Looking Fit 02/2005: Skin Typing 2005

by Patricia Reykdal and Donald L. Smith

Mother Nature has provided us with three separate ways to avoid overexposure to ultraviolet radiation (UVR). Overexposure is defined as a dose of UVR sufficient to cause a sunburn that can damage the skin. [Note: Exposure is defined as a dose of UVR below the level necessary to cause a sunburn, and underexposure to UVR is defined as a dose of UVR too low to stimulate the production of vitamin D and melanin.]

The three natural ways of preventing sunburn are constitutive pigmentation, facultative pigmentation and sunburning.

Sunburning. The sometimes painful process of sunburning is the first natural way people have to protect their DNA from damage. The redness and swelling associated with a sunburn all serve to protect humans from further acute damage from UVR and is Mother Nature’s way of letting us know that we haven’t been very smart.

Constitutive Pigmentation. Constitutive pigmentation is a person’s natural skin color and it is based upon his or her genetic heritage. As a rule of thumb, the darker a person’s natural skin color, the greater his or her protection from overexposure to UVR; it provides the only permanent means of photoprotection. Individuals who are Skin Type 0s (albinos), who have no protective pigmentation, and Skin Type 1s (the most UVR-sensitive Caucasians), who are genetically incapable of developing protective pigmentation, have the highest relative risk of sunburning; therefore, these individuals must wage a lifelong battle against the sunburning power of UVR by utilizing sun avoidance, protective clothing and sunscreens.

Facultative Pigmentation. Facultative pigmentation—better known as a “tan”—is a person’s level of acquired (adaptive) protection to UVR above and beyond their natural (constitutive) protection. [Note: A tan (and the accompanying thickening of the skin) provides protection equivalent to an SPF 3 to SPF 6 sunscreen.] This means protection from UVR is transitory since a tan darkens or fades in direct response to whether the person is exposed to UVR.

There are at least three reasons why tanning salons should utilize a standardized questionnaire to determine the skin type of all of their new clients.

1. Because the FDA policy statement dated Aug. 21, 1986, states that “Since the UV radiation dose that causes a barely discernible pink coloration (minimal erythemal dose or MED) is not the same for different skin types, the exposure schedule for first-time users will depend on the skin type of the user.” [Note: The problem is that the FDA has been silent for 19 years and has not clarified what it meant by this statement or offered guidance as to how skin-typing should be accomplished; that task has been left up to the indoor tanning industry.]

2. Because our common sense tells us that we must, at the very least, screen out Skin Type 1 individuals.

3. Because by knowing the skin type of your clients (i.e., determining their level of constitutive pigmentation), you can help them develop and maintain a tan (i.e., facultative pigmentation) that will help them protect their skin from the painful consequences of overexposure to UVR (i.e., sunburning).

In 1996, we introduced the first version of our indoor tanning industry specific skin-typing system (Reykdal-Smith I) that was based upon a modification the Fitzpatrick system that is used by medical doctors to determine the correct dose of UVR in PUVA therapy for psoriasis. Our original system was improved the next year (Reykdal-Smith II) by segmenting the most UVRsensitive Skin Type 2 clients into three subtypes (2A, 2B and 2C) and adding two subtypes of 3 (3A and 3B) and improved again this year (Reykdal-Smith III) by further segmenting skin type 3s into three subtypes (3A, 3B and 3C).

This latest version specifically addresses the unique challenges faced by indoor tanning salon owners and makes it possible to quickly and easily 1) screen out the Skin Type 1s who are genetically incapable of developing protective pigmentation so that they can be prohibited from tanning, and 2) classify those clients who can develop protective pigmentation (i.e., that are able to tan) into nine (Skin Subtypes 2A, 2B, 2C, 3A, 3B, 3C and Skin Types 4, 5 and 6) segments, each of which has a different level of tolerance to UVR, so that we can develop exposure times appropriate for each level.

If your only goal is to identify Skin Type 1s so that they can be prohibited from tanning in your salon, you only need to use a questionnaire that asks one two-part question.

1. When exposed to ultraviolet radiation (sunlight or tanning bed):
A. Do you eventually develop a tan? Yes ___ No ___
B. Do you always sunburn without tanning? Yes ___ No ___

If the answer to 1-A (Do you eventually develop a tan?) is “Yes” and the answer to 1-B (Do you always sunburn without tanning?) is “No,” you know that the client is not a Skin Type 1 and can develop protective pigmentation. On the other hand, if the answer to 1-A is “No” and the answer to 1-B is “Yes,” you know that the client is a Skin Type 1 and must be told he or she is not able to develop protective pigmentation and cannot be allowed to tan in your salon.

If your goal is to offer your clients complete skin typing/subtyping (and develop some helpful information regarding their tanning history), you can use a questionnaire to determine their tolerance to UVR. If you would like a customized questionnaire, e-mail reyksmith@aol.com your salon name and mailing address and we will (at no charge) send you a “master” that you can copy and use in your salon.

The statistics shown next (based upon more than 50,000 results) provides an approximate idea of how many of each skin type/subtype will patronize your salon.

Shown below is a quick-and-easy method that can be used to determine the initial session time (IST) for each of your sunbeds that will be used by new clients. [Note: These percentages are based upon delivering a dose of 0.75 MED of UVR on the IST.]

As mentioned at the start of this article, the goal of all professional salon owners is to provide their clients with a dose of UVR on each session that neither overexposes them to UVR nor underexposes them to UVR. The use of a standardized questionnaire to quickly and accurately determine their skin type/subtype (and tanning history) and the use of the percentage method of calculating initial session times shown above will help you achieve the goal of reducing the risks associated with overexposure to UVR and underexposure to UVR and thereby help clients enjoy the incontrovertible benefits of sensible, moderate and responsible exposure to UVR.