Different skin types react differently to the sun regarding pigmentation and a risk for skin cancer. We recognise the pioneering work of Dr Thomas Fitzpatrick who in 1975 developed the Fitzpatrick skin types I to VI as a system to evaluate the patient’s response to ultraviolet exposure regarding their burning and tanning. It is often known as the Fitzpatrick scale and is used by dermatologists, aesthetic practitioners and cosmetic surgeons in determining the risks and likely response of the skin to the sun as well as chemical peels and lasers.
Fitzpatrick skin Type I is the palest type skin colour which is white or very pale often with some freckles where the person has red or blond hair and often blue, green or grey eyes. They burn easily and rarely tan. In contrast type VI is black skin, with black hair, dark brown eyes and do not burn and do tan very easily. Type I is much more likely to develop a skin cancer than a type VI. This is because type 1 does not have the same melanin protection in the skin as the type VI.
Tanning is your skin throwing up protection in the form of melanin production and is seen as the pigment of the skin. The four skin types that are most commonly encountered in the UK are types I to IV. Type II has pale skin colour can have blond or dark hair, blue or brown eyes, may burn and tans gradually.
Fitzpatrick scale Type III has pale to light olive skin, dark brown hair, green or brown eyes, can sometimes burn and is an average tanner.
Whereas type IV has light to the moderate brown skin, brown or black hair and brown eyes, rarely burns and tans with ease.
In the lighter skins in Fitzpatrick I, II and III, some signs of sun damage include early wrinkling and sagging, thread veins formation and solar lentigines. In those who have skin type I and red hair, they produce a different melanin called Phaeomelanin which is largely ineffective unfortunately in protecting the skin’s UV exposure. Therefore those with lighter skin types present ageing signs before their darker skinned counterparts. Darker skin patients often look a lot younger as they have inherent protection and ageing from sun damage is more delayed than for the paler Caucasian skin. We are all seeing younger and younger patients with sun damage presenting with premature skin ageing in their 20s and even skin cancers below the age of 20 due to excessive sun exposure.
The skin types V to VI, the darker skin types, have a kind of melanin produced that is different particularly in skin type VI where eumelanin is produced which is very dark and highly effective at blocking UV photons and protecting the skin against UV damage. However, it is a total misconception that Fitzpatrick skin types IV to VI do not require skin protection.
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.