Fitzpatrick Skin Types—The Method and The Man Behind It

When performing laser procedures, the first step is determination of the patient’s Fitzpatrick skin type. This concept will not only ensure efficacy of procedures such as laser hair removal, but more importantly, safety, especially in the Fitzpatrick 4-6 skin types.

I am always interested in the historical significance of an idea or a method. Who was Fitzpatrick? Was he a dermatologist? A teacher? Why were the skin types developed initially? How does one take a concept, and make it simple and easy for everyone to understand?

Thomas B. Fitzpatrick, M.D., PhD was a dermatology professor at Harvard who wanted to determine safety prior to PUVA (psoralen +UVA therapy) for psoriasis patients. With the advent of cutaneous laser therapy, Dr. Fitzpatrick became a household name in the aesthetic industry for his Fitzpatrick scale. He was the first to create a system which could easily and consistently classify the amount of melanin a person’s skin cells could produce. With increasing melanin production comes an increase in UV resistance and a decrease in skin cancer risk.

However, the same melanin which becomes more protective with the higher Fitzpatrick types inversely becomes riskier with laser procedures due to thermal energy (heat) produced as a byproduct. Harnessing this thermal energy with particular devices can effectively produce desirable results such as new collagen formation (a process known as neocollagenesis), but it can also induce complications such as blistering, hyperpigmentation, permanent discoloration and scarring. Thus, it is critical to properly assess a patient’s proper Fitzpatrick skin type before initiating laser or light therapy.

Who was this persona whose legend lives on each day in the world of aesthetic medicine? I was curious to know more. Yes, he was a dermatologist and a professor who wrote multiple textbooks and scientific publications, and taught many students. His obituary listed incredible accomplishments than less than 1% of us will ever achieve.

But I believe John A. Parrish, M.D.  said it best when he described his former teacher in the Archives of Dermatology “Fitzpatrick never removed himself from the front lines of patient care. He consulted and taught in both inpatient and outpatient settings and had an unrestricted, busy, non-superspecialized practice of general dermatology. Until weeks before his death, Dr. Fitzpatrick treated difficult problem cases referred from dermatologists all over the world and his own very loyal patients. He delivered primary care one on one, facing cosmetic blemishes and very sick patients with serious systemic illness. He consulted his textbook in front of patients, examined scrapings from scaly toes, performed biopsies, learned and tried new treatments, and looked at microscopic slides himself. He never refused to see any patient any time with any student or doctor.”

“Fitzpatrick's most contagious traits were his childlike curiosity and his genuine joy of work, wonderful gifts that were spread to dermatologists throughout the world during his half-century of dedicated service. His leadership is measured not so much by the number of people he led but by the number of leaders he created.”

Parrish’s description of Fitzpatrick reminds me of so many of my professors along my journey of education. Dr. Fitzpatrick left us a legacy, and provides a way to help our patients achieve safe and effective outcomes in the fields of dermatology and aesthetic medicine. As we classify our patients correctly according to the method he created, let it be a gentle reminder it is a privilege and an honor to care for our patients each day.