Do you know your Fitzpatrick skin type? While you may not be familiar with the term, chances are you’re pretty in tune with the concept of the Fitzpatrick Skin Phototype. The scale classifies a person’s skin tone based on how likely they are to burn. With Skin Cancer Awareness Month upon us and summertime just around the corner, it’s time to learn how you measure up and how dermatologists use a patient’s score to help determine everything from skincare regimens to sun-prevention methods.
What Is the Fitzpatrick Skin Phototype?
In 1975, Thomas B. Fitzpatrick, MD, a dermatologist and chairman of the department of dermatology at Harvard Medical School, was experimenting with a treatment for psoriasis that involved exposing test subjects to UVA rays. Dr. Fitzpatrick (a.k.a. the “father of modern academic dermatology”) initially used hair and eye color to determine the recommended amount of UVA exposure to give participants (all of whom were white). But when dark-haired, brown-eyed patients ended up sunburned, Dr. Fitzpatrick realized that he needed to base his treatment on more than just hair or eye color. Instead, he needed to consider how the subjects’ skin responded to the sun.
He began asking patients to describe what happened to their skin after sun exposure when they didn’t have any sun protection. Based on their answers, he created four categories to classify patients’ tendencies to burn (erythema) versus tan (induce pigmentation) — providing an estimation of the amount of melanin present in skin cells. It didn’t take long for the phototype to be widely adopted for clinical use as a useful predictor of skin cancer. A decade later, two more categories were added to encompass a larger spectrum of skin tones.
How to Determine Your Fitzpatrick Skin Type
Consulting a board certified dermatologist is the most effective and accurate way to determine your Fitzpatrick skin type, especially for those with darker skin tones. While a sunburn may show up as redness on pale skin, it may manifest as tenderness on darker skin. Similarly, those with paler skin tend to associate ‘tanning’ with skin darkening, but those with darker skin don’t necessarily think of it the same way.
Whether it is you or a dermatologist attempting to determine your classification, below are the characteristics associated with each Fitzpatrick skin type (and a few celebs that fit the bill):
- Light (pale white) skin
- Light blue or green eyes
- Red or blonde hair
- Always burns, never tans
- e.g. Emma Stone and Prince Harry
- White (fair) skin
- Blue or green eyes
- Blonde hair
- Burns easily, tans poorly
- e.g. Gwyneth Paltrow and Justin Timberlake
- Medium (white to olive) skin
- Hazel or light brown eyes
- Dark blonde or light brown hair
- Burns mildly, tan gradually
- e.g. Kendall Jenner and Nick Jonas
- Olive (moderate brown) skin
- Dark brown eyes
- Dark brown hair
- Burns minimally, tans easily
- e.g. Sofia Vergara and Mario Lopez
- Brown (dark brown) skin
- Dark brown to black eyes
- Dark brown to black hair
- Tans easily, rarely burns
- e.g. Beyonce and John Legend
- Black (very dark brown to black) skin
- Brown/black eyes
- Black hair
- Never burns, tans easily
- e.g. Lupita Nyong’o and Daniel Kaluuya
How Dermatologists Use the Fitzpatrick Scale
“It is very much an inherent part of the dermatologic physical exam,” says Nikhil Dhingra, MD, a board certified dermatologist at Spring Street Dermatology in New York City, of the Fitzpatrick scale. As such, dermatologists use the diagnostic tool in several ways:
- To Assess Skin Cancer Risk: “Type I skin, for example, is the fairest and at the highest risk for most skin cancers, while a type IV or VI might come in with a rare subtype of melanoma in locations like under the foot,” Dr. Dhingra explains.
- To Determine In-Office Procedures: “Many laser treatments are totally inappropriate and unsafe once you enter the territory of skin types III to VI,” he says. “This dichotomy highlights the imbalance in the technologies available on the market when it comes to treating a diverse patient base.”
- To Evaluate Medical Conditions: “Understanding skin types and what a rash or medical condition can look like when shaded with pigment is another critical use of the Fitzpatrick system for most dermatologists,” Dr. Dhingra shares. As he explains it, a rash that looks one way on a type VI patient could look very different than it would on a type I.
More than just a collection of color swatches, the Fitzpatrick scale helps to inform proper patient care. “It’s important to recognize these differences, so your patients get the correct diagnosis and treatment,” Dr. Dhingra says.
