Steven Y He1, Charles E McCulloch2, W John Boscardin3, Mary-Margaret Chren1, Eleni Linos1, Sarah T Arron4. 1. Department of Dermatology, University of California at San Francisco, San Francisco, California. 2. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California. 3. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; Department of Medicine, University of California at San Francisco, San Francisco, California. 4. Department of Dermatology, University of California at San Francisco, San Francisco, California. Electronic address: ArronS@derm.ucsf.edu.
Abstract
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.
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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