When discussing skincare, different approaches and treatments are often categorized by factors such as age or natural oil levels. One common way of grouping is by race or ethnicity, with certain skin conditions being more prevalent in Black and Latinx populations, while white individuals are at a higher risk of skin cancer. However, race and ethnicity only tell part of the story, as individuals within these groups can have vastly different skin, hair, and eye colors, requiring different skincare needs.
To address this, the Fitzpatrick Skin Type Scale was developed by Thomas B. Fitzpatrick in 1972. This classification system categorizes skin based on its tendency to burn or tan, rather than by the individual’s race or ethnicity. In this article, board-certified dermatologist Elyse M. Love, MD, explains the different skin types within the Fitzpatrick Scale and how understanding your skin type can help you assess your risk for skin cancer, photo-aging, and more.
What Is the Fitzpatrick Skin Type Scale?
The Fitzpatrick Skin Type Scale is a classification system that is used to categorize the diverse range of skin colors and tones found among people. It assesses an individual’s response to sunlight and creates boundaries that are typically associated with skin color, eye color, and hair color. The skin types are categorized based on how easily they burn or tan when exposed to sunlight. This response is a useful predictor of an individual’s risk for skin cancer, cosmetic concerns, and potential complications when undergoing laser treatments.
What Are the Fitzpatrick Skin Types?
There are six Fitzpatrick Skin Types.
Fitzpatrick Skin Type I
Individuals who are classified as Fitzpatrick Skin Type I are characterized by their inability to form a tan when exposed to sunlight, and their tendency to always burn instead. This skin type is typically associated with people who have red or blonde hair, and blue eyes.
Fitzpatrick Skin Type II
Fitzpatrick Skin Type II refers to individuals who have fair skin that burns easily and tans with difficulty. They may observe a tan on their skin once the sunburn fades, but they are unlikely to tan without a preceding sunburn. This group of people has fair skin.
Fitzpatrick Skin Type III
Fitzpatrick Skin Type III refers to individuals who have skin that tans easily, but they may also develop mild sunburns depending on the intensity and duration of sun exposure. This skin type encompasses a broad group of people, including many of Italian, Greek, Spanish, Cuban, Latin, and Asian descent. Additionally, many mixed-race individuals may also belong to this category.
Fitzpatrick Skin Type IV
Fitzpatrick Skin Type IV refers to individuals who rarely burn and instead tan easily. This skin type also includes a diverse range of races and ethnicities, similar to Fitzpatrick Skin Type III.
Fitzpatrick Skin Type V
Fitzpatrick Skin Type V refers to individuals who rarely experience sunburns and tan very easily. This skin type is commonly found in people of South Asian or African descent. However, it’s important to remember that skin type is defined by the response to the sun, not race. People with Fitzpatrick Skin Type V tend to have brown eyes and naturally dark hair.
Fitzpatrick Skin Type VI
Fitzpatrick Skin Type VI refers to individuals who never experience sunburns and tan very easily. This skin type is often found in people of African descent, although it can be present in other ethnicities as well.
Does the Fitzpatrick Skin Type Scale Have Relevance?
As you may have noticed from the descriptions, skin type classification based on the Fitzpatrick Skin Type Scale is not limited to any specific race or ethnicity. This scale provides a way to objectively assess the risk of skin cancer and adverse reactions to laser treatments without the influence of cultural context or biases related to race and ethnicity.
For instance, people of Asian descent can fall under different skin types, such as FST IV or FST V, which have different skin cancer risks. Similarly, individuals who identify as Black may belong to FST IV, V, or VI, depending on their response to sunlight. FST III has a significantly higher risk of laser complications than FST II, despite having a similar skin tone in the winter.
In clinical practice, I assess a patient’s Fitzpatrick Skin Type before determining the appropriate laser settings. Higher skin types are more prone to post-inflammatory hyperpigmentation, laser burns, and scarring. Lower skin types may be more likely to develop fine lines, wrinkles, redness, and sunspots as they age. Meanwhile, higher skin types are more likely to have hyperpigmentation.
