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Original Investigation |

Accuracy of Self-report in Assessing Fitzpatrick Skin Phototypes I Through VI

Steven Eilers, BA1; Daniel Q. Bach, MD, MPH1; Rikki Gaber, BS1; Hanz Blatt, MA1; Yanina Guevara, BA1; Katie Nitsche, MS1; Roopal V. Kundu, MD1; June K. Robinson, MD1
[+] Author Affiliations
1Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Dermatol. 2013;149(11):1289-1294. doi:10.1001/jamadermatol.2013.6101.
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Importance  Determining Fitzpatrick skin phototypes (FST) allows physicians to assess a person’s risk of developing sunburn and, by extension, the need for sun protection to prevent the development of skin cancer. Reflectance spectrophotometry objectively measures the melanin index and can assist in determining the accuracy of self-report of FST compared with dermatologist-determined FST.

Objectives  To assess whether self-reported or dermatologist-determined FST is more accurate in identifying a participant’s FST for FST I through VI and to assess the relevance of the burning and tanning measures for a range of skin types among ethnically diverse participants.

Design and Setting  A convenience sample of participants in an observational study from June 2, 2010, through December 15, 2010, at an ambulatory academic dermatologic practice and employee health center in an urban city.

Participants  Participants, staff, and students of Northwestern University, who self-identified as being non-Hispanic white, Hispanic or Latino, Asian or Pacific Islander, or black.

Main Outcomes and Measures  Melanin index as measured with reflectance spectrophotometry compared with dermatologist- and participant-determined FST.

Results  Forty-two percent (114 of 270) of the participants’ responses to the burning and tanning questions could not be classified using standard FST definitions. The spectrophotometry measurements for dermatologist-determined FST were significantly different for FST III and IV (P < .001) and FST IV and V (P < .001). The spectrophotometry measurements for participant-determined FST were significantly different for FST III and IV (P < .001) but not for FST IV and V (P = .90). Participant responses to burning and the dermatologist-determined FST were significantly correlated (Spearman ρ, 0.764; P < .001). Participant responses to tanning and the dermatologist-determined FST were not significantly correlated (Spearman ρ, 0.089; P = .15). Spectrophotometry measurements assessing FST were statistically significantly different for FST III through VI (P < .001).

Conclusions and Relevance  Dermatologist-determined FST is more accurate than self-report for FST III through VI. Rephrasing the questions using specific descriptors that have meaning to people with skin of color, such as skin irritation, tenderness, itching, or skin becoming darker, may allow physicians to more accurately assign a skin phototype and, by inference, assess the risk of these participants developing skin cancer.

Trial Registration  clinicaltrials.gov Identifier: NCT01124513

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Figures

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Figure 1.
Dermatologist-Determined Fitzpatrick Skin Phototype (FST) vs Spectrophotometric Melanin Index

Mean values were measured by the spectrophotometer with 95% CIs.

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Figure 2.
Participant-Determined Fitzpatrick Skin Phototype (FST) vs Spectrophotometric Melanin Index

Mean values were measured by the spectrophotometer with 95% CIs.

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Figure 3.
Fitzpatrick Skin Phototype (FST) Determined From Participant Self-report of Sunburn vs Spectrophotometric Melanin Index (A) and Tanning vs Spectrophotometric Melanin Index (B)

Mean values were measured by the spectrophotometer with 95% CIs.

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