Review of Fitzpatrick skin types

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 Editor: Richard Usatine

Author(s): Rachel Manci, Richard Usatine
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Review of Fitzpatrick Skin Types[edit]

The Fitzpatrick skin type system was developed in 1975 by Dr. Thomas Fitzpatrick. It was originally used as a basis to determine the proper ultraviolet A dose for the newly developed photochemotherapy treatment of severe generalized psoriasis in patients with white skin. [1]


Today, the system has been expanded to also include those with brown and black skin. The system characterizes skin types by visible color and the tendency to tan and/or burn in response to ultraviolet light exposure, which is greatly determined by the amount of melanin pigmentation within the skin. [2] There are six Fitzpatrick skin types today, ranked on a scale of 1 to 6, with one being the lightest skin tone and six being the darkest skin tone (Table 1). This system is widely used to evaluate skin cancer risk. [3]


Table 1. Fitzpatrick skin types


Fitzpatrick skin typing is easy to use and widely accepted, but has several limitations. Most notably, this system has incited criticism due to its subjective nature. [3] Trained dermatologists are more accurate in their self-report of Fitzpatrick skin type compared to the general population, but high variability still exists. [3] In an attempt to negate this subjectivity, several objective measures have been developed. These objective measures include pigment protection factor (which utilizes diffuse remittance spectroscopy), spectrophotometry, and colorimetric analysis.


Those with lighter skin phenotypes have less melanin pigmentation and are more likely to burn from ultraviolet light exposure. Therefore, these individuals more easily and quickly accumulate a mutational burden in the skin, which increases susceptibility to cutaneous malignancies. [3] Patients with lighter skin, specifically those with Fitzpatrick skin types 1-3, are also more likely to experience skin sensitivity in response to the application of skincare products. [4]


In contrast, those of darker skin phenotypes have a greater melanin concentration and are better able to withstand ultraviolet light exposure. These individuals are more likely to tan than burn, and are overall less likely to develop cutaneous malignancies induced by ultraviolet light. [3] Additionally, those with darker skin types are more likely to develop post-inflammatory hyperpigmentation. [5]


It is the goal of this full chapter to describe and provide examples of dermoscopy in skin of color (Fitzpatrick skin types 4-6)

Links to additional chapters on Skin of Color[edit]

References[edit]

  1. Fitzpatrick: The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988;124:869-71. PMID: 3377516. DOI.
  2. Sharma & Patel: Laser Fitzpatrick Skin Type Recommendations. ' 2021;. PMID: 32491558.
  3. 3.03.13.23.33.4 Holm-Schou et al.: Skin cancer phototype: A new classification directly related to skin cancer and based on responses from 2869 individuals. Photodermatol Photoimmunol Photomed 2019;35:116-123. PMID: 30312498. DOI.
  4. Dubin et al.: Objective Evaluation of Skin Sensitivity Across Fitzpatrick Skin Types. J Drugs Dermatol 2020;19:699-701. PMID: 32726552. DOI.
  5. Castillo & Keri: Chemical peels in the treatment of acne: patient selection and perspectives. Clin Cosmet Investig Dermatol 2018;11:365-372. PMID: 30038512. DOI.