Fitzpatrick Skin Phototype Classification Research Articles

Skin Pigmentation Impacts the Clinical Diagnosis of Wound Infection: Imaging of Bacterial Burden to Overcome Diagnostic Limitations

Underrepresentation of diverse skin tones in medical education and providers’ implicit racial bias drives inequities in wound care, such as disproportionally poor outcomes for Black patients. Diagnostic indicators (e.g., erythema) can present differently depending on skin pigmentation. This post hoc analysis of 350 chronic wounds from a prospective 14-site clinical trial aimed to determine how the perception of clinical signs and symptoms of infection (CSS) differs by patient skin tone and if fluorescence-imaging can offer a more objective diagnostic solution. Participants were grouped by skin tone (low, medium, high) as measured by the Fitzpatrick Skin Phototype Classification (FSPC) scale. CSS and total bacterial load (TBL) were compared across FSPC groups, along with sensitivity to detect TBL >104 CFU/g using CSS alone and combined with fluorescence-imaging. Erythema was reported less often with increasing FSPC score (p = 0.05), from 13.4% (low), to 7.2% (medium), to 2.3% (high), despite comparable bacterial loads (median = 1.8 × 106 CFU/g). CSS sensitivity in the high group (2.9%) was 4.8-fold to 8.4-fold lower than the low (p = 0.003) and medium groups (p = 0.04). Fluorescence-imaging significantly improved the detection of high bacterial load in each group, peaking in the high group at 12-fold over CSS alone. These findings underscore the threat of pervasive racialized health inequities in wound care, where missed diagnosis of pathogenic bacteria and infection could delay treatment, increasing the risk of complications and poor outcomes. Fluorescence-imaging is poised to fill this gap, at least in part, serving as a more objective and equitable indicator of wound bacteria. Clinicaltrials.gov#NCT03540004 registered 16-05-2018.

An Overview of Methods to Characterize Skin Type: Focus on Visual Rating Scales and Self-Report Instruments

Skin type classification is important because it provides guidance for professionals and consumers to recommend and select the most appropriate cosmetic products and skin care protocols and it is also important in clinical research. Several methods have been proposed for classifying skin typologies such as non-invasive bioengineering tools (examples: Corneometer® and Sebumeter®), visual and tactile methods (subjective methods that evaluate skin appearance, texture, temperature, and abnormalities), artificial intelligence-based tools and instruments (examples: visual rating scales, and self-report instruments). Examples of known visual rating scales used to classify skin aging are the Griffiths Photonumeric Scale, the Glogau Scale, and the SCINEXA Scale. The Fitzpatrick Skin Phototype Classification and the Baumann Skin Type System are some of the self-report instruments used for skin type classification. Despite the diversity of methods to classify skin type and degree of skin aging, data on instruments are scarce and not adequately compiled. Validation in larger samples and with individuals of different ethnicities and geographic locations is needed to promote a more universal use. Visual rating scales and instruments are interesting tools that allow the skin to be promptly and efficiently examined, without using costly or complex equipment, and are very useful in a clinical or self-assessment context.

Decrypting the Potential of Nanotechnology-Based Approaches as Cutting-Edge for Management of Hyperpigmentation Disorder.

The abundant synthesis and accretion of melanin inside skin can be caused by activation of melanogenic enzymes or increase in number of melanocytes. Melasma is defined as hyperpigmented bright or dark brown spots which are symmetrically distributed and have serrated and irregular borders. The three general categories of pigmentation pattern include centro facial pattern, malar pattern, and mandibular pattern. Exposure to UV rays, heat, use of cosmetics and photosensitizing drugs, female sex hormonal therapies, aberrant production of melanocyte stimulating hormone, and increasing aesthetic demands are factors which cause the development of melasma disease. This review gives a brief overview regarding the Fitzpatrick skin phototype classification system, life cycle of melanin, mechanism of action of anti-hyperpigmenting drugs, and existing pharmacotherapy strategies for the treatment of melasma. The objectives of this review are focused on role of cutting-edge nanotechnology-based strategies, such as lipid-based nanocarriers, i.e., lipid nanoparticles, microemulsions, nanoemulsions, liposomes, ethosomes, niosomes, transfersomes, aspasomes, invasomes penetration-enhancing vesicles; inorganic nanocarriers, i.e., gold nanoparticles and fullerenes; and polymer-based nanocarriers i.e., polymeric nanoparticles, polymerosomes, and polymeric micelles for the management of hyperpigmentation.

