Abstract The concept of sun-reactive "skin typing" was created in 19751 for a specific need: to be able to classify persons with white skin in order to select the correct initial doses of ultraviolet A (UVA) (in joules per cubic centimeter) in the application of the then newly developed technique for the treatment of psoriasis—oral methoxsalen photochemotherapy (PUVA).2 The need arose as a result of experience with several patients who were a "dark" phenotype (brown or even black hair, and some with brown eyes) but, to our surprise, developed severe phototoxic reactions following oral ingestion of 0.6 mg/kg of methoxsalen and then, two hours later, were exposed to 4 to 6 J/cm2. These initial doses were obviously too high, and it was then understood that the estimation of the white-skinned person's tolerance level to oral PUVA could not be based solely on the phenotype (hair and eye color). References 1. Fitzpatrick TB: Soleil et peau . J Med Esthet 1975;2:33-34. 2. Parrish JA, Fitzpatrick TB, Tanenbaum L, et al: Photochemotherapy of psoriasis with oral methoxsalen and long-wave ultraviolet light . N Engl J Med 1974;291:1207-1211.Crossref 3. Melski JW, Tanenbaum L, Parrish JA, et al: Oral methoxsalen photochemotherapy for the treatment of psoriasis: A cooperative clinical trial . J Invest Dermatol 1977;68:328-335.Crossref 4. Roenigk HH, Martin JS: Photochemotherapy for psoriasis . Arch Dermatol 1977;113:1667-1670.Crossref 5. Pathak MA, Jimbow K, Szabo G, et al: Sunlight and melanin pigmentation , in Smith KC (ed): Photochemical and Photobiological Reviews . New York, Plenum Press, 1976, pp 211-239. 6. Fitzpatrick TB: Ultraviolet-induced pigmentary changes: Benefits and hazards . Curr Probl Dermatol 1986;15:25-38. 7. Pathak MA, Fanselow DL: Photobiology of melanin pigmentation: Dose response of skin to sunlight and its contents . J Am Acad Dermatol 1983;9:724-732.Crossref 8. Stern RS, Momtaz K: Skin typing for assessment of skin cancer risk and acute response to UV-B and oral methoxsalen photochemotherapy . Arch Dermatol 1984;120:869-873.Crossref 9. Amblard P, Beani JC, Gautron R, et al: Statistical study of individual variations in sunburn sensitivity in 303 volunteers without photodermatosis . Arch Dermatol Res 1982;274:195-206.Crossref 10. Sayre RM, Desrochers DL, Wilson CJ, et al: Skin type, minimum erythema dose (MED), and sunlight acclimatization . J Am Acad Dermatol 1981;2:439-443.Crossref 11. Agin PP, Desrochers DL, Sayre RM: The relationship of immediate pigmentation darkening to minimal erythema dose and eye color . Photodermatology 1985;2:288-294. 12. Sunscreen drug products for over-the-counter human drugs: Proposed safety, effective, and labeling conditions . Federal Register 1978;43( (Aug 25) ):38206-38207. 13. Rampen FHJ, Fleuren BAM, de Boo ThM, et al: Unreliability of self-reported burning tendency and tanning ability . Arch Dermatol 1988;124:885-888.Crossref 14. Wolff K, Honigsmann H, Gschnait FD, et al: Photochemotherapie bei Psoriasis: Klinische Erfahrungen bei 152 Patienten . Dtsch Med Wochenschr 1975;100:2471-2477.Crossref 15. Schulze R: Einige Versuche und Bemerkungen zum Problem der handelsublichen Lichtschutzmittel . Parf Kosmetik 1956; 37:310-365. 16. Simoni S, Perotti R, Fimiami M, et al: Evaluation of cutaneous pigmentation in skin cancer patients . Program and abstracts of the First Meeting of the European Society for Pigment Cell Research, Sorrento (Naples), Oct 11-14, 1987 , p 57. 17. Kollias N, Baqer, Chedekel MR: In vivo spectroscopic observation of melanogenesis . Program and abstracts of the First Meeting of the European Society for Pigment Cell Research, Sorrento (Naples), Oct 11-14, 1987 , p 1.
Archives of Dermatology – American Medical Association
Published: Jun 1, 1988