Skin phototype; types, reason, and references

Skin phototype is considered to be mainly related to the pigmentation of the skin and the ratio of eumelanin (brown pigments) to pheomelanin (yellow, red pigments) that it contains. 

Everyone has both pigments but in various proportions and it is the variability of these pigments that determines our skin color.

Caucasian skins express pheomelanin to a greater extent while black, dark, and mixed-race skins express eumelanin to a greater extent.

It is now known that these brown pigments have the ability to absorb the sun’s UV rays, which partially protects darker skin from its harmful effects.

Their photoprotective character leads to the following conclusion: the more eumelanin the skin contains, the darker it will be and the more naturally it will be protected from the sun.

However, it is important to remember that whatever the skin tone, this so-called natural protection is insufficient. The skin phototype, therefore, helps to predict possible sun damage to the skin. The most benign are dehydration or tightness and the most dangerous may be the appearance of skin cancer.

The skin phototype classification system was developed by Thomas B. Fitzpatrick in 1975. It is based on the sensitivity of the skin to sunburn and the ability of the skin to tan. The skin phototype can predict skin cancer risk.

Phototypes range from I to VI, and are primarily related to skin color. Skin color is determined by the amount of melanin in the skin, which is controlled by genetics. Melanin is the main line of natural protection for the skin against the damaging ultraviolet rays of the sun.

Although melanin provides protection from UV radiation, too much melanin can prevent the beneficial absorption of UV light for vitamin D synthesis.

Thus, there is a range of skin types around the world that are related to the intensity of sunlight in the ancestral environment. Melanin is a broad term for a group of natural pigments found in most organisms.

Reasons for skin phototype

Skin phototypes can be measured objectively using a skin-analyzing instrument. The skin phototype scale has been used extensively in population-based and case-control studies of skin cancer. It can be used for self-assessment of sun sensitivity through a questionnaire.

Skin phototype can be used in the field of dermatology to estimate the minimal erythema dose (MED) for initial dose phototherapy. Phototherapy is a treatment used for some skin conditions such as psoriasis, eczema, and jaundice in newborns.

Skin types IV-VI are at risk of hyperpigmentation or hypopigmentation with laser hair removal and laser resurfacing. They may also have pigmentation changes with chemical peeling.

The Fitzpatrick skin type classification system is outdated and subjective.

Skin phototype

Although the model is still used, it may not accurately reflect your risk of developing skin cancer. It’s possible that you will not meet all the characteristics of any one Fitzpatrick skin type.

A dermatologist may use this classification system, along with your history and other methods, to determine the appropriate settings for laser therapy.

The skin phototype scale began with only three phototypes, applicable to lighter skin. The current Fitzpatrick skin type classification has six types ranging from extremely fair (Type I) to very dark (type VI).

Types of skin phototypes

The phototypes are as follows:

Type I-Ivory white in color, Very pale, sometimes translucent, milky white or porcelain tone, easily blushes due to nervous tension, often with many freckles, burns easily, never tans. It is caused by the low content of melanin in this zone. This skin type is typical for Europeans.

Type II-White, burns easily, tans minimally with difficulty, burns moderately, tans moderately, the skin tans poorly and the tan does not last.

Type III-White, burns moderately, tans moderately.

Type IV-Beige or olive, burns minimally, tans moderately and easily.  The phototype is typical for residents of Latin America, Asia, the Caucasus, and the Mediterranean.

Type V- Moderately brown, rarely burns, tans profusely. dark, dark brown with a yellowish tint; no freckles. The phototype is found mainly in residents of Southeast Asia and many Latin American countries.

Type VI-Dark brown, bluish-black or black, never burns, tans profusely, The phototype is inherent in people from the African continent and Australian aborigines.

Traits such as hair color, eye color, and skin reaction to sun exposure are taken into account when determining skin phototype

Conclusion on skin phototypes

Fitzpatrick skin phototypes are typically used to determine the correct settings for phototherapy for certain skin conditions.

Phototypes may also be used to determine settings for cosmetic laser skin treatments and can help dermatologists and skin care professionals avoid damage to the skin, which may result in photoaging and pigmentation changes.

There are limitations with the scale, especially for People of Color, who may not fit neatly into one of the six types.

The limitations of medical professionals who rely on the scale have led to a limitation of education around skin cancer risk in People of Color, which may contribute to diagnosing skin cancer in later stages.

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Prota, G. (1997). Pigment cell research: what directions? Pigment Cell Res. 10511