Self-reported Race/Ethnicity and Occult Hypoxemia: Comment

I am writing in regard to the recently published article by Burnett et al., “Self-reported Race/Ethnicity and Intraoperative Occult Hypoxemia: A Retrospective Cohort Study.”1 In this retrospective cohort study, the authors investigate the association between self-reported race/ethnicity and occult hypoxemia and hypothesize a greater prevalence of occult hypoxemia in non-White cohorts. Analyzing 151,070 oxygen saturation measured by pulse oximetry–arterial oxygen saturation readings in 46,253 patients, Burnett et al. find that occult hypoxemia was higher in Black and Hispanic cohorts than in White ones, in both bivariate (odds ratio, 1.44; 95% CI, 1.11 to 1.87) and multivariable analysis (odds ratio, 1.31; 95% CI, 1.03 to 1.68).1In the introduction, the authors state that their exposure “self-reported race/ethnicity” serves “as a surrogate for skin pigmentation.”1 Previous research has addressed the nonequivalence of socially constructed racial and ethnic categories and skin pigmentation.2,3 The use of this proxy can thus lead to incorrect interpretations or conclusions. Interpretation of this study’s data should focus upon race/ethnicity rather than skin pigmentation. Limitations of using race/ethnicity as a surrogate for skin pigmentation were acknowledged in the discussion of the article but were not sufficient given the scientific and social issues raised by the surrogacy.With the available data set, the article could have investigated race/ethnicity as the primary exposure without it serving as a surrogate for skin pigmentation. Explanations for findings could then have explored (but not been limited to) skin pigmentation, varied placement of pulse oximeters by providers, or different use of certain types of nail treatments among patients (or a combination thereof). That is, could there be nonbiologic reasons that Black and Hispanic cohorts are more likely to experience occult hypoxemia than White patients?4 This question is important given that socially constructed categories do not have meaningful biologic distinction.5 If future investigators are interested in studying the association of skin pigmentation and occult hypoxemia in the vein of previous research,6 they might consider performing a prospective study and use measurement tools such as the Fitzpatrick skin phototype classification.7Research on race and ethnicity in our field is important and much needed. I commend the authors for taking on this subject matter.The author declares no competing interests.

Plant-based paraben-free moisturizer, Venusia Max Cream, is a nonirritant

Objectives To ensure that the marketed product is irritant-free, extensive premarket clinical testing of cosmetic products is necessary. Therefore, the present study evaluated the skin irritation reactions of the test product Venusia Max Cream-Paraben-free using a patch test. Material and methods This single group, blinded, controlled trial was conducted to compare our test product with negative saline and positive SLS control in healthy human subjects aged between 18 and 53 years (mean age of 30.93 years) having Fitzpatrick skin phototype classification III-V. During an initial phase, a patch dipped in test product, negative and positive control were applied under occlusion to the upper arm of participants and removed after 24 hours. Clinical evaluation of skin reactions (erythema, edema, dryness, and scaling wrinkling) in the area of the test product, negative and positive control after 24 hours of patch removal and then were scored based on the Draize scale. Results A total of 30 subjects were initiated and completed the study. Scoring for skin irritation (erythema/dryness/wrinkles/edema) of the subjects were evaluated based on Draize’s scale between test product, positive, and negative control. The combined mean score, i.e., of erythema/dryness/wrinkles, and edema was 0.00 in test product and negative control whereas 2.60 in the positive control. No adverse events or intolerances were reported due to the test product. Conclusion Venusia Max Cream-Paraben-free was dermatologically tested and found to be nonirritant.

Solar UV Radiation in the Tropics: Human Exposure at Reunion Island (21° S, 55° E) during Summer Outdoor Activities.

Reunion Island is a popular tourist destination with sandy beaches, an active volcano (Piton de la Fournaise), and Piton des Neiges, the highest and most dominant geological feature on the island. Reunion is known to have high levels of solar ultraviolet radiation (UVR) with an ultraviolet index (UVI) which can reach 8 in winter and 16 in summer (climatological conditions). UVR has been linked to skin cancer, melanoma, and eye disease such as cataracts. The World Health Organization (WHO) devised the UVI as a tool for expressing UVR intensity. Thresholds ranging from low (UVI 1–2) to extreme (UVI > 11) were defined depending on the risk to human health. The purpose of the study was to assess UVR exposure levels over three of the busiest tourist sites on the island. UVR was measured over several hours along popular hiking trails around Piton de la Fournaise (PDF), Piton des Neiges (PDN), and St-Leu Beach (LEU). The results were compared with those recorded by the local UV station at Saint-Denis. In addition, cumulative standard erythemal dose (SED) was calculated. Results showed that UVI exposure at PDF, PDN, and LEU were extreme (>11) and reached maximum UVI levels of 21.1, 22.5, and 14.5, respectively. Cumulative SEDs were multiple times higher than the thresholds established by the Fitzpatrick skin phototype classification. UVI measurements at the three study sites showed that Reunion Island is exposed to extreme UVR conditions. Public awareness campaigns are needed to inform the population of the health risks related to UVR exposure.

