Fitzpatrick skin types (or phototypes) — FST (or FSP) — refer to a skin tone scale developed to classify skin coloring and response to ultraviolet (UV) radiation.

The Fitzpatrick skin phototypes (FSP) were developed in Boston in 1975 for use with phototherapy. The scale’s original purpose was to help determine a patient’s risk of burning or tanning when exposed to UV light.

Fitzpatrick initially based the scale on a person’s skin and eye color to determine the amount of UV therapy used to treat skin disorders without causing phototoxicity, or irritation from UV light.

It has also been used by medical professionals to assess risk for sunburn and skin cancer. It was thought that people with a lower FSP and lighter skin tone would require a shorter exposure than a person with a higher FSP and darker skin tone.

The scale is still used to determine the dose of photo-therapy, UV, or laser therapy a person can have to treat certain skin disorders.

The current scale classifies skin from types I to VI. Type I refers to skin that always burns, while type VI refers to skin that never burns. In general, a lower FSP means a person’s skin burns more easily than it tans. A higher FSP means that a person’s skin does not burn easily.

The Fitzpatrick scale was also used to determine the risk of skin cancer from exposure to UV rays.

Now, the scale is intended for dermatologists to use in determining the amount of UV therapy or treatment a patient can have to treat certain skin disorders.

The scale is also often used to determine the setting on a laser when performing laser hair removal. Lasers can cause burns and depigmentation when the correct setting is not used for patients with darker skin coloring or those who have a tan. Because most lasers target pigment, a person’s potential risk of possible burns or depigmentation may be greater if they have a darker skin tone.

Keep reading to learn about the Fitzpatrick skin types, the scale’s limitations, and proposed alternatives.

While the FSP scale is still widely used, it has some limitations.

Limitations in describing skin of color

The original version of the scale did not contain classifications for darker skin tones. In its first version, the scale only included types I to IV and was considered “Anglo-Irish centric.” Types V and VI were added later.

It may not be surprising with its problematic beginning that the Fitzpatrick scale still provides limited options for People of Color.

FSP does not take into account the skin color ranges of people with darker pigment (more melanin). It does not include the variance of skin color in People of Color and people who are mixed race. This contributes to healthcare disparities.

A 2021 review notes that the scale is not accurate when used for educating people about their risk of developing skin cancers.

According to 2020 research, some professionals who do not identify as People of Color may misuse the FSP scale and may not accurately educate their clients about the risk of developing skin cancer.

FSP and race

Some professionals may incorrectly use FSP to classify race, according to a 2020 survey conducted anonymously among dermatological professionals. The authors also reported that dermatologists who do not identify as having skin of color may misuse the FSP classification system more often.

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Subjectivity and language

The language used in this skin coloring model is subjective and may make it difficult for People of Color to classify their FSP.

The descriptors used in the scale focus on the words “tan” and “burn,” which can mean different things to different people. Labeling your skin based on its tendency to tan or burn may not be reliable.

According to a 2019 review of research, a number of participants in separate studies were unable to classify themselves by FSP as a result of the scale’s limitations.

In a 2015 study involving 556 people in South Africa with FSP types V and VI, 96.8% of participants reported that the sun affected their skin. Of 390 Black African participants in the study, 95.6% described themselves as photosensitive. The authors of this study propose that FSP VI should only be used for individuals who are 100% not photosensitive.

Rather than using words like “burn” or “tan,” 2020 research suggests that using different terms may help people identify their photosensitivity risk better. Proposed terms include:

  • skin irritation
  • tenderness
  • itching
  • skin becoming darker from sun exposure

Sun cancer risk

The FSP model may not accurately determine your risk of developing skin cancer, especially in People of Color.

People of all skin colors can develop skin cancer. In the United States, skin cancer affects approximately 4.5 million People of Color each year, according to research.

Darker skin tones have increased melanin. Larger amounts of melanin provide more protection against UV radiation compared with people with lesser amounts of melanin. This can lead to fewer of the early signs of aging brought on by UV light exposure.

But according to the American Academy of Dermatology Association, even people who never sunburn can get skin cancer.

An individual’s skin cancer risk is based on a number of factors that include skin color and sensitivity to the sun but that also include:

  • family history
  • history of sun exposure
  • medication, such as immunosuppressants, that may increase risk

Classification may lead some individuals and professionals to underestimate skin cancer risk. This may lead to fewer protective measures being taken. It may also lead to a later diagnosis of skin cancer. A later diagnosis can contribute to a worse outcome.

The Fitzpatrick skin type classification system is outdated and subjective.

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.

It may also be difficult to identify your skin type using the descriptors below. A dermatologist may use this classification system, along with your history and other methods, to determine the appropriate settings for laser therapy.

The Fitzpatrick skin types include:

Fitzpatrick skin type classificationDescription
Fitzpatrick skin type Iskin always burns, never tans, and is sensitive to UV exposure
Fitzpatrick skin type IIskin burns easily and tans minimally
Fitzpatrick skin type IIIskin burns moderately and tans gradually to light brown
Fitzpatrick skin type IVskin burns minimally and always tans well to moderately brown
Fitzpatrick skin type Vskin rarely burns and tans profusely to dark
Fitzpatrick skin type VIskin never burns, is deeply pigmented, and is least sensitive to UV exposure

Your FSP may help a skin care professional determine your ideal settings when you’re receiving phototherapy for certain skin diseases.

When it comes to sun exposure and skin sensitivity, people of all FSP identifications should apply sunscreen daily to receive maximum protection from UV light. Sun exposure can increase your risk of photoaging and skin cancer.

