The Fitzpatrick scale (also Fitzpatrick skin typing test; or Fitzpatrick phototyping scale) is a numerical classification schema for human skin color. It was developed in 1975 by American dermatologist Thomas B. Fitzpatrick as a way to estimate the response of different types of skin to ultraviolet (UV) light. [2] It was initially developed on the basis of skin color to measure the correct dose of UVA for PUVA therapy, and when the initial testing based only on hair and eye color resulted in too high UVA doses for some, it was altered to be based on the patient's reports of how their skin responds to the sun; it was also extended to a wider range of skin types. [3] [4] [5] The Fitzpatrick scale remains a recognized tool for dermatological research into human skin pigmentation.
The following table shows the six categories of the Fitzpatrick scale in relation to the 36 categories of the older von Luschan scale: [6] [7] [8]
von Luschan | Fitzpatrick | Monk | Characteristics | |
---|---|---|---|---|
1 | I | 1 | Always burns, never tans (palest; freckles); very light or white, "Celtic" type | |
2 | ||||
3 | ||||
4 | 2 | |||
5 | ||||
6 | ||||
7 | II | 3 | Usually burns, tans minimally (light colored but darker than pale); light or light-skinned European | |
8 | ||||
9 | 4 | |||
10 | ||||
11 | ||||
12 | ||||
13 | 5 | |||
14 | III | Sometimes mild burn, tans uniformly (golden honey or olive); light intermediate, or dark-skinned European | ||
15 | ||||
16 | 6 | |||
17 | ||||
18 | ||||
19 | ||||
20 | ||||
21 | IV | 7 | Burns minimally, always tans well (moderate brown); dark intermediate or "olive skin" | |
22 | ||||
23 | ||||
24 | 8 | |||
25 | ||||
26 | ||||
27 | ||||
28 | V | 9 | Very rarely burns, tans very easily (dark brown); dark or "brown" type | |
29 | ||||
30 | 10 | |||
31 | ||||
32 | ||||
33 | ||||
34 | ||||
35 | VI | Never burns (deeply pigmented dark brown to darkest brown); very dark or "black" type | ||
36 |
The Fitzpatrick scale is also the basis of skin color in emoji, with five modifiers according to the Fitzpatrick scale (types I and II merged).
The Fitzpatrick scale has been criticized for its Eurocentric bias and insufficient representation of global skin color diversity. [9] The scale originally was developed for classifying "white skin" in response to solar radiation, [2] and initially included only four categories focused on white skin, with "brown" and "black" skin types (V and VI) added as an afterthought. [3]
The scale's methodology, relying on self-reporting of skin color, sunburn, and sun tanning response, fails to capture the broad spectrum of skin reflectance. Studies demonstrate that European populations have the narrowest skin color variation, whereas groups categorized as 'brown' or 'black' exhibit a much wider range. [10] [11]
The efficacy of the Fitzpatrick scale even among white-skinned individuals has been argued to be questionable, [9] since studies such as that on a Dutch student population [12] have found it inadequate for categorizing, challenging its appropriateness for investigating the relationship between sunburn tendency and tanning ability. [9]
The Fitzpatrick scale's Eurocentric orientation and its limitations in accurately representing global skin color diversity, along with similar biases in classifying other phenotypic traits, have been argued to require more inclusive and scientifically valid categorizations in dermatological and genetic research. [9]
Ultraviolet radiation, also known as simply UV, is electromagnetic radiation of wavelengths of 10–400 nanometers, shorter than that of visible light, but longer than X-rays. UV radiation is present in sunlight, and constitutes about 10% of the total electromagnetic radiation output from the Sun. It is also produced by electric arcs, Cherenkov radiation, and specialized lights, such as mercury-vapor lamps, tanning lamps, and black lights.
Human skin color ranges from the darkest brown to the lightest hues. Differences in skin color among individuals is caused by variation in pigmentation, which is the result of genetics, exposure to the sun, disorders, or some combination thereof. Differences across populations evolved through natural selection or sexual selection, because of social norms and differences in environment, as well as regulations of the biochemical effects of ultraviolet radiation penetrating the skin.
Melanin is a family of biomolecules organized as oligomers or polymers, which among other functions provide the pigments of many organisms. Melanin pigments are produced in a specialized group of cells known as melanocytes.
Melanocytes are melanin-producing neural crest-derived cells located in the bottom layer of the skin's epidermis, the middle layer of the eye, the inner ear, vaginal epithelium, meninges, bones, and heart found in many mammals and birds. Melanin is a dark pigment primarily responsible for skin color. Once synthesized, melanin is contained in special organelles called melanosomes which can be transported to nearby keratinocytes to induce pigmentation. Thus darker skin tones have more melanosomes present than lighter skin tones. Functionally, melanin serves as protection against UV radiation. Melanocytes also have a role in the immune system.
Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. It occurs when skin cells grow uncontrollably, forming malignant tumors. The primary cause of skin cancer is prolonged exposure to ultraviolet (UV) radiation from the sun or tanning devices. Skin cancer is the most commonly diagnosed form of cancer in humans. There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC). Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin that may be shiny with small blood vessels running over it or may present as a raised area with an ulcer. Squamous-cell skin cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.