The Relationship Between Fitzpatrick Types and Skincare
It’s important to see the Fitzpatrick scale as a spectrum that can inform how the skin generally behaves. “The fairest of skin types is going to be high-risk for skin cancers and prone to sunburns, freckling, and conditions like rosacea,” Dr. Dhingra says. “Type VI skin patients, on the other hand, are going to be more prone to issues of pigmentation, while patients in the middle groups will have varying features of each extreme.” With that in mind, here’s how the phototype can inform your professional and at-home skincare routines:
Morgan Rabach, MD, a board certified dermatologist and co-founder of LM Medical in Manhattan, says she considers a patient's skin concern (think: aging or oiliness) and Fitzpatrick score when making product recommendations. “Types I to III often have red tones to their skin and may benefit more from ingredients like sulfur or niacinamide to reduce redness,” she says. “Type III to VI have more chances of hyperpigmentation, so certain alpha and beta hydroxy acids and bleaching agents like hydroquinone may be helpful.”
There are, however, a few active ingredients that almost all her patients can benefit from. She is a fan of antioxidants and sunscreen in the morning and retinol and more nourishing moisturizers at night. Dr. Dhingra agrees that antioxidants like vitamin C have a universal appeal. “My recommendations include the Isdin Isdinceuticals Flavo-C Serum and La Roche Posay Redermic C Vitamin C Lotion,” he says.
Your Fitzpatrick score is critical when considering any professional cosmetic treatment or procedure. “It’s important for patients to seek out a board certified dermatologist for proper treatment, especially if you belong to a Fitzpatrick III to VI category,” Dr. Dhingra says. “You have a higher risk of burning and pigmentary issues, if an inappropriate treatment is done in the wrong hands.”
While it is important to consult with a board certified dermatologist before undergoing any cosmetic procedure, there are few rules that tend to hold true. “Fitzpatrick skin types I to III are the ideal skin types for laser hair removal,” Dr. Rabach shares. “The higher melanin content in skin types above a III creates a risk of the laser changing the skin color and causing blistering.” Similarly, she recommends skin types IV and above stay away from microdermabrasion and chemical peels. “They are more likely to cause hyperpigmentation,” she says.
People with less melanin (types I, II, and III) are more susceptible to the aging effects of UV rays — though sun damage affects the entire scale to some extent. Dr. Dhingra recommends all patients use a daily moisturizer with an SPF of 30 to 45 (yes, that’s even meant to be used on days you are working from home or cooped up inside!). He likes the EltaMD UV Clear Tinted Broad Spectrum SPF 46 for types III to VI skin, and the non-tinted EltaMD UV Daily Broad-Spectrum SPF 40 for types I and II.
Generally speaking, those on the fairer end of the spectrum need to be extra cautious when venturing out into the sun: “Think UV clothing, hats, and umbrellas,” he suggests, adding that those on the darker end of the spectrum — namely, types IV to VI skin — should be mindful of sunlight exacerbating preexisting pigmentary concerns (i.e. melasma and hyperpigmentation from acne).
Skin Cancer Risk
Research has shown that the lower your Fitzpatrick score, the higher your risk of skin cancer. But that doesn’t mean types IV through VI are in the clear. “All skin types can get skin cancer,” Dr. Rabach warns. “Therefore, all skin types should see a board certified dermatologist for skin checks.”
While analyzing your Fitzpatrick skin score online can be useful and fun (think: Am I a Sofia or a Beyoncé?), nothing beats the advice of a board certified dermatologist — particularly if you fall into categories III and above, as more than half the United States population does.
“Having trained in New York City — and as a type IV skin type myself — I’m particularly comfortable having preselected a list of products and treatments for our skin of color community,” Dr. Dhingra says. “This can mean recommending a certain acne cream that I also find helpful for also combatting the resultant hyperpigmentation. Lighter skin types, conversely, are often betrayed by their fairer skin when it comes to things like rosiness of the cheeks, so I may err for a milder routine as not to flare up the redness.”
Needless to say, there is a lot of nuance to the skin that goes far beyond the Fitzpatrick scale. Before you start surfing celebrity social media accounts in search of your next skincare routine, make an appointment for your yearly skin cancer screening and, while you’re there, ask your dermatologist to determine your Fitzpatrick score.
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