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The Fitzpatrick Skin Type Scale has been a cornerstone of dermatology for decades, but how much does it really tell us about your skin?
In this episode of Skinside Out, the team breaks down the six Fitzpatrick skin types, explains the difference between tanning and burning, and discusses why skin type is about much more than skin color alone. They explore how dermatologists use the scale to assess sun sensitivity, skin cancer risk, and laser treatment safety, while also examining its limitations in today's increasingly diverse population.
You'll learn why ethnicity, genetics, and individual skin behavior matter, how misconceptions about tanning can affect skin health, and why newer classification systems may provide a more personalized approach to dermatologic care in the future.
Whether you're curious about your own skin type, considering laser treatments, or simply want to better understand how your skin responds to sun exposure, this episode offers valuable insights from the experts.
Learn more about Noor Dermatology:
https://www.noorderm.com/
https://www.noorderm.com/
00:00 – Introduction to the Fitzpatrick Skin Type Scale
00:35 – What the Fitzpatrick Scale actually measures
01:00 – Why skin tone and skin type are not the same thing
01:45 – Understanding Fitzpatrick Skin Type I
02:20 – Fitzpatrick Skin Type II explained
02:45 – Fitzpatrick Skin Type III explained
03:00 – Fitzpatrick Skin Type IV explained
03:10 – Fitzpatrick Skin Type V explained
03:20 – Fitzpatrick Skin Type VI explained
03:35 – How dermatologists use the scale in clinical practice
04:05 – Why patient history matters more than appearance alone
05:00 – The importance of discussing ethnicity before laser treatments
06:00 – Common misconceptions about tanning and sun exposure
07:20 – Tanning vs. burning: what's actually happening in your skin?
08:10 – How skin type affects sun protection recommendations
08:45 – Limitations of the Fitzpatrick classification system
09:10 – Emerging alternatives and newer skin classification methods
10:00 – How AI may help personalize skin analysis in the future
10:40 – The importance of diverse representation in dermatology research
11:30 – Why skin-of-color education is becoming increasingly important
12:00 – Should dermatology move beyond the Fitzpatrick Scale?
12:45 – The future of personalized skin assessments
13:20 – Why the Fitzpatrick Scale remains useful despite its limitations
14:00 – Final thoughts and key takeaways
14:40 – Closing remarks
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
56 - Skinside Out
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Dr. Zain Husain, MD: [00:00:00] Welcome to Skin Side Out. I'm your host, Dr. Zain, with Heather and Courtney. So today we're gonna be exploring the Fitzpatrick skin type scale from the inside out. So let's get right into it. So the Fitzpatrick skin scale, um, what is it?
Heather Murray, PA-C: So it's a classification system that we use. It was termed, um, or named after Dr.
Thomas Fitzpatrick, which, who was a dermatologist. Um, and this kind of creates a spectrum or a system that we use to classify, um, how likely is someone in, to burn or get ultraviolet radiation.
Dr. Zain Husain, MD: Yeah. And I know that we, uh, often use it to kind of almost imply, like, skin tone. Um, so that's not really what this, you know, scale measures.
So Courtney, what does it actually measure?
Courtney Carroll, LE: Um, yeah, I think there's a common [00:01:00] misconception that when you're looking at different Fitz types, uh, starting from type one to start, to type six, you're looking for the shade or tone of someone. So you might assume, you know, someone who is pale like me is, like, a type one or a two, and someone with darker skin types, maybe your African American patients are gonna be closer to type five or six.
But really it is measuring, um, how well you tan versus burn and what that exposure to UV looks like. So you know, it's funny, I think about one of our coworkers, um, she is Hispanic, and she's very pale, and if you were just solely going off- Mm ... of shades, um, you might say, "Oh, she's a two." Mm-hmm. But if you ask her, "Do you tan when you're exposed to the sun, or do you burn?"
And that will give you the true intel on really what type she is. Yeah. She'd actually be probably a four.
Dr. Zain Husain, MD: So let's go into the actual six skin types on the Fitzpatrick scale, what they actually mean. So let's start off with Fitzpatrick skin type one. I know that Courtney mentioned she might be-
classified as such. Um, I'm not so sure about that. [00:02:00]
Courtney Carroll, LE: I burn.
Dr. Zain Husain, MD: But you have a little bit of color to you. Yeah. Um, so let's go into skin type one.
