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The Validity and Practicality of Sun-Reactive Skin Types I Through VI

Thomas B. Fitzpatrick, MD
Arch Dermatol. 1988;124(6):869-871. doi:10.1001/archderm.1988.01670060015008.
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The concept of sun-reactive "skin typing" was created in 19751 for a specific need: to be able to classify persons with white skin in order to select the correct initial doses of ultraviolet A (UVA) (in joules per cubic centimeter) in the application of the then newly developed technique for the treatment of psoriasis—oral methoxsalen photochemotherapy (PUVA).2 The need arose as a result of experience with several patients who were a "dark" phenotype (brown or even black hair, and some with brown eyes) but, to our surprise, developed severe phototoxic reactions following oral ingestion of 0.6 mg/kg of methoxsalen and then, two hours later, were exposed to 4 to 6 J/cm2. These initial doses were obviously too high, and it was then understood that the estimation of the white-skinned person's tolerance level to oral PUVA could not be based solely on the phenotype (hair and eye color).

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