Validity of the Fitzpatrick Skin Phototype Classification in Ecuador.

ABSTRACTBACKGROUNDThe Fitzpatrick Skin Phototype Classification (FSPC) is the most common tool used to assess skin phototype in White populations according to the amount of pigment the skin has and its reaction to sun exposure. Scientific evidence about the use of this scale for persons with darker skin is limited.OBJECTIVETo assess the internal consistency, reliability, and construct validity of the FSPC for Ecuadorians.METHODSThis observational cross-sectional study recruited participants of both sexes between 40 and 90 years of age living in a rural area of Quito, Ecuador. Cronbach α values were used to assess the internal consistency of the scale. Construct validity was assessed with confirmatory factor analysis.RESULTSThe internal consistency coefficients indicated that the reliability of the responses to the scale was fair. Total α value was .515, whereas the α values of the two factors were .42 and .67. Most item-to-factor correlations had a low to moderate magnitude, ranging from r = 0.30 to 0.37. Confirmatory factor analysis supported a two-factor solution and achieved good overall fit as indicated by root mean square error of approximation = 0.08, and nonnormed fit index = 0.88 was mediocre. Goodness-of-fit χ2 = 177.10, P < .001. The factor loads were greater than 0.30, ranging from 0.30 to 0.99.CONCLUSIONSThe FSPC showed an acceptable construct validity and a fair internal consistency. The five-item scale could potentially be used as an effective instrument for assessing skin phototype in non-White people.

Clinical assessment of skin phototypes: watch your words!

Fitzpatrick skin phototype classification is widely used to assess risk factors for skin cancers. This skin type evaluation is easy to use in clinical practice but is not always applied as initially described, nor practiced in a standardised way. This can have implications on the results of relevant dermato-epidemiological studies. To demonstrate, in a large multinational setting, that the phrasing of questions on sun sensitivity can have a strong impact on the perception and reporting of skin phototype, as well as the importance of a standardised procedure for phototype assessment. Using data collected from 48,258 screenees of the Euromelanoma campaign in six European countries from 2009 to 2011, we analysed the impact of change in the question phrasing on phototype classification in each country. Changing the wording of a question to assess the phototype of a person also significantly influenced the classification of phototypes in different countries (p<0.001 for each country). The difference essentially corresponded to a shift towards a less sun-sensitive skin type when a shorter question that did not include skin colour description was used. The only exception was Portugal where phototype was not patient-assessed and classification shifted towards a more sun-sensitive phototype. Results were statistically significant and highly consistent, irrespective of gender. The phrasing of questions on skin type is important and substantially influences reporting. A standardized procedure to classify phototypes should be used in order to obtain comparable data between studies.

Light pigmentation phenotype is correlated with increased substantia nigra echogenicity.

This study was undertaken to address the question of whether pigmentation may be mechanistically linked with Parkinson's disease. In a cross-sectional, observational study, 116 healthy subjects received transcranial sonography of the substantia nigra. Pigmentation phenotype was assessed using the Fitzpatrick skin phototype classification, and five additional phenotypic pigmentation traits as well as a photographic method (Melanin index) in a subgroup of 46 subjects. Lighter skin phototype was associated with larger echogenic substantia nigra area and increased prevalence of abnormally enlarged echogenic substantia nigra area. The strongest association of substantia nigra echogenicity and phenotypic pigmentation traits was found for hair color and facial tanning. Findings suggest an increasing prevalence of structural abnormality of substantia nigra with decreasing darkness of skin and thus may provide additional evidence in favor of a pathogenic link of pigmentation and Parkinson's disease.

