Fitzpatrick skin typing is a way of classifying skin types. Types range from 1 to 6, depending on skin features and the risk of sunburn and skin cancer.
The sun’s UV rays increase the risk of skin cancer. Sun exposure can also cause sunburn and visible signs of aging.
The Fitzpatrick system aims to help people understand their risk of sun-induced skin damage. However, it is important to note that everyone needs to take steps to protect their skin from the sun, regardless of their Fitzpatrick type.
This article explores the Fitzpatrick skin typing system and looks at how to protect the skin from sun damage.
The Fitzpatrick skin type system categorizes skin tones based on their color, how they respond to sunlight, and the subsequent risk of developing skin cancer.
Thomas B. Fitzpatrick developed these categories in
Fitzpatrick identified six distinct skin types based on melanin levels, which is a brown pigment in the skin that provides a small amount of protection against the sun. The more melanin a person has, the darker their skin tone.
Today, doctors also use the Fitzpatrick scale to assess whether certain cosmetic or medical treatments are safe for people with different skin tones.
For example, those with types 5 or 6 can have a higher risk of skin alterations after laser or light therapies.
The table below summarizes the Fitzpatrick skin types and their features:
| Type | Features of unexposed skin | Tanning and burning |
| 1 | very pale skin | |
| 2 | pale skin | burns easily, rarely tans |
| 3 | fair skin | burns moderately, tans a light brown |
| 4 | light brown skin | burns moderately, tans a darker brown |
| 5 | brown skin | easily tans to a darker color and rarely burns |
| 6 | dark brown skin | 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.
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 ages
30 or older . - 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.
Artificial tanning beds and machines are very harmful to all skin types, emitting 10 to 15 times the UV radiation as the sun at its most intense.
The sections below discuss the additional steps each skin type may require.
Types 1 and 2
People with Fitzpatrick types 1 and 2 need to be extra cautious about sun exposure.
The
To avoid this, it is best to avoid sun exposure as much as possible. Wear protective clothing that covers the body and ideally has a UV protection factor (UPF) rating. Dark colors are
Types 3 and 4
The risk of skin cancer due to sun exposure is lower for types 3 and 4 than for types 1 and 2, but there is still a risk.
A tan does not mean the skin has adapted to the sun – it is a sign of sun damage. This is why there is no such thing as a “healthy tan”.
It is important to be aware of this, since the populations that tend to have type 3 and 4 skin may overlook their risk.
Type 5 and 6
People with skin types 5 and 6 have the lowest risk of developing skin cancer out of the Fitzpatrick types. However, they can still develop sunburn, visible sun damage, and skin cancer.
For example, skin cancer accounts for just 1% to 2% of all cancers in Black people, who can have type 5 or 6 skin. But when it does occur, it may go unnoticed or untreated for longer.
In the U.S.,
Several factors contribute to this, including:
- the misconception that those with darker skin cannot get skin cancer, or are very unlikely to
- the location of melanomas, which are more likely to occur in areas that receive little sun exposure in Black people
- reduced access to healthcare due to structural racism
As a result, it is just as essential for those with skin types 5 and 6 to take protective measures against sun exposure and to check their skin for any changes. It is also essential for clinicians to be aware of the risk.
While dermatologists often use the Fitzpatrick scale, it has limitations.
Fitzpatrick types and race
A 2020 article from the Skin of Color Society notes that some practitioners use the Fitzpatrick scale as a proxy for race or ethnicity. However, race does not consistently correlate with skin pigmentation.
For example, Asian, Black, and Latine people can all have skin tones ranging from light to dark. White people can also have a variety of skin tones.
Race and ethnicity are social categories, not scientific ones. Using the Fitzpatrick scale to describe a person’s race or ethnicity, rather than the melanin in their skin, may overlook their true cancer risk.
Accuracy
Another criticism of the scale is its accuracy in medical practice. Previous studies have found differences between how clinicians and patients assess their Fitzpatrick skin type.
Spectrophotometers can accurately assess melanin in skin, but they are
Not everyone’s skin will fit neatly into one of the types. The system acts as a guide rather than a definitive classification.
People of all skin types should check their skin once per month. They should seek medical help if they find a mole or skin patch that:
- is new, growing, or changing shape, especially if the person is aged 30 or older
- 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 appear differently on different skin types.
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 people of all skin types, and sun exposure increases the risk.
Everyone should check their skin regularly, including areas that do not receive direct sunlight. People should see a doctor if they notice any unusual changes.