Fitzpatrick classification: the different skin phototypes.

Designed in 1975 by American dermatologist Thomas FITZPATRICK, a professor at Harvard University, the Fitzpatrick classification was initially developed to assess the skin’s response to UV radiation and better understand the risks of sunburn. This scale is based on the principle that an individual’s skin and eye colour can predict their reaction to sun exposure. FITZPATRICK thus established an objective system for quantifying individual sensitivity to UV radiation, drawing on clinical observations of tanning and redness following exposure.

The Fitzpatrick classification places the role of melanin, the skin pigment that serves as a natural shield against UV radiation. Produced by melanocytes, it is transferred to keratinocytes in the form of melanosomes, small pigmented structures that accumulate above the nucleus of skin cells. This strategic arrangement forms a photoprotective barrier that absorbs and scatters a portion of UV rays before they reach cellular DNA. The greater the amount of eumelanin, a dark brown pigment, the more effective this protection. Conversely, pheomelanin, a pigment characteristic of fair skin, provides less defence.

The Fitzpatrick scale comprises six phototypes, ranging from phototype I, corresponding to very fair skin that always burns without tanning, to phototype VI, characterising very dark skin, naturally protected against UV rays.

The Fitzpatrick scale thus relies on the skin’s responsiveness to sunlight, specifically on the quantity and nature of the melanins it produces. Depending on this biological reaction, phototypes are grouped into three main categories: melano-compromised, melano-competent and melano-protected. This classification reflects human pigmentary diversity, but also the degree of natural photoprotection conferred by melanin against UV radiation.

Melano-compromised phototypes: limited protection against sunlight.

So-called melano-compromised skin types produce very little melanin, primarily pheomelanin, a light, poorly protective pigment that favours the appearance of freckles. These phototypes are prone to sunburn and almost never tan.

• Phototype 1: very fair skin, often ivory, with red or very pale blonde hair and blue, green or grey eyes. It never tans and always burns, as its UV defence capacity is minimal.

• Phototype 2 : fair or pale complexion, blonde to chestnut hair and blue, green or grey eyes. It tans poorly and remains prone to sunburn, although slightly more resistant than phototype 1.

Melano-competent phototypes: an intermediate adaptation.

These skins have more efficient melanocytic activity and can produce a higher proportion of eumelanin, the protective brown pigment. They remain sensitive to UV radiation but can tan gradually.

• Phototype 3 : fair skin with golden undertones, light chestnut to dark blonde hair, hazel or light brown eyes. The skin burns moderately but tans slowly.

• Phototype 4 : olive or light brown skin, dark brown hair and eyes. This skin type tans readily and is seldom sunburnt.

Melano-protected phototypes: a robust pigmentary defence.

Melano-protected skin types produce large amounts of eumelanin. They exhibit excellent sun tolerance and a minimal risk of sunburn.

• Phototype 5 : dark to very dark brown skin, dark hair and dark eyes. It tans rapidly and tolerates sun exposure well.

• Phototype 6 : very deeply pigmented skin, ranging from dark brown to black, with black hair and black eyes. This phototype never experiences sunburn and does not exhibit freckles.

Even though they have naturally better protection, individuals with darker skin should not underestimate the sun’s hazards and the risk of skin cancer, nor neglect photoprotection : the application of sunscreen, wearing protective clothing and seeking shade during the hottest hours, etc....

The Fitzpatrick scale is a clinical reference for predicting the skin’s response to UV radiation and for adapting aesthetic and medical protocols.

In dermatology, the Fitzpatrick classification is primarily used to assess the risk of photoageing and skin cancer, which directly depends on the amount and quality of melanin in the skin, the pigment that absorbs and scatters UV rays, thereby reducing oxidative damage to keratinocytes. Thus, fair skin (phototypes I to III), low in eumelanin, has a lower minimal erythemal dose (MED) and consequently greater sun sensitivity, increasing their risk of melanoma or carcinoma. Conversely, phototypes IV to VI benefit from more effective natural photoprotection, limiting premature sun-induced ageing and the risk of skin cancer, although not eliminating it.

The Fitzpatrick classification is also a reference tool for phototherapy, a medical technique that involves exposing the skin to a source of ultraviolet radiation for therapeutic purposes. Phototherapy is notably used to manage psoriasis, the vitiligo and certain forms of eczema. Phototypes I to III, more sensitive to UVB, require low doses (around 20 to 40 J/cm²) with a very gradual increase over successive sessions to avoid inflammatory reactions or burns. Conversely, phototypes IV to VI exhibit better tolerance to ultraviolet light and can receive higher doses, sometimes around 60 J/cm².

In aesthetic practice, the Fitzpatrick scale can also assume a certain importance. Before laser hair removal, a chemical peel or dermabrasion, the phototype enables the assessment of hyperpigmentation risks, to which darker skin types are particularly susceptible. Similarly, the Fitzpatrick classification helps to evaluate tolerance to depigmenting agents, such as hydroquinone.

Despite its relevance and international recognition, the Fitzpatrick classification has several methodological and biological limitations that call its accuracy into question. One of the main criticisms concerns its inability to faithfully represent the true global diversity of skin tones, particularly the darkest complexions. Indeed, the scale relies on a linear view of pigmentation from very light (type I) to very dark (type VI), assuming that darker skin always tans and almost never burns. However, it is a dangerous shortcut.

Contrary to what the Fitzpatrick classification may suggest, black skin can also suffer from sunburn. Although melanin plays an essential photoprotective role, it does not provide complete protection against UV-induced damage, especially during prolonged or intense exposure. Thus, individuals with Fitzpatrick phototypes V or VI can develop erythematous lesions or even cumulative photodamage, yet these manifestations are often underestimated or poorly recognised by both patients and some healthcare professionals. This false sense of security among individuals with darker skin has significant clinical consequences. Believing they are not at risk from sun exposure, many neglect sun protection and do not check their moles, a behaviour that contributes to increased mortality from skin cancer in darker-skinned populations.

Furthermore, with increased migration and genetic mixing, these biases have become even more problematic. The Fitzpatrick system, founded on a predominantly Eurocentric categorisation, can no longer reflect the genetic and pigmentary complexity of contemporary populations. Phototypes V and VI, added subsequently to include Asian, Indian and African skin tones, are insufficient to account for intra-group variability – namely the multiple hues and cutaneous reactivities exhibited by individuals within the same category.

Modern dermatology today aims to move beyond this approach by developing more inclusive and quantitative models, incorporating objective measures of pigmentation, UV sensitivity, and cutaneous inflammatory response. The aim is to better tailor medical and aesthetic care and interventions to the biological reality of each individual’s skin — rather than to a pigmentary typology inherited from the 1970s which, although interesting, remains incomplete.

The Fitzpatrick classification remains a useful tool but must be supplemented by a more inclusive and individualised approach to reflect the true diversity of skin types.

• SACHDEVA S. & al. Fitzpatrick skin typing: Applications in dermatology. Indian Journal of Dermatology, Venereology and Leprology (2009).

• SHARMA V. K. & al. Skin typing: Fitzpatrick grading and others. Clinics in Dermatology (2019).

• SERENA T. & al. Skin pigmentation impacts the clinical diagnosis of wound infection: Imaging of bacterial burden to overcome diagnostic limitations. Journal of Racial and Ethnic Health Disparities (2023).