The Validity and Practicality of Sun-Reactive Skin Types I Through VI
1988/06/01 by Thomas B. Fitzpatrick · 3,365 citations
Immunology and Microbiology · Medicine · Neuroscience · #Biology #Dark skin #Dermatology #Genetics #Medicine #Methoxsalen #Olfactory and Sensory Function Studies #Optics #PUVA therapy #Phototoxicity #Physics #Psoriasis #Psoriasis: Treatment and Pathogenesis #Skin Protection and Aging #Ultraviolet
paper · doi:10.1001/archderm.1988.01670060015008
published in Archives of Dermatology 124(6), 869 (American Medical Association)
openalex publication_date 1988/06/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/05
Abstract
The concept of sun-reactive "skin typing" was created in 1975<sup>1</sup>for a specific need: to be able to classify persons<i>with white skin</i>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).<sup>2</sup>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/cm<sup>2</sup>. 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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