Heather Murray, PA-C: Skin type one is, um, skin that always burns and very rarely tans. Um, you might also, like, if you get a wound, it's gonna turn red before it heals, whereas the darker skin types, um, or, like, Fitzpatricks four, five, and six, a wound might turn brown before it heals.
Um, so that's another way to kind of, like, help classify.
Dr. Zain Husain, MD: Yeah. And phenotypically we see this in fairer individuals, um, light hair, light eyes. Um, redheads especially, um, are often classified as type one. Blon- really blondes and blue-eyed, uh, individuals, um, they often fall into this category.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: Type two.
Courtney Carroll, LE: someone that usually burns, but they may tan, like, minimally. So I guess I'd probably, yeah, fall into that.
Heather Murray, PA-C: Yeah, me too
Dr. Zain Husain, MD: And [00:03:00] then type three
Heather Murray, PA-C: Type three is they, um, sometimes burn, but they will, um, kind of gradually fill in that tan
Dr. Zain Husain, MD: Okay. Four? .
Courtney Carroll, LE: rarely burns and tans easily.
Dr. Zain Husain, MD: Type five.
Heather Murray, PA-C: skin that rarely burns and tans deeply.
Dr. Zain Husain, MD: And finally, type six.
Courtney Carroll, LE: Almost never burns. Um, they are deeply pigmented.
Dr. Zain Husain, MD: So I find that there is some utility to this scale, um, especially when we are using it as a general way to stratify risk, right? So skin cancer risk, um, laser safety, we often, um, you know, think in skin types. Uh, sun sensitivity, and also other cosmetic treatments. However, it does have its limitations, right?
So especially in a world that is becoming more multicultural, um, a lot more mixed, um, you know, genotypes. So we're seeing a lot of, you know, different ethnicities, uh, coming [00:04:00] together. And even though a patient may look phenotypically like one skin type- Mm-hmm ... their skin may behave biologically like another, and that's why it's really important to get a good history.
Um, I often ask patients about their ethnic backgrounds. Mm-hmm. Um, and, you know, especially if they have, you know, some skin tones that I'm not entirely sure of. Like, you can't just assume- Mm-hmm ... um, because you do want your patients to be safe, especially with certain procedures.
Courtney Carroll, LE: Yeah.
Heather Murray, PA-C: Yeah, I think the issue with the Fitzpatrick's, um, system is that it, um, kind of went off of this idea of being a very, like, neat, linear spectrum, and it's definitely not that, that case.
Dr. Zain Husain, MD: Yeah. And initially it was actually used to, like, do studies for photosensitivity and burning. So it really wasn't intended to u- be used for that purpose of classifying patients. Um, so that's something that I always put in the back of my mind, um, when I'm doing a history.
Courtney Carroll, LE: Yeah. I, during all of my laser [00:05:00] hair consults, I will ask them, um, even regardle- uh, I will just straight out say, like, "What is your ethnicity?"
And it's so funny, sometimes people throw out, like, "I'm just white." And I'm like, "I know, but, like, let's break that down." Yeah. Like, what kind of white are you? Yeah. Like, are you, like- 'Cause Mediterranean- ... Eastern- ... or Southeast- Mediterranean. Exactly. Like, it, there could be a wide variety Or Northern
Dr. Zain Husain, MD: European.
Irish. Mm-hmm.
Courtney Carroll, LE: Yeah.
Dr. Zain Husain, MD: Scandinavian. So, like, there's a huge spectrum. Um, and oftentimes patients also, you know, self-report incorrectly.
Courtney Carroll, LE: Exactly. You know? So- And that's... I'll ask them secondly, like, out in the summer, like, do you find yourself, um, burning easily or do you find yourself tanning? And... 'Cause sometimes, you know, it, it's funny, like, um, even with said coworker earlier, sometimes, you know, on her skin type historically I will use a 1064, um, for laser hair removal, which is safe for all skin types.
But- Um, we weren't getting where we wanted to be. We did a couple test spots with the 755, which I would normally reserve for types one, two, maybe three, and, um, you know, we comfortably did it, and it went fine. But yeah, that's why you really wanna ask those questions before, um, you get something like laser.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: [00:06:00] And I have been fooled many a time, um, you know, when seeing a patient, and I could be convinced they have this particular, you know, background, and it was completely different.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: And then I- even know for myself, when patients look at me, um, sometimes they can't tell what I am. Mm-hmm. So, you know, could I be, you know, Middle Eastern?
