North Texas Research Forum 2025

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Division

North Texas

Hospital

Medical City Fort Worth

Specialty

Dermatology

Document Type

Poster

Publication Date

2025

Keywords

skin pigmentation, race, ethnicity, skin color, comparison, Fitzpatrick scale

Disciplines

Dermatology | Medicine and Health Sciences | Skin and Connective Tissue Diseases

Abstract

Introduction: The Fitzpatrick skin scale has long been used as a proxy for skin tone categorization. However, its initial creation was to classify reactivity of white skin to ultraviolet A radiation. A reported one-third of dermatologists conflate the Fitzpatrick skin scale for race and ethnicity. Approximately half of the dermatologists also reported utilizing the Fitzpatrick scale to describe skin color. The goal of this study was to compare the Fitzpatrick scale to skin color and ethnicity in a larger, cohort including the full spectrum of skin tones. Methods: Subjects completed a standardized questionnaire. The questionnaire encompassed subjective classification methods: self-reported skin color descriptors (very fair, fair, olive, light brown, dark brown, and very dark), self-assessed Fitzpatrick skin type (I-VI) and ethnicity. The questionnaire included the following ethnicities: White, Asian, African American or Black, Hispanic or Latino, Native Hawaiian or Pacific Islander, Multiple Ethnicities, and Other. If more than one ethnicity was chosen, the subject was reported as “multiple ethnicities.” Chi-squared tests were performed comparing skin color and ethnicity to Fitzpatrick skin type. Results: 440 subjects completed the questionnaire. Chi squared test revealed that each Fitzpatrick type was composed of significantly different proportions of skin colors (p < 2.2e-16). There was a weak association between Fitzpatrick type and self‐described skin color (Cramér’s V=0.3). While there is a significant difference in the percentage of each ethnicity found in each Fitzpatrick type (p < 2.2e-16), each ethnicity could not be modeled off individual Fitzpatrick types. There was representation from all ethnicities in each Fitzpatrick type. There was a weak association between Fitzpatrick-type and ethnicity (Cramér’s V=0.3). Conclusion: This study confirms previously cited flaws of the Fitzpatrick scale. Our study found no statistically significant proportion of a singular skin color descriptor or ethnicity within each Fitzpatrick skin type. This serves as emphasis that there is no relationship between physical traits or cultural identity with the Fitzpatrick scale.

Original Publisher

HCA Healthcare Graduate Medical Education

Investigating the Relationship Between Skin Color, Ethnicity, and the Fitzpatrick Skin Scale

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