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Eur J Dermatol. 2017 Dec 1;27(6):615-619. doi: 10.1684/ejd.2017.3129.

Clinical assessment of skin phototypes: watch your words!

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Second Department of Dermatology and Venereology, Aristotle University, Papageorgiou Hospital, Thessaloniki, Greece, Department of Dermatology, St.Pierre Hospital, Brussels, Belgium.
Centre of Dermatology, Vilnius University, Vilnius, Lithuania.
Centro Dermatologia Epidermis, Instituto CUF and Faculty of Medicine of University of Porto, Porto, Portugal.
Department of Dermatology, University Hospital Zurich, Switzerland.
Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia.
Department of Dermatology, University of Belgrade, School of Medicine, Clinic of Dermatovenereology, Clinical Centre of Serbia, Belgrade, Serbia.
Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain.
Department of Dermatology, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece.
Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Division of Chronic Diseases, University Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.


Fitzpatrick skin phototype classification is widely used to assess risk factors for skin cancers. This skin type evaluation is easy to use in clinical practice but is not always applied as initially described, nor practiced in a standardised way. This can have implications on the results of relevant dermato-epidemiological studies. To demonstrate, in a large multinational setting, that the phrasing of questions on sun sensitivity can have a strong impact on the perception and reporting of skin phototype, as well as the importance of a standardised procedure for phototype assessment. Using data collected from 48,258 screenees of the Euromelanoma campaign in six European countries from 2009 to 2011, we analysed the impact of change in the question phrasing on phototype classification in each country. Changing the wording of a question to assess the phototype of a person also significantly influenced the classification of phototypes in different countries (p<0.001 for each country). The difference essentially corresponded to a shift towards a less sun-sensitive skin type when a shorter question that did not include skin colour description was used. The only exception was Portugal where phototype was not patient-assessed and classification shifted towards a more sun-sensitive phototype. Results were statistically significant and highly consistent, irrespective of gender. The phrasing of questions on skin type is important and substantially influences reporting. A standardized procedure to classify phototypes should be used in order to obtain comparable data between studies.


Fitzpatrick skin phototype classification; country; phrasing; question; standardised procedure; sun sensitivity; wording

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