Study Highlights Gaps in Fitzpatrick Skin Type Determination

Key Takeaways

• Providers and patients agreed on Fitzpatrick Skin Type (FST) 84% of the time; discrepancies were in borderline classifications.
• Male patients and patients with darker skin tones showed higher rates of misclassification.
• Dermatologists should independently verify FST and provide education to improve accuracy in sun sensitivity assessment.

New research published in The Journal of Clinical and Aesthetic Dermatology evaluated concordance between self-assessed and provider-determined Fitzpatrick skin types (FSTs).

Study researchers conducted the analysis of 472 patients attending a dermatology practice and included data from questionnaires and professional evaluations to determine FST. They created a voluntary patient survey to collect patient information on patient demographics and skin reaction to the sun (burning vs. tanning, intensity of redness, irritation, tenderness, itching, and darkening). 

The analysis revealed an overall agreement of 84% between patients and providers. Discrepancies primarily occurred in borderline classifications (such as distinguishing between FST II and III or FST III and IV). According to the results, patients more often underestimated their risk of sun sensitivity, potentially underreporting tendencies to burn. Demographic variables influenced accuracy. Male patients and those with darker skin tones (FST IV–VI) showed greater discrepancies in self-assessment compared to lighter skin tones (FST I–III). These differences underscore the need for provider intervention in guiding sun protection and other dermatologic recommendations.

"It is without surprise that the results of our study support more recent calls for updated methods of skin type assessment. The incongruencies between provider-determined FST and our patient’s understanding of their burn/tan risk highlight the problems faced when utilizing the scale as a surrogate solely to describe patient skin color," the authors wrote. "Until better methods for stratifying skin color and sun exposure are developed, extreme caution must be used to prevent the misuse and overgeneralization of the FST scale. Even with its inherent flaws, the accuracy of the tool can be bolstered when used appropriately. Trainees should be reminded that it is patient-guided responses that ultimately determine FST. This, alone, should be used to guide clinical decision making when necessary."

Source: Bhanot A, et al. Journal of Clinical and Aesthetic Dermatology. 2024;17(12):18–22.