Tanorexia: The psychodermatology of compulsive tanning

Tanorexia, commonly described as tanning dependence or tanning addiction, refers to a compulsive pattern of UV-seeking behavior in which individuals continue to tan despite awareness of or exposure to significant dermatologic and systemic risks. Rather than representing a simple aesthetic preference, tanorexia is increasingly understood as a psychodermatologic and biopsychosocial phenomenon involving reward-related neurobiologic pathways, body-image concerns, genetic susceptibility, and psychiatric comorbidities. Indoor tanning is particularly concerning, because UV-emitting tanning devices are established carcinogenic exposures, and early initiation of sunbed use is associated with a substantially increased risk of melanoma. Emerging evidence also suggests that excessive tanning shares clinical and behavioral features with substance use and behavioral addictive disorders, including craving, impaired control, reinforcement, and continued use despite harm. For dermatologists, compulsive tanning should, therefore, be approached not only as a risk factor for photoaging and skin cancer, but also as a potential marker of underlying psychological vulnerability. Screening and assessment tools, including the modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (mDSM-IV-TR) criteria, the modified CAGE (mCAGE; Cut down, Annoyed, Guilty; Eye-opener) questionnaire, the Structured Interview for Tanning Abuse and Dependence, and the Behavioral Addiction Indoor Tanning Screener, may help identify at-risk individuals and guide appropriate counseling or referral. This review evaluates the etiology, clinical manifestations, screening approaches, dermatologic consequences, and management implications of tanorexia, with an emphasis on its relevance to dermatologic practice and public health prevention.