Could I be South Asian? Could I be... I get Hispanic a lot. I get South American a lot. So, you know, it's just hard to sometimes determine that.
Heather Murray, PA-C: Mm-hmm.
Dr. Zain Husain, MD: And it's really important to really just evaluate and talk to our patients- Mm-hmm ... prior to doing anything.
Heather Murray, PA-C: Mm-hmm. I think sometimes there's this societal issue still where, like, people want to not brag, but, like, be able to tan easily.
Mm-hmm. And I feel like sometimes patients... Like, if I'll a- I'll ask them, like, "Do you tan easily?" And I'm, like, pretty sure their answer is no. Mm-hmm. But then they say yes, and I'm like, "Eh." Like, and then [00:07:00] that- that's when I typically ask the question about, like, when you get a wound- Mm-hmm ... does it turn brown, or does it turn red?
And then they'll say red. And I'm like, "Okay. Yeah, that's what I thought."
Courtney Carroll, LE: Yeah. I just think back of, like, my high school days where, like, all my friends would go out tanning, and l- my saving grace is really that I just burn so easily that- Yes. Yeah ... I never would go out
Heather Murray, PA-C: tanning. I feel like people think that that's tanning, but you're just, like- It's
Dr. Zain Husain, MD: burning
Heather Murray, PA-C: burning- Yeah, you're burning. ... to the point where you're, like, showing a little bit of color change.
Courtney Carroll, LE: Like, when people say, "Oh, you have to get your base tan," I'm like, "That's not
Dr. Zain Husain, MD: real."
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: And then that goes into the question, what is burning versus tanning? Yeah. Yes. Right? So tanning is, you know, this reaction that your skin has.
Um, it's basically melanin that's already in your melanocytes being distributed. Um, and that's usually a quicker process. A burn is actually when you have enough UV radiation damage to actually harm and damage the skin cells. That's why we see blisters. That's why we [00:08:00] see peeling- Mm-hmm ... erythema, redness.
So it's a very different type of reaction.
Heather Murray, PA-C: Mm-hmm. Mm-hmm.
Dr. Zain Husain, MD: Um, so how does this impact what we counsel our patients in terms of sun protection, and does it change anything?
Courtney Carroll, LE: I think it historically has. I mean, as we kind of touched on, the scale is being changed and reevaluated. I think it was very limiting, and I think people were using it more kind of, yeah, for that, like, toning or shade.
You can't look at one person and say, um, "Oh, you're a type four, so, like, you probably don't ever burn, and, like, let's just do this," or vice versa. Um, so I think it held importance. I think we are learning that there are different factors that we can use to correctly, um, you know, treat someone
Dr. Zain Husain, MD: better.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: And now there are, like, newer classification systems coming about, um, that maybe more accurately depict, um, these variances that we see between ethnicities and, you know, [00:09:00] their sk- how their skin behaves with sun exposure. Um, so there are a variety of them that are being developed, some that are already in, uh, practice and use.
And I feel like with more data, um, it's always probably more useful than kind of using, like, a generic, um, kind of scale, like the Fitzpatrick skin type scale, which wasn't even intended to, you know, classify patients based on their skin color.
Heather Murray, PA-C: Mm-hmm.
Dr. Zain Husain, MD: So, um, I, I, I'm glad that that's out there now and people are thinking about that because I think there will be a paradigm shift with how we will use that information for, you know, our skin treatments.
Heather Murray, PA-C: Yeah, I think it's something that we will still keep in mind, and it will still be clinically practical- Yeah ... but it will be adding to it- Mm-hmm ... to, um, to make our, um, clarifications more precise.
Dr. Zain Husain, MD: Yeah. And as we further understand the biology, um, of skin cells, [00:10:00] I feel like we will have more tools, especially with the advent of AI being so ubiquitous now.
We may be able to use some of those, um, algorithms and just analyze skin and kind of give some of those properties and characteristics once we have enough of that data. So I think that'd be cool.
Courtney Carroll, LE: Yeah, I think, yeah, like, touching on the data, I think, you know, historically, I think one misconception, and even further than just the Fitzpatrick scale, but one misconception is, um, if there's no data on something that it's inherently bad or inherently unsafe.
