The Best Skin Typing System to Prescribe Skin Care Routines
The Best Skin Typing System to Prescribe Skin Care Routines
Many “skin typing systems” are available, but for a skin typing system to be considered scientifically valid and to provide reproducible results, the skin typing classification system should meet the following criteria:
- Diagnosis of skin type is made with a scientifically validated measurement instrument.
- The instrument must be shown to give the same results when used by different dermatologists.
- If self-administered, the instrument must be shown to give the same results when self-administered as compared to when given by a dermatologist.
- The instrument should be tested on various ages, genders, ethnicities, and geographic locations
Ideally, the best skin typing system would also have these traits:
- The skin typing system is preferred by dermatologists and used in their medical practices
- The skin typing system is independent from a skin care brand or pharmaceutical company to prevent bias
- The skin typing system is used by many different brands and doctors, researchers, chemists, aestheticians, and medical providers so that data can be accurately compared
- The skin typing system should be updated by dermatologists specializing in skin typing as new scientific discoveries are made
- Updates to the skin typing system should be validated scientifically
- The skin typing system should remain unadulterated and not altered from user to user so that the results remain consistent, updates will be adopted by all users at the same time, and the vocabulary will remain consistent among users
There are 2 main skin typing systems used by dermatologists, aestheticians, and medical providers to discuss skin type; the Fitzpatrick Skin Type and the Baumann Skin Type®. These skin typing systems are not mutually exclusive because they measure different things.
Fitzpatrick Skin Type
The Fitzpatrick Skin Type corresponds with the skin tanning response to UV and light exposure. (Fig ) It was developed by Dr. Fitzpatrick at Harvard to determine the proper dose of UV light to treat psoriasis.1 The initial version included only lighter skin types and was later updated to include darker skin types. It is now used to choose laser settings. The current skin color of the patient may not correspond to the Fitzpatrick Skin Type. For example, a Fitzpatrick III Skin Type who avoids the sun and always wears sun-protective clothing and sunscreen may appear to be a Fitzpatrick II. Using the questionnaire in the Fitzpatrick Skin Typing Questionnaire about how the skin responds to sun exposure is a more effective method of choosing laser settings than looking at the skin color alone. The Fitzpatrick skin typing system is often incorrectly used to prescribe skin care but it was never intended for this purpose; it only gives information about melanocyte response to light and not about the underlying barriers to skin health such as inflammation and dehydration. The higher the Fitzpatrick skin type number is, the more robust the melanin production response to light is. A higher Fitzpatrick Skin Type suggests an increased risk of post-inflammatory hyperpigmentation and a lower risk of skin cancer due to sun exposure. The Fitzpatrick skin typing questionnaire is more accurate when administered by a dermatologist as compared to self-administered.2 This skin typing system may not be accurate in Asians3 and has been found to be unreliable in Korean skin.4 The Fitzpatrick Skin Type is genetically determined and does not change with time unless the patient is exposed to photosensitizers.
The Fitzpatrick Skin Type:
- Measures the skin’s ability to produce melanin pigment in response to UV exposure.
- It must be assessed by a trained provider rather than self-administered.
- Is not accurate in many Asian ethnicities.
- Corresponds to what dose of UV or light should be used to treat skin disorders
- Helps determine what laser setting to use when treating hair or pigment
- Helps predict post-inflammatory pigment alteration (PIPA) after lasers, lights and other cosmetic procedures
- May help predict skin cancer risk
- Must be assessed by a trained medical provider
- Does not correspond to skin care routine or skin care product needs
- The Fitzpatrick Skin Type does not change with time
- Applies to all of the skin on the body
Baumann Skin Type®
The Baumann Skin Type is used to prescribe facial skin care. The Baumann Skin Type specifies the presence or absence of 4 barriers to skin health: dehydration, inflammation, dyspigmentation, and aging lifestyle factors. These 4 parameters are combined in different combinations into 16 distinct Baumann Skin Types. 6 7(figure) The skin types that exhibit inflammation are further divided into 4 subsets of sensitive skin: acne, rosacea, stinging, and allergic. (Figure pink box- see corresponding chapters). The Baumann Skin Type is identified using a 4 letter designation, a color and a number to help patients remember which skin type they are. Eight of the Baumann Skin Types have sensitive skin that exhibits inflammation. These are further divided into 4 sensitive skin subtypes. (fig) Sensitive skin types can exhibit more than one sensitive skin subtype. For example, a sensitive skin type can have acne, facial redness (rosacea), and skin stinging. This is discussed in chapter 13. The Baumann Skin Type reveals the underlying issues that need to be addressed in the skin care routine to improve skin health. Taking in all of the various combinations of barriers to skin health, sensitive skin subtypes, patient preferences and lifestyle habits yields over 40,000 different skin care regimen options that can be further customized at the patient visit by the medical provider.
The Baumann Skin Type:
- Identifies the 4 main barriers to skin health: dehydration, inflammation, dyspigmentation and lifestyle factors that speed aging.
- Diagnosed via a scientifically validated questionnaire.
- Diagnostic questionnaires can be self-administered.
- Validated for all genders and ethnicities
- Gives specific recommendations on what ingredients to use.
- Gives specific recommendations on what ingredients to avoid.
- Used to develop personalized and customized skincare regimens.
