title: Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University of California at San Francisco, San Francisco, California.
authors.forename: Steven Y
authors.initials: SY
authors.lastname: He
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: 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.
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.affiliation: Department of Dermatology, University of California at San Francisco, San Francisco, California.
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Chren
authors.affiliation: Department of Dermatology, University of California at San Francisco, San Francisco, California.
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.affiliation: Department of Dermatology, University of California at San Francisco, San Francisco, California. Electronic address: ArronS@derm.ucsf.edu.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Arron
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010641:Phenotype; D010787:Photosensitivity Disorders / Q000208:ethnology / Q000235:genetics; D011237:Predictive Value of Tests; D044469:Racial Groups / Q000235:genetics*; D018570:Risk Assessment; D057566:Self Report; D012737:Sex Factors; D012867:Skin / Q000528:radiation effects*; D012878:Skin Neoplasms / Q000208:ethnology / Q000235:genetics; D012880:Skin Pigmentation / Q000235:genetics* / Q000502:physiology; D013471:Sunburn / Q000208:ethnology / Q000235:genetics; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Fitzpatrick skin phototype; Fitzpatrick skin type; eye color; hair color; pigmentary phenotype; predictor; race; skin cancer risk; skin color; sunburn risk; suntan