning lotions or tans. 5 4 3

45. Determine Your Skin Type
Part II: Reaction to Extended Sun Exposure
How does your skin respond to the sun?
0. Always burns, blisters and peels
Often burns, blisters and peels
Burns moderately
Burns rarely, if at all
Never burns
Does your skin tan?
0. Never -- I always burn
Seldom
Sometimes
Often
Always
How deeply do you tan?
0. Not at all or very little
Lightly
Moderately
Deeply
My skin is naturally dark
How sensitive is your face to the sun?
0. Very sensitive
Sensitive
Normal
Resistant
Very resistant/Never had a problem
Total score for reaction to sun exposure: _______
Your Fitzpatrick Skin Type __________________
Part I: Genetics 
Your eye colour is:
0. Light blue, light gray or light green
Blue, gray or green
Hazel or light brown
Dark brown
Brownish black
Your natural hair colour is:
0. Red or light blonde
Blonde
Dark blonde or light brown
Black
Your natural skin colour (before sun exposure) is:
0. Ivory white
Fair or pale
Fair to beige, with golden undertone
Olive or light brown
Dark brown or black
How many freckles do you have on unexposed areas of your skin?
0. Many
Several
A few
Very few
None
Total score for genetic disposition: _______
Combine total score from Parts 1 and 2 to determine your Skin Type Score:
0-7: Type 1
8-16: Type 2
17-25: Type 3
26-30: Type 4
30+: Type 5-6
Combine total score for genetic disposition with total score for reaction to sun exposure to determine your Fitzpatrick Skin Type
Skin Type Score
0-7: Type I
8-16: Type II
17-25: Type III
26-30: Type IV
30+: Type V-VI

46. For Additional Information
Haliburton, Kawartha,
Pine Ridge District Health Unit
Call toll-free at
Visit
If you have any questions or wish to register your salon. Please contact your local health unit.