Sunscreen, also known as sunblock, sun lotion or sun cream, is a photoprotective topical product for the skin that helps protect against sunburn and prevent skin cancer. Sunscreens come as lotions, sprays, gels, foams, sticks, powders and other topical products. Sunscreens are common supplements to clothing, particularly sunglasses, sunhats and special sun protective clothing, and other forms of photoprotection.
Sun tanning or tanning is the process whereby skin color is darkened or tanned. It is most often a result of exposure to ultraviolet (UV) radiation from sunlight or from artificial sources, such as a tanning lamp found in indoor tanning beds. People who deliberately tan their skin by exposure to the sun engage in a passive recreational activity of sun bathing. Some people use chemical products that can produce a tanning effect without exposure to ultraviolet radiation, known as sunless tanning.
Indoor tanning involves using a device that emits ultraviolet radiation to produce a cosmetic tan. Typically found in tanning salons, gyms, spas, hotels, and sporting facilities, and less often in private residences, the most common device is a horizontal tanning bed, also known as a sunbed or solarium. Vertical devices are known as tanning booths or stand-up sunbeds.
Ultraviolet light therapy or ultraviolet phototherapy is a treatment for psoriasis, atopic skin disorder, vitiligo and other skin diseases.
Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure.
Sunless tanning, also known as UV filled tanning, self tanning, spray tanning, or fake tanning, refers to the effect of a suntan without exposure to the Sun. Sunless tanning involves the use of oral agents (carotenids), or creams, lotions or sprays applied to the skin. Skin-applied products may be skin-reactive agents or temporary bronzers (colorants).
The ultraviolet index, or UV index, is an international standard measurement of the strength of the sunburn-producing ultraviolet (UV) radiation at a particular place and time. It is primarily used in daily and hourly forecasts aimed at the general public. The UV index is designed as an open-ended linear scale, directly proportional to the intensity of UV radiation, and adjusting for wavelength based on what causes human skin to sunburn. The purpose of the UV index is to help people effectively protect themselves from UV radiation, which has health benefits in moderation but in excess causes sunburn, skin aging, DNA damage, skin cancer, immunosuppression, and eye damage, such as cataracts.
Polymorphous light eruption (PLE) presents with itchy red small bumps on sun-exposed skin, particularly face, neck, forearms and legs. It generally appears 30 minutes to a few hours after sun exposure and may last between one and 14 days. The bumps may become small blisters or plaques and may appear bloody,often healing with minimal scarring.
Liver spots are blemishes on the skin associated with aging and exposure to ultraviolet radiation from the sun. They range in color from light brown to red or black and are located in areas most often exposed to the sun, particularly the hands, face, shoulders, arms and forehead, and the scalp if bald.
Light skin is a human skin color that has a low level of eumelanin pigmentation as an adaptation to environments of low UV radiation. Due to migrations of people in recent centuries, light-skinned populations today are found all over the world. Light skin is most commonly found amongst the native populations of Europe, East Asia, West Asia, Central Asia, Siberia, and North Africa as measured through skin reflectance. People with light skin pigmentation are often referred to as "white" although these usages can be ambiguous in some countries where they are used to refer specifically to certain ethnic groups or populations.
Sunburn is a form of radiation burn that affects living tissue, such as skin, that results from an overexposure to ultraviolet (UV) radiation, usually from the Sun. Common symptoms in humans and other animals include red or reddish skin that is hot to the touch or painful, general fatigue, and mild dizziness. Other symptoms include blistering, peeling skin, swelling, itching, and nausea. Excessive UV radiation is the leading cause of (primarily) non-malignant skin tumors, which in extreme cases can be life-threatening. Sunburn is an inflammatory response in the tissue triggered by direct DNA damage by UV radiation. When the cells' DNA is overly damaged by UV radiation, type I cell-death is triggered and the tissue is replaced.
Photoaging or photoageing is a term used for the characteristic changes to skin induced by chronic UVA and UVB exposure. Tretinoin is the best studied retinoid in the treatment of photoaging.
Exposure of skin to ultraviolet radiation from sunlight presents both positive and negative health effects. On the positive side, UV exposure enables the synthesis of vitamin D3, which is essential for bone health and potentially plays a role in inhibiting certain cancers. While vitamin D can also be obtained through dietary supplements, UV exposure offers benefits such as enhanced subdermal nitric oxide production and improved endorphin levels, which are not achievable through supplementation alone. Additionally, exposure to visible light supports melatonin synthesis, maintains circadian rhythms, and reduces the risk of seasonal affective disorder.
Animal-type melanoma is a rare subtype of melanoma that is characterized by heavily pigmented dermal epithelioid and spindled melanocytes. Animal-type melanoma is also known to be called equine-type melanoma, pigment synthesizing melanoma, and pigmented epithelioid melanocytoma (PEM). While melanoma is known as the most aggressive skin cancer, the mortality for PEM is lower than in other melanoma types. Animal-type melanoma earned its name due to the resemblance of melanocytic tumors in grey horses.
Dark skin is a type of human skin color that is rich in melanin pigments. People with dark skin are often referred to as black people, although this usage can be ambiguous in some countries where it is also used to specifically refer to different ethnic groups or populations.