And, you know, I know we've talked about this a little bit with, um, you know, recently, like Accutane and doing, like, laser hair removal on Accutane. Like, some of the studies, I think it's interesting, like- There might not be studies, and not because it's unsafe or we shouldn't do it, but just because it hasn't been studied.
And especially when you look at, like, the history of our country and you think about, like, just the racial component, you know, a lot of Black patients weren't really seen as [00:11:00] patients in, specifically cosmetic patients until the last, like, you know, 10, 15 years. And so a lot of this, like, early on, um, like, research wasn't taking them into consideration.
And so I think, yeah, there's definitely a lapse in some of, like, the research that we've had, and hopefully that also kind of continues to improve to include more, you know, diversity.
Dr. Zain Husain, MD: Yeah, I've been really pleased to see more interest and advancement in skin of color, um, in respects to dermatology. And, you know, there are training programs where it's predominantly a Caucasian population.
Sometimes those residents don't even see, you know, pathology in darker skin types. So it's really important to be able to train our future physicians- Mm-hmm ... to understand that there's dif- different presentations with different skin types. And, um, it's, it's really good that they're emphasizing a lot in education now.
do you feel like having another classification system is helpful, or [00:12:00] should we not be looking at skin types in this way?
Heather Murray, PA-C: No, I think, I think it is helpful. Um, I think we should be looking at skin types in this way, but just thinking of it as, like, we can use that Fitzpatrick scale as a foundation, but-
Dr. Zain Husain, MD: Mm-hmm
Heather Murray, PA-C: there are lots of other things that are factored in to create this complete, um, profile for a patient.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: I was gonna agree. I think we shouldn't limit... I think, you know, the one thing about the Fitzpatrick scale to me has always been how limiting it is. Mm-hmm. Even just the fact of having six. I mean, it's funny, like, even when I think about people like my mom, who...
You know, I'd put her at, like, a 3.5. Mm-hmm. And, you know, I don't think the six- Mm-hmm ... is really quite enough to capture. Oh, yeah. I think you start putting people- Mm-hmm ... in these, uh, categories that doesn't accurately reflect, you know- Yeah ... their true type.
Dr. Zain Husain, MD: Yeah. And I think eventually there'll be probably some, like, genetic testing, like genome [00:13:00] sequencing, like, of, you know, skin cells to kind of really determine all these various characteristics that we see in skin, including, you know, propensity to burn or skin tone.
Um, 'cause they're two different things.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: Yeah. Yeah. Um, all right. So I think that this was a great discussion on, you know, the Fitzpatrick skin types. It is something that we hear a lot about in the dermatology world, but also now, like, on TikTok and YouTube, people are discussing skin types, and a lot of people don't know what they are.
Courtney Carroll, LE: People will ask. Yeah. I get a lot of people that ask me.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: And what- Yeah. I'm like, "I don't even wanna go there." Like, you know?
Dr. Zain Husain, MD: Yeah. So I... It is helpful as a framework, but there are a lot of different factors, um, regarding your skin health that we, um, look into, and there's also different properties, right?
So, like, we're looking at, you know, oily- Mm-hmm ... combination or dry skin and other, you know- Mm-hmm ... various other characteristics. So, um, I think that it is important to know [00:14:00] this because I don't think it's gonna disappear. Yeah. I think it's very well entrenched into our vocabulary and how we understand skin, but we also have to understand the limitations, and, um, that will allow you to get a better picture of how to treat your skin and being safe.
Courtney Carroll, LE: Yeah. I- Mm-hmm. You know, it's funny. I used to work with a dermatologist who, during all of her skin checks, she would type people, but she never asked- Mm-hmm ... those questions. Like, she would just tell us- Just look at the person ... two through, you know? Yeah. And, like, looking back, I'm like, "Eh." Like
Heather Murray, PA-C: Yeah. Yeah. I don't
Courtney Carroll, LE: like that.
Heather Murray, PA-C: It's definitely becoming more personalized.
Courtney Carroll, LE: Yeah.
Dr. Zain Husain, MD: Mm-hmm.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: Yeah. All right. So that is the Fitzpatrick skin type scale. Um, I hope you enjoyed this episode. Um, please like, follow, ask any questions that you may have, and until next time, skin side
Heather Murray, PA-C: out. [00:15:00]