- Changes with aging, stress, diet, hormones, geographic location, season, and skin care routine
- May help predict skin cancer risk by identifying risky lifestyle habits
- Applies to facial skin only
The Skin Type Solutions System
The Skin Type Solutions System (STS) utilizes software to facilitate the Baumann Skin Type diagnosis and prescribes a skin care routine that is customized for the Baumann Skin Type, preferences, budget and lifestyle habits of the patient. This software employs a validated self-administered questionnaire 8 that has been tested in both genders 9 10, multiple ethnicities 11 12 and many climates.13 This system is used by hundreds of dermatologists inside and outside of the US to diagnose the patient’s skin type 14 15, prescribe a skin care regimen 16 17 18 and perform research.19 20 The STS software works for any brands that meet the stringent criteria. (see chapter 33 on How to Choose Skin Care Products). The Skin type Solutions Regimen Management System generates a skin care regimen that only contains ingredients that are right for the patient’s skin type and does not contain ingredients that should be avoided by that skin type. Multiple factors are taken into account to layer the products in the proper step-by-step order to increase the efficacy of the entire skin care regimen. (see ch 35 skin care regimen design).
1 Fitzpatrick, T. B. (1988). The validity and practicality of sun-reactive skin types I through VI. Archives of dermatology, 124(6), 869-871.
2 Eilers, S., Bach, D. Q., Gaber, R., Blatt, H., Guevara, Y., Nitsche, K., ... & Robinson, J. K. (2013). Accuracy of self-report in assessing Fitzpatrick skin phototypes I through VI. JAMA dermatology, 149(11), 1289-1294.
3 Stanford, D. G., Georgouras, K. E., Sullivan, E. A., & Greenoak, G. E. (1996). Skin phototyping in Asian Australians. Australasian Journal of Dermatology, 37, S36-S38.
4 Park, S. B., Suh, D. H., & Youn, J. I. (1998). Reliability of self‐assessment in determining skin phototype for Korean brown skin. Photodermatology, photoimmunology & photomedicine, 14(5‐6), 160-163.
5 Baumann, L. (2008). Understanding and treating various skin types: the Baumann Skin Type Indicator. Dermatologic clinics, 26(3), 359-373.
6 Baumann, Leslie S. “The Baumann Skin Typing System” in Farage MA, et al. Textbook of Aging Skin Skin. Springer-Verlag Berlin Heidelberg (2017): 1579-1594.
7 Baumann, L. (2008). Cosmetics and skin care in dermatology. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw Hill, 1357-2363.
8 Baumann LS, Penfield RD, Clarke JL, et al. A validated questionnaire for quantifying skin oiliness. J Cosmet Dermatol Sci App. 2014;4:78-84.
9 Lee, Young Bin, Sung Ku Ahn, Gun Young Ahn, Hana Bak, Seung Phil Hong, Eun Jung Go, Chang Ook Park et al. "Baumann Skin Type in the Korean Male Population." Annals of Dermatology 31, no. 6 (2019): 621-630.
10 Ahn, S. K., Jun, M., Bak, H., Park, B. D., Hong, S. P., Lee, S. H., ... & Goo, J. W. (2017). Baumann skin type in the Korean female population. Annals of dermatology, 29(5), 586-596.
11 Choi, J. Y., Choi, Y. J., Nam, J. H., Jung, H. J., Lee, G. Y., & Kim, W. S. (2016). Identifying skin type using the Baumann skin type questionnaire in Korean women who visited a dermatologic clinic. Korean Journal of Dermatology, 54(6), 422-437.
12 Baumann, Leslie. “Cosmeceuticals in skin of color” Seminars in Cutaneous Medicine and Surgery 35 (2016): 233-237.
13 Baumann, Leslie. “Validation of a Questionnaire to Diagnose the Baumann Skin Type in All Ethnicities and in Various Geographic Locations” Journal of Cosmetics, Dermatological Sciences and Applications 6 (2016): 34-40.
14 Lee, Y. B., Park, S. M., Bae, J. M., Yu, D. S., Kim, H. J., & Kim, J. W. (2017). Which Skin Type Is Prevalent in Korean Post-Adolescent Acne Patients?: A Pilot Study Using the Baumann Skin Type Indicator. Annals of Dermatology, 29(6), 817.
15 Baumann, L. (2009). The Baumann skin-type indicator: a novel approach to understanding skin type. Handbook of Cosmetic Science and Technology, 3rd Edition, Informa Healthcare, New York, 29-40.
16 Baumann, L. (2020). 14 A Scientific Approach to Cosmeceuticals. The Art of Aesthetic Surgery, Three Volume Set: Principles and Techniques.
17 Baumann, L. (2018). How to Use Oral and Topical Cosmeceuticals to Prevent and Treat Skin Aging. Facial Plastic Surgery Clinics, 26(4), 407-413.
18 Baumann, L. (2013). Nonsurgical skin care and rejuvenation. Gurtner GC, Neligan PC. Plastic Surgery (3rd ed). China: Elsevier, 25.
19 Roberts, W. E. (2009). Skin type classification systems old and new. Dermatologic clinics, 27(4), 529-533.
20 Park, J. W., Park, S. J., Park, K. Y., Ahn, G. Y., Seo, S. J., & Kim, M. N. (2019). P062: A study on the correlation of skin types with genetic factors and environmental factors in Koreans. 프로그램북 (구 초록집), 71(2), 354-354.