Assessing the role of race in quantitative measures of skin pigmentation and clinical assessments of photosensitivity

Chan, Joanna L.; Ehrlich, Alison; Lawrence, Reva C.; Moshell, Alan N.; Turner, Maria L.; Kimball, Alexa B.

doi:10.1016/j.jaad.2004.03.051

Cited by 41 publications

(32 citation statements)

References 26 publications

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“…We present this data to highlight the potential limitations of a patient’s self-reported race and physical appearance in predicting individual sun sensitivity, and by extension, self-reported skin cancer risk. The results from our study expand on previous data demonstrating that self-reported FSPT correlates poorly with race 20 . Currently, FSPT as defined by patient self-report remains to be the gold standard for describing sensitivity to UV exposure, and by extension UV-related outcomes such as skin cancer risk 8–10, 27 .…”

Section: Discussionsupporting

confidence: 85%

“…These data suggest that pigmentary phenotypes may be predictive of FSPT in Caucasians, but not in non-Caucasian minorities, rendering PSPT a less effective method of assessing skin cancer risk in an ethnically diverse population like the U.S. Physicians frequently overestimate sunburn risk for Caucasians based on patient appearance and underestimate sunburn risk for racial minorities 20 . Several studies also discovered that physicians predominantly assign non-Caucasian, ethnic minorities to FSPT IV, V or VI based on their skin color or ethnic background and that this method has proven to be unreliable 21–23 .…”

Section: Discussionmentioning

confidence: 96%

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Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population

McCulloch

Boscardin

et al. 2014

Journal of the American Academy of Dermatology

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Background Fitzpatrick skin phototype (FSPT) is the most common method used to assess sunburn risk and is an independent predictor of skin cancer risk. Due to a conventional assumption that FSPT is predictable based on pigmentary phenotypes, physicians frequently estimate FSPT based on patient appearance. Objective To determine the degree to which self-reported race and pigmentary phenotypes are predictive of FSPT in a large, ethnically diverse population. Methods A cross-sectional survey collected responses from 3386 individuals regarding self-reported FSPT, pigmentary phenotypes, race, age and sex. Univariate and multivariate logistic regression analyses were performed to determine variables that significantly predict FSPT. Results Race, sex, skin color, eye color and hair color are significant but weak independent predictors of FSPT (P<0.0001). A multivariate model constructed using all independent predictors of FSPT only accurately predicted FSPT to within one point on the Fitzpatrick scale with 92% accuracy (weighted kappa statistic=0.53). Limitations Our study enriched for responses from ethnic minorities and does not fully represent the demographics of the U.S. population. Conclusions Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by Fitzpatrick skin phototype. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 96%

Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population

McCulloch

Boscardin

et al. 2014

Journal of the American Academy of Dermatology

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“…(Table 1) Sunburn sensitivity is determined by melanin density, distribution, and type in the epidermis and can be estimated accurately with a spectrophotometer. (Amblard, Beani, Gautron, Reymond, & Doyon, 1982;Chan et al, 2005;Dwyer, Muller, Blizzard, Ashbolt, & Phillips, 1998;Pershing et al, 2008) The melanin density of the upper inner arm, constitutive pigmentation, measured by spectrophotometry is a strong predictor of risk of skin cancer. (Dwyer et al, 2002) This research aimed to validate Latinos' self-reported responses to the adapted FST with spectrophotometric assessment of the constitutive pigmentation among urban Latinos in Chicago.…”

Section: Introductionmentioning

confidence: 99%

Recognizing Latinos’ range of skin pigment and phototypes to enhance skin cancer prevention

Robinson

Penedo

Hay

et al. 2017

Pigment Cell Melanoma Res

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Summary Latinos in the United States may have the mistaken assumption that their natural pigmentation protects them from developing skin cancer that, effectively, serves as a barrier to Latinos receiving education in primary and secondary prevention of skin cancer. Latino adults of Mexican or Puerto Rican heritage attending community health fairs in the greater Chicago area responded to a culturally informed and sensitive measure for sunburn and tan, which was previously adapted to capture skin irritation with tenderness from the sun occurring in darker skin types (n=350). By self-reported responses and spectrophotometry assessment of constitutive pigmentation, adapted Fitzpatrick skin types (FST) ranged from skin type I to IV in the Mexican-American participants and from II to V in the Puerto Rican participants. The objectively measured proportion of adapted FST II skin type was greater than commonly perceived and demonstrated that many Latinos do indeed have sun sensitive skin.

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“…The heterogeneity of those with multi-ethnic backgrounds makes it difficult to assess susceptibility to skin cancer on the basis of skin color, which is predominantly determined by pigments such as hemoglobin, melanin, bilirubin and carotene [23,24,4] . There has been a tendency to group people of similar ethnic group into a single category of SPT, which introduces potential bias into the subjective assessment of SPT by investigators [25][26][27] .…”

Section: Resultsmentioning

confidence: 99%

Digital dermoscopy to determine skin melanin index as an objective indicator of skin pigmentation

et al. 2016

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Clinical assessment of skin photosensitivity is subjectively determined by erythema and tanning responses to sunlight recalled by the subject, alternatively known as Fitzpatrick Skin Phototype (SPT). Responses may be unreliable due to recall bias, subjective bias by clinicians and subjects, and lack of cultural sensitivity of the questions. Analysis of red-green-blue (RGB) color spacing of digital images may provide an objective determination of SPT. This paper presents the studies to assess the melanin index (MI), as determined by RGB images obtained by both standard digital camera as well as by videodermoscope, and to correlate the MI with SPT based upon subjects' verbal responses to standardized questions administered by a dermatologist.A sample of subjects representing all SPTs I-VI was selected. Both the digital camera and videodermoscope were calibrated at standard illumination, light source and white balance. Images of constitutive skin of the upper ventral arm were taken of each subject using both instruments. The studies showed that 58 subjects (20 M, 38 F) were enrolled in the study (mean age: 47 years; range: 20-89), stratified to skin phototype I-VI. MI obtained by using both digital camera and videodermoscope increased significantly as the SPT increased (p = 0.004 and p < 0.0001, respectively) and positively correlated with dermatologist-assessed SPT (Spearman correlation, r = 0.48 and r = 0.84, respectively). Digital imaging can quantify melanin content in order to quantitatively approximate skin pigmentation in all skin phototypes including Type VI skin. This methodology holds promise as a simple, non-invasive, rapid and objective approach to reliably determine skin phototype and, with further investigation, may prove to be both practical and useful in the prediction of skin cancer risk.

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Assessing the role of race in quantitative measures of skin pigmentation and clinical assessments of photosensitivity

Cited by 41 publications

References 26 publications

Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population

Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population

Recognizing Latinos’ range of skin pigment and phototypes to enhance skin cancer prevention

Digital dermoscopy to determine skin melanin index as an objective indicator of skin pigmentation

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