As “dermfluencers” become a more popular source for skin-care insight on social media, the Fitzpatrick scale is gaining visibility. But, when I asked my friends in a group setting if they knew what this “skin type scale” was, only one person did, and guess what? She works for a dermatologist. Here, top derms shed light on what this classification system is exactly, and how it’s used to help patients in the office. (Note: It’s not only used in-office, and more skin-care brands are including Fitzpatrick references in their marketing when helping consumers choose the right products.)
What is the Fitzpatrick Scale?
“The Fitzpatrick scale is a pigmentation classification system that allows skin-care professionals to categorize skin shades, predisposition to sunburn, sun damage, and skin cancer risks for patients,” explains Davie, FL dermatologist Marianna Blyumin-Karasik, MD. “This is based on scientific evidence that lighter skin shades have higher UV (ultraviolet) radiation damage predisposition and darker skin tones have higher skin resilience against this damage due to their naturally higher concentration and type of melanin. Melanin absorbs UV light and oxidative stress on the skin’s surface and protects against the sun damaging rays. Interestingly, in darker-toned individuals this translates to not only lower skin cancer risks, but also more skin endurance and delayed photoaging, such as wrinkles and skin laxity.”
New York dermatologist Elaine Kung, MD says the Scale is named after Dr. Thomas B. Fitzpatrick who was a long-time professor of dermatology at Harvard Medical School (he passed away in 2004 at the age of 85). “He first classified skin types I to III based on his outdoor sunscreen study in Australia in 1972. The skin’s reactivity to the sun of fair-skinned Australians was categorized as follows: I: those who sunburn easily and do not tan at all; II: those who sunburn easily and tan with difficulty; and III: those who sunburn moderately, but can tan. Later, the Fitzpatrick skin classification was expanded to phototypes IV (medium brown), V (dark brown skin) and VI (black skin). The later two categories were more based on skin color rather than reactivity to the sun.”
What are the six different skin types on the Fitzpatrick scale?
The Fitzpatrick scale grades the shades of skin color pigmentation from skin type I to VI (light to dark). “So, skin types I and II, for example, are the palest tones, have more freckles, and are easily prone to sunburn and photoaging,” says Dr. Karasik. “If you have an olive complexion and can tan, then you are in the middle skin type III range. Meanwhile, types V and VI are the darkest, rarely sunburn and easily tan, and have slower photoaging processes.”
How do dermatologists use the Fitzpatrick Scale?
Dermatologists still often use this phototyping system as a tool to determine their patients’ best skin management, says Dr. Karasik. “At our clinic, we often apply the Fitzpatrick scale to guide us with the optimal and safer mode of cosmetic treatments, such as chemical peels, microneedling and lasers. In general, for darker individuals with higher Fitzpatrick skin types (III and above) who are more prone to post-procedural skin pigmentation due to higher melanin concentration and reactive melanogenesis, it is very critical to choose more conservative treatment options and settings. Therefore, the aesthetic procedures with minimal melanogenesis risk, or less heat induction, mechanical abrasion and inflammation, are better cosmetic options for darker Fitzpatrick skin types.”
There are some in-office treatments, however, that Dr. Karasik says are universally friendly to all skin types, including “Hydrafacial for skin clarity and radiance, the PicoWay laser to even out skin tone, and the UltraClear laser for skin resurfacing to smooth skin texture.”
Criticisms of the Fitzpatrick Scale
Dr. Kung says the main criticism of Fitzpatrick skin classification is “the subjectiveness of phototyping based on questions that doctors ask regarding a patient’s skin reactivity to sun exposure for fairer-skinned people. On the other hand, people who are Northern Asian or Middle Eastern may automatically be classified as skin type III or IV, and Latin American or Southeast Asian may automatically be classified as skin type IV or V. African Americans may automatically be classified as V or VI based on ethnicity instead of skin reactivity to sun exposure.”
“Objective methods of skin typing, such as pigment protection factor and skin color measurement, have been developed, but they require spectroscopy or colorimetric analysis, which are not readily available or feasible in a clinic,” Dr. Kung adds. “Regardless, there is much more to classifying skin than just looking at its color. Genetic background and ethnicity play an important role. The level of eumelanin versus pheomelanin not only determines skin color, but also contributes to the level of ultraviolet or environmental stress protection.”