Fitzpatrick classification: the different skin phototypes.

Designed in 1975 by American dermatologist Thomas FITZPATRICK, a professor at Harvard University, the Fitzpatrick classification was originally 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 a person’s skin and eye color can predict their reaction to sun exposure. FITZPATRICK thus established an objective system to quantify individual sensitivity to UV rays, based on clinical observation of tanning and redness after exposure.

The Fitzpatrick classification places at its core the role of melanin, the skin pigment that serves as a natural shield against UV rays. 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 creates a photoprotective barrier that absorbs and scatters part of the UV radiation before it reaches cellular DNA. The more eumelanin—a dark brown pigment—the skin contains, the more effective this protection. Conversely, pheomelanin, a pigment characteristic of lighter skin, offers less defense.

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

The Fitzpatrick scale is thus based on the skin’s responsiveness to sunlight—and more precisely on the amount and type of melanin it produces. Depending on this biological response, phototypes are grouped into three main categories: melano-compromised, melano-competent, and melano-protected. This classification reflects human pigment diversity, but also the degree of natural photoprotection conferred by melanin against UV rays.

Melano-compromised phototypes: reduced protection against sun exposure.

So-called melano-compromised skin produces very little melanin, primarily pheomelanin, a light, poorly protective pigment that promotes the appearance of freckles. These phototypes burn easily in the sun and almost never tan.

• Phototype 1: very fair skin, often ivory in tone, with red or very pale blonde hair and blue, green, or gray eyes. It never tans and always burns because its defense capacity against UV radiation is minimal.

• Phototype 2 : fair or light-colored skin, blonde to light brown hair, and blue, green, or gray eyes. It tans poorly and remains susceptible to sunburn, although slightly more resistant than Phototype 1.

Melano-competent phototypes: an intermediate adaptation.

These skin types exhibit more efficient melanocyte activity and can produce a higher proportion of eumelanin, the protective brown pigment. They remain sensitive to UV radiation but can gradually develop a tan.

• Phototype 3 : skin is light with golden undertones, hair ranges from light brown to dark blonde, eyes are hazel or light brown. It is moderately susceptible to sunburn, but tans slowly.

• Phototype 4 : olive or light brown skin, dark brown hair and eyes. This skin phototype exhibits easy tanning and infrequent sunburn.

Melano-protected phototypes: a robust pigmentary defense.

Melano-protected skin types produce large quantities of eumelanin. They exhibit excellent solar tolerance and have a minimal risk of sunburn.

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

• Phototype 6 : highly pigmented skin, dark brown to black, black hair and eyes. This phototype never burns and does not develop freckles.

Although they are naturally better protected, individuals with darker skin should not underestimate the dangers of sun exposure and the risk of skin cancer, nor neglect photoprotection : applying sunscreen, wearing protective clothing, and seeking shade during the hottest hours of the day, etc...

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

In dermatology, the Fitzpatrick classification is primarily used to assess the risk of photoaging and of 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-skinned individuals (phototypes I to III), low in eumelanin, have a lower minimal erythema dose (MED) and thus greater sun sensitivity, increasing their risk of melanoma or carcinoma. Conversely, phototypes IV to VI enjoy more effective natural photoprotection, limiting premature sun-induced aging and the risk of skin cancer, although it does not completely prevent it.

The Fitzpatrick classification is also a reference tool for phototherapy, a medical technique involving exposure of the skin to a source of ultraviolet radiation for therapeutic purposes. Phototherapy is commonly used to manage psoriasis, the vitiligo and certain forms of eczema. Phototypes I through III, which are more sensitive to UVB, require low doses (approximately 20 to 40 J/cm²) with very gradual increases across sessions to avoid inflammatory reactions or burns. Conversely, phototypes IV through VI show greater tolerance to ultraviolet light and can be treated with higher doses, sometimes around 60 J/cm².

In aesthetic medicine, the Fitzpatrick scale can also be of particular importance. Before laser hair removal, chemical peels, or dermabrasion, phototype allows evaluation of the risks of hyperpigmentation, to which darker skin types are particularly prone. Likewise, the Fitzpatrick classification helps evaluate tolerance to depigmenting agents, such as hydroquinone.

Despite its relevance and international recognition, the Fitzpatrick classification presents several methodological and biological limitations that call its accuracy into question. One of the main criticisms leveled against it is its inability to faithfully represent the true diversity of skin tones worldwide, particularly the darkest complexions. Indeed, the scale relies on a linear spectrum of pigmentation ranging from very fair (Type I) to very dark (Type VI), assuming that darker skin tones always tan and almost never burn. Yet, this is a dangerous oversimplification.

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

Furthermore, with increasing migration and genetic mixing, these biases become even more problematic. The Fitzpatrick system, based on a primarily Eurocentric categorization, no longer manages to reflect the genetic and pigmentary complexity of contemporary populations. The later-added phototypes V and VI—introduced to include Asian, Indian, and African skin tones—are insufficient to cover intragroup variability, meaning the multiple shades and skin reactivities exhibited by individuals within the same category.

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

The Fitzpatrick classification remains a useful tool but must be supplemented by a more inclusive and individualized approach to accurately 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).