Fitzpatrick skin typing is a way of classifying skin types with specific reference to the risk of sunburn and skin cancer.
Sun exposure can also cause sunburn and skin aging.
This article explores the Fitzpatrick skin typing system and looks at how to protect the skin from sun damage.
Also known as the Fitzpatrick skin phototype, scientists developed the Fitzpatrick skin type system in 1975. It remains a useful way to determine skin type and skin cancer risk.
Skin cancer is a common type of cancer in the United States. According to the Skin Cancer Foundation, 1 in 5 people in the U.S. will develop skin cancer during their lifetime.
Experts established the Fitzpatrick skin types by asking people how their skin reacted to the sun. The results showed clear trends that allowed researchers to identify six different skin types, according to how much melanin was present.
A 2013 study confirmed that the system was useful in identifying who was most at risk of sunburn, but it also found that it was more effective when a dermatologist carried out the assessment rather than an individual.
It is also worth noting that not everyone’s skin will fit neatly into one of the types. The system acts as a guide rather than a definitive classification.
The Fitzpatrick skin type system can help predict who is at risk of sunburn by categorizing skin according to how much melanin is present.
Skin with very little melanin has little protection from the sun’s UV rays and is likely to burn quickly. When the skin burns, it increases the risk of skin cancer.
Melanin is a dark brown pigment present in hair, skin, and the irises of the eyes. The more melanin a person has, the darker their skin, hair, and eyes will be, and the more likely it is that their skin will tan rather than burn.
The table below shows a summary of the Fitzpatrick skin types and their features.
|Type||Features of unexposed skin||Tanning and burning|
|1||very pale white skin, often with green or blue eyes and fair or red hair||burns without tanning|
|2||white skin, often with blue eyes||burns and does not tan easily|
|3||fair skin with brown eyes and brown hair||burns first then tans|
|4||light brown skin, dark eyes, and dark hair||burns a little and tans easily|
|5||brown skin, dark eyes, and dark hair||easily tans to a darker color and rarely burns|
|6||dark brown or black skin, dark eyes, and dark hair||never burns but tans darker|
Remember that these descriptions are only a guide. A person’s skin type may not fit neatly into one category. For example, an individual’s skin may appear pale, but the person may tan rather than burning in the sun.
The sun’s UV rays can cause damage to any skin type. Anyone who is spending time outdoors should:
- Use a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or above.
- Remember that the sun’s rays are strongest between 10 a.m. and 4 p.m.
- Sit or walk in the shade when possible.
- Wear a wide-brimmed hat and sunglasses that block UV rays.
- Wear protective clothing if out in the sun for extended periods.
- Check the skin at least once per month for changes and seek medical advice if any occur.
The sections below discuss the risks associated with each skin type and why everyone needs to protect their skin.
Types 1 and 2
There is a high risk of sun damage, which can lead to:
- signs of aging
- skin cancer
People with very fair skin should take additional precautions to protect their skin.
For example, they should use a broad-spectrum sunscreen with an SPF of at least 30. SPF 70 and 100 are also available. A broad-spectrum sunscreen protects from both UVA and UVB rays.
It is also best for people with this skin type to avoid sun exposure as much as possible and wear protective clothing that reflects the sun’s rays.
Types 3 and 4
If a person has skin type 3 or 4, their skin can burn, but it will also tan. The risk of skin cancer due to sun exposure is lower than it is for those with type 1 and 2 skin, but there is still a risk.
Although skin types vary widely among people of a similar origin, those with types 3 and 4 often include people of Mediterranean, Southern European, Latino, and Asian ancestry.
For example, skin cancer accounts for 2–4% of all cancers in people of Asian origin and 4–5% of all cancers in people of Hispanic origin.
The authors of a 2012 study expressed concern about the risk of skin cancer among Hispanic people in the U.S. They called for “culturally relevant, tailored interventions” to raise awareness of the need for sun protection and preventive measures.
Among Hispanic populations in the U.S., skin cancer affects just over 4 people in every 100,000 each year. A Hispanic person is more likely to receive a diagnosis at a younger age, at a later stage, and with a lower chance of survival compared with a white person.
The ACS also express concern, noting that skin cancer rates have risen by nearly 20% among Hispanic people in the U.S. in the past 20 years.
Type 5 and 6
People with skin types 5 and 6 also have a risk of developing skin cancer, though the risk is lower than it is for people with skin types 1 or 2. Even if the skin does not burn, sun damage can lead to cancer and early signs of skin aging.
Skin cancer accounts for just 1–2% of all cancers in Black people. When it does occur, the outlook may be worse for several reasons, including the following:
- Awareness: As with Hispanic communities, Black people and their healthcare providers may be less watchful for signs of skin cancer, given that it mainly affects lighter skin.
- Expectation: Healthcare workers are less likely to expect that skin cancer will be present in darker skin and may not perform a full check. Lesions may also look different on darker skin than those shown in educational materials.
- Location: In skin types 5 and 6, changes may occur in places that are not exposed to the sun, such as the soles of the feet. This may make them less noticeable.
According to the Skin Cancer Foundation, the 5-year survival rate for melanoma in Black people is 65%, compared with 91% for white people. With an early diagnosis, the survival rate is 99%.
Protective measures are as essential for skin types 5 and 6 as they are for other types.
However, sunscreens designed for lighter skin may leave a residue on the face that gives an ashen or chalky look.
According to one expert, writing for the Skin Cancer Foundation, creams that contain nanoparticles of zinc oxide and titanium dioxide may work well.
All skin types
Artificial tanning beds and machines can be harmful to all skin types. One 2013 study suggests that people who use an artificial tanning bed before the age of 35 are 75% more likely to develop melanoma later in life.
Regardless of skin type, experts do not recommend artificial tanning beds for any purpose.
People of all skin types should check their skin around once per month. They should seek medical help if they find a mole or skin patch that:
- is new or changing, especially if the person is aged 30 or older
- is over a quarter-inch (6 millimeters) across
- has a blotched or uneven outline
- is asymmetrical with an uneven texture, shape, and color
- is changing color, from brown to black
- is becoming raised or lumpy
- is changing texture and becoming rough or ulcerated
- feels itchy or tingly
- is bleeding or weeping
It is worth noting that skin cancer may look different on different types of skin.
Basal cell carcinoma, for example, often appears pink and pearly, especially on lighter skin. However, it is pigmented in around half of all cases in darker skin. In these cases, it will appear brown.
Acral lentiginous melanoma is a type of skin cancer not directly related to sun exposure. It appears as a dark spot, often on the palms of the hands or the soles of the feet. It seems to be more prevalent in people with skin types 5 and 6.
A person should see a doctor if any skin changes look unusual or cause concern.
Fitzpatrick skin types can help predict a person’s risk of skin cancer due to sun exposure. Overall, the risk of skin cancer is higher for people with type 1 or 2 skin.
However, skin cancer can affect any skin type, and sun exposure increases the risk.
Everyone should check their skin regularly, including areas where the sun does not reach. People should see a doctor if they notice any unusual changes.