Embracing diversity: New skin type system addresses procedures for treating skin of color

Key Points

Rancho Mirage, Calif. - As the presence and diversity of ethnic skin of color (SOC) continue to grow worldwide, an expert says a more comprehensive skin-type classification system will help dermatologists predict these patients' response to dermatologic procedures.

"SOC has been increasingly integrated into the core curriculum in dermatology residency training programs and educational venues," Dr. Roberts says.

Mixed skin types

But to date, Dr. Roberts says that with regard to mixed skin types, "There's been a disconnect between the phenotype or the exterior appearance and the ability to predict the possible complications of that mixed skin type, which is not addressed in the concept of the six photo skin types" recognized by the popular Fitzpatrick skin type classification system.

"It's worked for many years. However, Fitzpatrick scores do little to predict the skin's response to trauma from certain procedures such as laser therapy and surgery," she says. Additionally, she says the Fitzpatrick system is "a tad misleading, because all skin types - even those classified as a Fitzpatrick VI - are susceptible to burning from UV radiation. The bottom line is, black skin tans and burns."

Similarly, she says the Glogau wrinkle evaluation scale and the Baumann Skin Type Indicator (Baumann L. Dermatol Clin. 2008 Jul;26(3):359-73, vi) don't address skin responses to dermatologic procedures. Therefore, Dr. Roberts has introduced a skin type classification system that she says accounts for all the factors required to keep patients with ethnic SOC safe with regard to dermatologic procedures (Roberts WE. J Drugs Dermatol. 2008 May;7(5):452-6).

Dr. Roberts' system includes Fitzpatrick skin type (F) and the Glogau wrinkle scale (G), plus additional scales for quantifying a patient's risks of hyperpigmentation (H) and scarring (S). The latter scales each include six grades: from H0 (denoting a risk of hypopigmentation) to H6 (severe, permanent hyperpigmentation) and S0 (atrophy) to S5 (keloidal nodule). Using this system, a 40-year-old black and Irish female would have skin type F4, H2, G0, S3. "So she burns minimally, tans well, has minimal and permanent hyperpigmentation, no photoaging and may experience hypertrophic scarring."

Because black skin burns and white skin scars, says Dr. Roberts, "Who knows what skin color in between will do? There is much work to be done. Skin color and ancestry alone cannot predict a patient's response to skin trauma."