Tanning beds and other artificial tanning machines are harmful for everyone, regardless of skin type.

According to the Centers for Disease Control and Prevention, your risk of sun damage is also higher if you live near the equator. The closer to the equator you are, the more intense the sun’s rays are, so being vigilant about sun protection is crucial.

People who spend a lot of time outdoors, such as farmers and construction workers, may also have an increased risk of skin cancer due to UV radiation.

If you have a family history of melanoma, you may be at a higher risk of developing it yourself, regardless of your FSP. If you have a family history of melanoma or a personal history of any type of skin cancer, it’s especially important that you see a dermatologist for regular full-body exams and to conduct self-exams at home.

When skin cancer is diagnosed early, people usually have a better outlook and more options for treatment.

Cancer risk and sun protection

People of all skin tones can develop skin cancer and should take protective measures to limit their UV exposure, which includes:

  • applying water-resistant, broad-spectrum sunscreen of at least SPF 30 daily, regardless of FSP
  • reapplying sunscreen every 2 hours, after sweating or after getting out of water
  • performing a skin exam at home once per month
  • getting their skin checked at least once per year by a skin care specialist such as a dermatologist; those with a history of skin cancer may need more frequent exams
  • limiting sun exposure and seeking shade whenever possible
  • wearing a wide-brimmed hat when outdoors
  • wearing clothing and shoes that protect your skin from the sun
  • wearing UV-blocking sunglasses
  • avoiding tanning lamps or sun lamps, as these can increase your skin cancer risk
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Here’s what else you should know about your skin and how to protect it based on your skin type.

Types 1 and 2

If your skin type is 1 or 2, you may have a higher risk of:

Types 3 and 4

If your skin type is FSP 3 or 4, you generally have a lower risk of skin cancer than people of types 1 and 2. But you may still be at risk of developing:

  • sun damage
  • skin aging from sun exposure
  • melanoma and other skin cancers

Types 5 and 6

If your skin type is FSP 5 or 6, you generally have a lower risk of skin cancer compared with people of lighter skin tones. But according to the AAD, you may be more likely to develop an aggressive form of skin cancer or receive a later diagnosis.

The Skin Cancer Foundation notes that Black people who have been diagnosed with melanoma are often diagnosed at a later stage, contributing to a poorer overall outlook.

This may be due to:

  • lack of public awareness about skin cancer in People of Color
  • less early identification of skin cancer in People of Color by healthcare professionals
  • skin cancer appearing in less exposed areas, such as the soles of the feet
  • a lack of medical educational materials featuring People of Color or descriptions of skin cancer in People of Color
  • a lack of access to healthcare and education research on skin cancers

If you’re at an increased risk of skin cancer, it’s important to schedule regular skin exams. Talk with a doctor about how often you should come in for a screening. Depending on your individual needs, skin screening could be more frequent than your annual checkup.

You can also talk with a doctor about how and when you should do your own skin checks.

It’s important to make an appointment with a dermatologist for a skin exam if you notice:

  • new growths on your skin
  • growths that have increased in size
  • a spot that looks different from others
  • a spot that changes, itches, or bleeds
  • sores that will not heal
  • a dark line underneath or around a fingernail or toenail

Despite its limitations, Fitzpatrick skin typing is still widely used. Some researchers have proposed alternatives to more accurately assess photosensitivity and skin cancer risk in People of Color. These methods include:

  • Genetico-Racial Skin Classification: This self-reported classification is based on race and genetic origin. It has 6 categories:
    • Nordics
    • Europeans
    • Mediterraneans
    • Indo-Pakistanis
    • Africans
    • Asians
  • Glogau wrinkle Scale: This scale is used for people who self-identify as white. It uses photographs to determine the extent of photoaging.
  • Goldman World Classification of Skin Type: This classification system uses skin color, response to questions about burning, tanning, and post-inflammatory hyperpigmentation based on race and ethnicity.
  • Kawada Skin Classification System for Japanese Individuals: This self-reported scale was created to describe skin types in Japanese people and their sensitivity to UV light, sunburn, and tanning.
  • Lancer Ethnicity Scale: This scale can be used along with FSP or on its own. It distinguishes skin types based on geography and heredity to determine risks for cosmetic laser surgery or chemical peels.
  • Modified Fitzpatrick Skin Type: This modified FSP scale includes changes to better assess phototype, skin color, and burning or tanning in Indian people.
  • Roberts Skin Type Classification System: In this system, skin phototype, hyperpigmentation, photoaging, and scarring are assessed to determine skin type and the skin’s predicted response to injury and inflammation.
  • Von Luschan chromatic scale: This scale determines race classifications by skin color using opaque glass tiles, which are compared to a person’s skin color.
  • Willis and Earles Scale: This scale was created for use with people of African descent to help classify skin color, UV light reaction, and any pigment-related disorders.

Technological methods, such as using a Wood’s lamp exam to determine the FSP or a spectrophotometry exam to determine skin darkening caused by increased melanin, have also been tried.

But the Wood’s lamp exam was not successful at distinguishing above FST 2, and the spectrophotometry exam can have high personnel and equipment costs.

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

FSP may also be used to determine skin cancer risk from UV light exposure. However, many additional factors, such as family history and geography, can contribute to skin cancer risk.

There are limitations with the FSP 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 FSP scale has led to a limitation of education around skin cancer risk in People of Color, which may contribute to diagnosing skin cancer in later stages.

Additional classification systems and modified versions of the FSP scale have been proposed. But despite the FSP scale’s limitations, it remains widely used.