WHAT ARE FITZPATRICK SKIN TYPES?
When participants are recruited for clinical dermatology research, the Fitzpatrick Skin Phototype Classification (FSPC) is the most commonly used method to stratify patients and identify differential skin responses. First described in 1972 by Dr. Thomas B. Fitzpatrick, the FSPC helps researchers quickly understand the skin’s sensitivity to light and propensity for tanning or burning . However, this is just one metric used to classify skin type and is not a definitive guide for skin cancer risk [2,3]. Below, we review the different FSPC phototypes and discuss clinical findings for commonly used dermatological interventions across skin types.
TYPES I, II, AND III
Types I-III are the most common skin types in the U.S. and due to the higher propensity for skin cancer, have guided federal recommendations for daily sunscreen use and limited sun exposure . On the positive, these skin types are less prone to hyperpigmentation, either over time or in response to skin barrier damage and inflammation . However, the generally thinner epidermis means that the skin is more fragile and prone to loss of elasticity over time .
TYPES IV, V, and VI
Typically, darker skinned individuals identify as Fitzpatrick types IV-VI and are less prone to sunburns. However, the effects of photoaging in melanated skin are still extremely relevant as collagen, elastin, and epidermal thickness all still decrease with time and UV exposure . Additionally, while skin cancer is less common in these types, the prognoses and survival rates with a skin cancer diagnosis are poorer . On the positive, darker skin types naturally have thicker dermis and epidermis skin layers, promoting resistance to wrinkles and loss of elasticity .
WHY IT MATTERS?
While self-reported race and melanin levels are decent predictors of Fitzpatrick skin types, less obvious underlying genetics also contribute to each person’s sunburn risk as evaluated by a physical phototest to UV exposure [9,10]. In other words, more melanin doesn’t always mean more sunburn protection. It’s best to err on the side of caution and use mineral sunscreen daily no matter which skin type you have. Thankfully, many well studied dermatological interventions retain efficacy across the FSPC scale. These include retinol and benzoyl peroxide for acne treatments , laser resurfacing , and microneedling . Advancements in laser hair removal technology have also made it possible for most skin types to receive this treatment however different lasers are needed to detect hair on light or dark skin backgrounds . Overall, The FSPC in combination with some variation of a physical UV response test will help accurately understand response to interventions in clinical studies [15,16]. However, it’s clear that recruitment and classification of participants with type IV-VI darker skin should take higher priority as comparative research between lighter and darker skin response is still limited in scope.
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