The six Fitzpatrick skin types
Type I: Very fair skin, freckles, red or blonde hair, blue or green eyes. Always burns, never tans. Very high risk of UV damage and skin cancer. Type II: Fair skin, lighter hair and eyes. Usually burns, tans minimally. High risk of UV damage. Type III: Medium skin, darker hair. Sometimes burns, tans gradually and uniformly. Moderate risk.
Type IV: Olive or light brown skin, dark hair and eyes. Rarely burns, tans easily and well. This is a very common skin type in South Africa — Mediterranean, Indian, Latin, and lighter African skin tones. Type V: Brown skin, dark hair and eyes. Very rarely burns. Common in South Asia, darker Hispanic, Middle Eastern, and many African communities. Type VI: Very dark brown or black skin, dark hair and eyes. Never burns. Common across Sub-Saharan Africa.
Why Fitzpatrick type matters for treatment
Darker skin tones (Type IV–VI) have more active melanocytes — cells that produce melanin. This melanin provides natural UV protection but also means the skin responds more dramatically to inflammation, injury, and even active skincare ingredients. Post-inflammatory hyperpigmentation (PIH) is significantly more common, more pronounced, and longer-lasting in Type IV–VI skin. Any treatment that causes irritation — too strong a chemical peel, too high a starting concentration of retinol — can trigger a PIH response that is harder to treat than the original concern.
For treatment safety, Fitzpatrick type guides peel strength selection (superficial peels only for Type V–VI; medium peels require significant experience and specific formulations), laser suitability (many lasers are not safe for Type IV–VI skin without specific wavelength selection), and the sequencing of active ingredients. This is why every Niki skin assessment and Dr Bangalee consultation includes skin tone assessment using the Fitzpatrick scale.
Visible light and Type IV–VI skin — a critical South African consideration
One of the most important and often overlooked findings in modern dermatology is that visible light (wavelengths 380–700nm — the part of the spectrum we can see) independently triggers melanin production in Type IV–VI skin through a pathway separate from UV. This means that on a cloudy day with no UV reaching the skin, visible light alone can activate melanocytes in darker skin tones.
The practical implication: standard chemical sunscreens that only filter UV are not sufficient for Type IV–VI patients with melasma or significant pigmentation. Iron oxide-containing sunscreens that filter visible light are necessary — Heliocare 360° Pigment Solution contains both Fernblock® and iron oxides for this specific purpose. At Star Aesthetic Centre, this distinction is fundamental to the SPF we prescribe for our patients.