Also Read: 10 Skin Care Mistakes You’re Making That Are Damaging Your Skin
What Your Skin Type Indicates
The following are my clinical observations and expertise regarding each skin type, based on my experience in the field.
Type I
Individuals with skin type I are unable to develop a tan and therefore, they typically avoid excessive sun exposure and take extra care to protect their skin from the sun. As a result, signs of skin aging such as fine lines, wrinkles, and redness may appear later in life compared to those with FST II.
On the opposite end of the spectrum are individuals who either reject their non-tanning skin type or grew up in an environment where family members tan easily. These individuals may develop frequent sunburns, extensive signs of photo-aging, and multiple skin cancers. Due to their higher risk of skin cancer, routine skin cancer screenings are recommended yearly. Moreover, because individuals with skin type I do not tan, they can tolerate more aggressive settings for laser treatments, potentially minimizing the number of treatments needed.
Type II
Individuals with Fitzpatrick Skin Type II typically experience sunburns followed by a tan. However, multiple sunburns, especially during childhood, are a significant risk factor for skin cancer formation. These individuals also tend to develop wrinkles, sunspots, and redness due to excessive sun exposure. Regular skin cancer screenings are crucial for those with FST II, particularly if they have a history of sunburns or indoor tanning. Fortunately, individuals with FST II typically tolerate laser treatments well.
Type III
Individuals with FST III tend to tolerate sun exposure well and develop a gradual tan, but they are still susceptible to sunburns. Many people with this skin type come from coastal cities and have a long history of sun exposure. Routine yearly skin cancer screenings are recommended for FST III individuals, especially if they have a history of frequent sunburns or prolonged sun exposure. For laser treatments, the skin’s reaction may vary depending on whether it is tanned or not. Therefore, laser treatment should only be considered when the skin is not tanned.
Type IV
Individuals with this skin type have a tendency to tan easily and infrequently burn. While the risk of developing melanoma is lower than in FST I-III, non-melanoma skin cancers are still common in this skin type. Regular yearly skin cancer screenings are recommended.
It is important that laser treatments are only carried out when the skin is not tanned, and with a board-certified dermatologist who has experience treating this skin type. Although they experience sunspots and redness similar to FST III individuals, the appropriate laser and treatment parameters differ significantly between the two skin types.
Type V
Individuals with this skin type have a low tendency to develop sunburns and have an easy tanning ability. However, skin cancer, although rare, has a poor prognosis if detected late. Therefore, regular yearly skin cancer screenings are recommended. Since only certain lasers are safe for this skin type, laser treatments should only be performed by a qualified dermatologist with conservative settings. Some laser treatments may overlap with natural pigmentation and lead to unwanted outcomes such as burns, scarring, and white or dark spots. These individuals also tend to develop post-inflammatory hyperpigmentation easily and may be prone to keloids.
Type VI
Routine yearly skin cancer screenings are recommended for individuals with this skin type, despite skin cancer being rare in this group. Late detection can result in a poor prognosis, so regular checkups are crucial.
Like FST V, only a subset of lasers are suitable for this skin type due to the risk of overlap with natural pigmentation, which can cause burns, scarring, white spots, and dark spots. Post-inflammatory hyperpigmentation tends to be deeper in this skin type than in FST V. Individuals with this skin type may also be more susceptible to keloids.
The Key Takeaway
Since race and ethnicity encompass a wide range of skin tones and colors, relying on them alone is not an effective method for determining the risk of skin cancer or laser treatment complications. Instead, the Fitzpatrick Skin Type Scale offers a more objective approach for dermatologists to assess risk and establish appropriate treatment plans. By focusing on an individual’s propensity to burn or tan when exposed to the sun, rather than their racial background, the scale provides a more accurate framework for understanding an individual’s skin type and associated risks.
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Photo: Pexels/ Angela Roma
