People with skin types Fitzpatrick scale V and VI skin have medium to a dark brown skin or black with dark brown or black eyes, dark brown or black hair who very rarely burn and tan easily. The point is that they still do tan, though often they are surprised about this when I tell them. They are always surprised when Dr Jennifer Crawley the Clinica London Dermatologist tells them that they have to stay out of the sun or put on sun screen.
How the skin reacts to sun exposure is dictated mainly by the amount of melanin produced by the melanocytes as well as the type of melanin. Those with type VI skin produce mainly eumelanin, which is a very darkly coloured and evenly distributed highly effective melanin blocking UV photons and protecting the skin against UV damage.
People with Fitzpatrick skin type IV to VI or a darker skin colour, do require sun protection. Whilst darker skins have less wrinkling and sagging skin, pigmentation can become an issue especially with increasing age as sunspots form and melasma. The actual pigmentation in the epidermis provides an inherent skin protection, which is less than the equivalent of SPF 20.
It has been estimated in a paper by Kaidbey that the natural skin protection in Fitzpatrick skin types IV to VI provides on average a protection similar to SPF of 13.4. This photo protective role of pigmented skin was evaluated by looking at the transmission of UV radiation of black and Caucasian skin samples in looking at UVA and UVB wavelengths. It was found that on average five times as much as UV light, both UVB and UVA, reached the upper dermis of Caucasians as that of black skin.
Pigmentation is the colouring of our skin and in Fitzpatrick type I to IV can appear as freckles, which when young are regarded as cute and attractive and make the person look sweet, but then as they get older, the freckle coalesce and enlarge and resulted in an ageing of the person’s face.
It is often the people who have skin types IV to VI that spend their time out in the sun not using sun protection because they thought they did not need it. Many such patients come to see their dermatologist such as Jennifer Crawley here at Clinica London, saying that they have uneven freckles, patches if dis-pigmentation or “dyschromia.” In other words, their skin is no longer a nice even tanned brown or black tone, but they have developed areas of light and dark patches giving a very mottled appearance with lots of different size and shaped freckles of different intensities and hues.
In my next blog, I will talk about how to get rid of dyschromia.
Jennifer Crawley is the Consultant Dermatologist at Clinica London with a special interest in dermatology. She is an expert in both adult and paediatric dermatology and has particular interests in research, teaching and leading audit projects.