Journal of the American Academy of Dermatology
Available online: 2014-06-11
DOI: 10.1016/j.jaad.2014.05.023
Steven Y. He, BS
Department of Dermatology
University of California, San Francisco
Charles E. McCulloch, PhD
Department of Epidemiology and Biostatistics
University of California, San Francisco
W. John Boscardin, PhD
Department of Epidemiology and Biostatistics; Department of Medicine
University of California, San Francisco
Mary-Margaret Chren, MD
Department of Dermatology
University of California, San Francisco
Eleni Linos, MD, MPH, DrPH
Department of Dermatology
University of California, San Francisco
Sarah T. Arron, MD, PhD
Department of Dermatology
University of California, San Francisco
Background
Fitzpatrick skin phototype (FSPT) is the most common method used to assess sunburn risk and is an independent predictor of skin cancer risk. Because of a conventional assumption that FSPT is predictable based on pigmentary phenotypes, physicians frequently estimate FSPT based on patient appearance.
Objective
We sought 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 < .0001). A multivariate model constructed using all independent predictors of FSPT only accurately predicted FSPT to within 1 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 US population.
Conclusions
Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by FSPT. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk.
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