Reliability of skin‐type self‐assessment: agreement of adolescents’ repeated Fitzpatrick skin phototype classification ratings during a cohort study

The Fitzpatrick Skin Phototype Classification (FSPC) is the most commonly used measure of skin type. In questionnaire-based surveys, self-rated FSPC is often used as a measure of respondents' skin type. The objective of this analysis was to assess test-retest reliability of the self-rated FSPC within a 12-month cohort study that examined the psychological sequelae of acne. Participants were students aged 14-17 years in four Australian secondary schools; two-government system schools and two private schools. The primary outcomes were a number of psychological measures. The FSPC was assessed by a single concise questionnaire item. Test-retest agreement (as measured by quadratic weighted kappa) of participants' self-rated FSPC at three time-points (baseline, 6 and 12 months) was calculated. Of the 244 participating students, 209 students (86%) completed all three rounds of data collection. A further 26 students (11%) completed two rounds. Quadratic weighted kappa for Rounds 1 and 2 was 0.757 (95% CI 0.663-0.831). For Rounds 2 and 3 it was 0.805 (95% CI 0.659-0.893). Between Rounds 1 and 3 it was 0.767 (95% CI 0.698-0.832). This represents good-to-very-good agreement. Skin type was retained as an independent variable in 8 of the 16 regression models built to explain psychological outcomes in this study. Skin type appears to be a significant factor in psychological morbidity in acne. The FSPC is a reliable method for assessing skin phenotype, even when elicited via a concise questionnaire item suitable for assessing skin type as a potential confounder in studies of other outcome factors.

Diffuse reflectance spectrophotometry for skin phototype determination

The Fitzpatrick skin phototype classification scheme has become the standard method for assessing the reaction of the skin to solar stimuli; this method can be easily biased by different factors, such as ethnicity or chronic sun exposure. Diffuse reflectance spectrophotometry (DRS) is an objective and non-invasive method used in this work to determine constitutive skin color from the upper volar arm as an objective way of measuring skin pigmentation. A DRS-determined melanin index that accounts for skin pigmentation was obtained for 35 subjects of Hispanic origin, this melanin index was compared with the physician-diagnosed and self-reported skin phototypes. The results show that at least for Hispanic individuals, there is a clear clinical distinction between subjects with skin phototype I and their DRS-determined melanin index; however, subjects with skin phototypes II-VI have a large melanin index overlap. Clinical assessment of skin phototype can be complemented by using DRS.

Skin Type Classification Systems Old and New

The history of classifying skin types is rather new and there has been considerable progress made with continuing awareness. The Fitzpatrick Skin Phototype Classification remains the gold standard. It is simple and user friendly, however this system fails to accurately predict skin reactions. The Roberts Skin Type Classification System is a tool to predict the skin response to injury and insult from cosmetic procedures and identify the propensity of sequelae from inflammatory skin disorders. It can be a predictor of an impending complication, such as hyperpigmentation and scarring, which can then be avoided. In addition, it includes the skin phototype and photoage. In evaluating patients' skin and developing a cosmetic plan, the four indices outlined in this article, hyper/hypopigmentation risk, scarring risk, skin phototype, and photoage, are crucial to identify for optimal outcomes.

Lack of correlation between minimal erythema dose and skin phototype in a colombian scholar population

Sun exposure and skin phototype are the most relevant risk factors for skin cancer. Colombia has high levels of ultraviolet radiation during the whole year, therefore, both, high UVI's and outdoor worker's daily activities, in our country are very important risk factors for the development of cutaneous cancer. To date no study has evaluated the usefulness of Fitzpatrick's skin phototype classification in Colombians and its correlation with the minimal erythema dose (MED) and constitutional skin color. Such information is gaining importance in other nations due to the fact that several country's population is becoming more ethnically diverse. To determine the skin phototype, accumulated sun exposure, sun protection behavior, MED and phenotype in a Colombian school population. Last year high school students from the western Antioquia were invited to participate by phone and letter through their respective school directors. A self-questionnaire was handled to each student. A representative sample of the universe was selected for a medical examination by a dermatologist in order to validate the results of the self-questionnaire. The constitutional skin color was determined with the chromameter CR 300 Minolta. The MED was defined as the minimal dose of UVB being able to induce erythema 24 h later. Eight schools of the area agreed to participate in the study, and a total of 911 students (58% girls and 42% boys) filled-out the self-questionnaire. Sun exposure in the majority of individuals was in a level between moderate and very high. Ninety percent of students do not use any sun protection device or cream. Only a 50% of concordance between self-assessed skin phototype vs. medical skin phototype was found, and the highest concordance corresponded to skin phototype II (82%). There was a marked difference in skin photosensitivity of Colombians compared with reports in Caucasians. We observed a marked overlapping in MED's and L* values in phototypes II and III. The Fitzpatrick's classification was not useful in Hispanic populations such as ours. Therefore, a new skin-phototype classification system is required. In our population the constitutional color was a good predictor of the MED but it did not correlate with skin phototype. The self-assessed questionnaire method was not useful to determine skin cancer risk in our population. The majority of this population has light skin phototypes and is highly exposed to solar UV radiation without proper protection.