Fitzpatrick scale

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The Fitzpatrick scale and the risk of skin cancer Influence of pigmentation on skin cancer risk.png
The Fitzpatrick scale and the risk of skin cancer

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.

Contents

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
1I1Always burns, never tans (palest; freckles); very light or white, "Celtic" type
2
3
42
5
6
7II3Usually burns, tans minimally (light colored but darker than pale); light or light-skinned European
8
94
10
11
12
135
14IIISometimes mild burn, tans uniformly (golden honey or olive); light intermediate, or dark-skinned European
15
166
17
18
19
20
21IV7Burns minimally, always tans well (moderate brown); dark intermediate or "olive skin"
22
23
248
25
26
27
28V9Very rarely burns, tans very easily (dark brown); dark or "brown" type
29
3010
31
32
33
34
35VINever burns (deeply pigmented dark brown to darkest brown); very dark or "black" type
36

Emoji modifiers

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).

Eurocentric bias

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]

See also

Related Research Articles

<span class="mw-page-title-main">Ultraviolet</span> Energetic, invisible radiant energy range

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.

<span class="mw-page-title-main">Human skin color</span>

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.

<span class="mw-page-title-main">Melanin</span> Group of natural pigments found in most organisms

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.

<span class="mw-page-title-main">Melanocyte</span> Melanin-producing cells of the skin

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.

<span class="mw-page-title-main">Skin cancer</span> Medical condition involving uncontrolled growth of skin cells

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.

<span class="mw-page-title-main">Sunscreen</span> Skin product helping to prevent sunburn

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.

<span class="mw-page-title-main">Sun tanning</span> Darkening of skin in response to ultraviolet light

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.

<span class="mw-page-title-main">Indoor tanning</span> Tanning using an artificial source of ultraviolet light

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.

<span class="mw-page-title-main">Ultraviolet light therapy</span> Form of treatment for skin disorders

Ultraviolet light therapy or ultraviolet phototherapy is a treatment for psoriasis, atopic skin disorder, vitiligo and other skin diseases.

<span class="mw-page-title-main">Actinic keratosis</span> Rough skin induced by UV exposure

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.

<span class="mw-page-title-main">Sunless tanning</span> Indoor tanning lotion

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).

<span class="mw-page-title-main">Ultraviolet index</span> Measurement of strength of sunburn-producing ultraviolet (UV) radiation

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.

<span class="mw-page-title-main">Polymorphous light eruption</span> Medical condition

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.

<span class="mw-page-title-main">Liver spot</span> Age-related skin blemish

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.

<span class="mw-page-title-main">Light skin</span> Human skin color

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.

<span class="mw-page-title-main">Sunburn</span> Burning of the skin by the suns radiation

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.

<span class="mw-page-title-main">Photoaging</span> Ultraviolet light-induced biological development over time

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.

<span class="mw-page-title-main">Health effects of sunlight exposure</span>

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.

<span class="mw-page-title-main">Dark skin</span> Human skin color

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.

References

  1. D'Orazio, John; Jarrett, Stuart; Amaro-Ortiz, Alexandra; Scott, Timothy (7 June 2013). "UV Radiation and the Skin". International Journal of Molecular Sciences. 14 (6): 12222–48. doi: 10.3390/ijms140612222 . PMC   5 . PMID   23749111.
  2. 1 2 Fitzpatrick, T. B. (1975). "Soleil et peau" [Sun and skin]. Journal de Médecine Esthétique (in French) (2): 33–34
  3. 1 2 Fitzpatrick, T.B. (1988), "The validity and practicality of sun-reactive skin types i through vi", Archives of Dermatology, 124 (6): 869–71, doi:10.1001/archderm.1988.01670060015008, PMID   3377516
  4. Pathak, M. A.; Jimbow, K.; Szabo, G.; Fitzpatrick, T. B. (1976). "Sunlight and melanin pigmentation". In Smith, K. C. (ed.): Photochemical and photobiological reviews, Plenum Press, New York. pp. 211–39[ ISBN missing ]
  5. Fitzpatrick, T. B. (1986). "Ultraviolet-induced pigmentary changes: Benefits and hazards", Therapeutic Photomedicine, Karger, vol. 15 of "Current Problems in Dermatology", pp. 25–38
  6. "The Fitzpatrick Skin Type Classification Scale". Skin Inc. (November 2007). 13 May 2008. Retrieved 7 January 2014.
  7. "Fitzpatrick Skin Type" (PDF). Australian Radiation Protection and Nuclear Safety Agency. Retrieved 30 November 2017.
  8. "What Is Golden Skin Tone? (With Pictures)". 9 March 2020.
  9. 1 2 3 4 Lasisi, Tina (2021-03-05). "The constraints of racialization: How classification and valuation hinder scientific research on human variation". American Journal of Physical Anthropology. 175 (2). Wiley: 376–386. doi:10.1002/ajpa.24264. ISSN   0002-9483. PMID   33675042.
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  11. Martin, Alicia R.; Lin, Meng; Granka, Julie M.; Myrick, Justin W.; Liu, Xiaomin; Sockell, Alexandra; Atkinson, Elizabeth G.; Werely, Cedric J.; Möller, Marlo; Sandhu, Manjinder S.; Kingsley, David M.; Hoal, Eileen G.; Liu, Xiao; Daly, Mark J.; Feldman, Marcus W.; Gignoux, Christopher R.; Bustamante, Carlos D.; Henn, Brenna M. (2017). "An Unexpectedly Complex Architecture for Skin Pigmentation in Africans". Cell. 171 (6). Elsevier BV: 1340–1353.e14. doi: 10.1016/j.cell.2017.11.015 . ISSN   0092-8674. PMC   5884124 . PMID   29195075.
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