How To Confidently Treat All Skin Tones on the Fitzpatrick Scale

How To Confidently Treat All Skin Tones on the Fitzpatrick Scale
The Fitzpatrick scale, which was created in 1975 by Dr. Thomas Fitzpatrick, continues to be used to measure how different skin reacts to UV radiation.

As estheticians, we are responsible for helping all skin types and conditions. But, sometimes I find we forget to properly incorporate our clients’ Fitzpatrick type into the treatments, advice and home-care recommendations we give. This might also be that many estheticians are not very confident working with all Fitzpatricks.

In my experience, we are all really good at mastering Fitzpatrick types most similar to our own (because we know what works there), but have a harder time exercising our experience and knowledge on the other end of the scale. Knowing how to work on skin of all shades and colors is, in my opinion, an imperative part of being a good esthetician and skin advisor.

As a refresher course, skin comes in a large variety of color shades, mostly derived from genetics and place of origin. The Fitzpatrick scale, which was created in 1975 by Dr. Thomas Fitzpatrick, continues to be used to measure how different skin reacts to UV radiation.


Related: Treating Hyperpigmentation in Multicultural Skin Types

Melanin, a substance produced by melanocyte cells in the Stratum Germinativum, is the key to unlocking this color, along with our hair and eye color. Its main function is to protect us from the sun by absorbing harmful UV radiation by producing pigment onto the skin’s surface. In those of us with darker skin, there tends to be more melanin produced, which by many is believed to be determined from our ancestral place of origin.

Generally speaking, darker skinned individuals’ ancestry can be commonly traced to sunnier and warmer climates, where genetics and DNA adapted to produce more melanin to protect the body from UV damage. Vice versa, we tend to see lighter-skin tones having much more northern, or less sunny ancestral origins, that helped these individuals adapt to these darker climates.

So how does this affect the way we treat different Fitzpatrick types? Based on your client’s skin tone, there may be more risks associated with certain treatments and skin care strategies. Ensuring you know these risks helps you avoid further skin damage on your clients, and aids in choosing the right ingredients and treatments best equipped for addressing their concerns.

Higher Fitzpatricks and Pigmentation Risks

Much of what we do as estheticians has to do with exfoliation, various stimulation methods and even controlled skin injury (chemical exfoliation, microdermabrasion, microneedling, etc) to achieve the results our clients desire. When we do this, we are hoping to increase microcirculation and initiate our skin’s natural healing and rejuvenating processes. But, this can also easily stimulate that multi-phase chain reaction of melanocyte activity and melanin distribution to our keratinocytes. So when working with darker-skinned individuals (think III and up), it is very important to be cautious with more stimulating treatments and ingredients.

Today we have a much larger arsenal of products and treatments appropriate and safe for our higher Fitzpatricks, but I always advise taking a conservative approach with all treatments that are potentially more risky. Application-wise, this means spending enough time prepping your client’s skin before performing stimulating treatments, or skipping more aggressive menu items at your clinic. It is also very important to educate your client on why that extra prep and/or avoidance is important for their skin goals. So in lieu of lasers, microdermabrasion, microneedling and advanced chemical peels, look for no downtime peels, LED acne light treatments and targeted anti-age electrotherapy like ultrasonic and microcurrent.

It is also important to get all your darker-skinned clients into tyrosinase inhibitors and/or melanin suppressants, which block certain phases of the melanogenesis pigmentation process, like blocking the enzyme tyrosinase from continuing to produce the melanosomes for the keratinocytes.

Ingredients like stabilized L-ascorbic acid, arbutin, kojic acid, azelaic acid, mulberry extract and tranexamic acid are some of my favorite ingredients to incorporate into a daily home care regimen before any treatment I perform on darker-skinned clients. It is also a good practice to use these ingredients to prevent more simple things like cuts, scrapes, bruises, tattoos, etc. from misfiring melanin as an immune response.

Related: Effective Treatments for Darker Skin Tones

Lower Fitzpatricks and Advanced Aging/Cancer Risks

Lower Fitzpatricks like myself (I’m straddle between a I and II) have much less melanin, which makes it easier for sun damage to occur in our skin. This can lead to all forms of advanced aging symptoms like dehydration, fine lines and wrinkles, loss of elasticity and collagen and hyperpigmentation. These individuals can also have a tendency to be more sensitive or sensitized while also being at a higher risk for certain skin cancers. And while daily sunscreen usage is imperative for any FItzpatrick type, your lower Fitzpatricks will need to be drilled with sun protection best practices and proper antioxidant and hydration practices to slow the aging process. 

For the large majority of my light-skinned clients, I am constantly infusing them with topical hydrators and emollients, while giving their skin plenty of antioxidants and UV protection ingredients like stabilized vitamin C, vitamin E and many B vitamins. I love to give these clients “protective” treatments that really help the skin barrier remain strong and energized.

While all skin is unique and different depending on your client’s genetics, lifestyle, health history, age, etc., it is still important to know your different Fitzpatrick types to ensure you’re incorporating thoughtfulness about various risks in their skin care strategies. This will only help you become a better esthetician, avoid unnecessary risks and help your clients reach and exceed their goals.

Emily Trampetti is a multi-state licensed esthetician, skincare expert and founder of Skin Property Virtual Esthetics. After successfully owning and running her spa in Chicago, she decided to expand virtually with her proprietary skin coaching program, which now supports clients from over 15 states, Puerto Rico and Europe. Her mission is to empower her clients to finally feel in control of their skin and reach their goals through personalized skincare, tailored education and lifetime empowerment. 

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