On the Fitzpatrick Skin Type Scale (The Fitzpatrick Skin Type is a skin classification system developed in 1975 by Thomas Fitzpatrick, MD, of Harvard Medical School), only skin types I, II and III can safely be treated with Plasma Pen. Anything higher and you are risking hyperpigmentation or hypopigmentation.
Some providers claim to be able to treat any skin type. This is generally untrue or at the very least misleading and is usually only because they are perhaps selling medical grade devices to cosmetic surgeons (who are then able to self-prescribe and fix any damage that they do) and/or because the treatments they are performing are merely “spray” rejuvenation only (i.e. they are not targeting the dermis and are only working on the epidermis).
The fact is that people with darker skins have melanocytes capable of making large amounts of melanin. When dark/black skin is injured (i.e. through the micro-trauma we create with Plasma Pen), these melanocytes can hyperpigment or hypopigment. This is because a combination of the inflammatory response and ultraviolet causes the inflammation to disrupt the basal cell layer. Melanin pigment is then released but subsequently it can become trapped by macrophages in the papillary layer. Once the wound healing has completed and the junction repaired then the melanin pigment granules can be caught within the dermal layer with no way of escape and this can cause pigmentation issues.
We will come onto how to determine skin types below but if someone is a borderline III/IV skin type then there are possibly some things you can do (such as the client using tyrosinase inhibitors in advance – you can see a good article on those here). A client who has perhaps spent time in the sun recently may perhaps present as darker than their true skin type really is so, in these instances, you should at least delay their procedure and encourage them to stay out of the sun in the meantime so that their skin returns to a treatable type in the area you are performing treatment. However, like any important contraindication, if there is any doubt about a treatment then you should not treat and if there is clear Indian or African ancestry then the chances are probably high that you will not be able to treat safely.
In terms of how to determine skin types then, firstly, you should buy an electronic skin type sensor from us. These are available for just £35+VAT and you can message us here to buy one. These should be used on the area being treated (after any make-up has been removed). This should give you an immediate and strong guide to their Skin Type.
We strongly recommend that all Plasma Pen Elite Technicians complete the following questionnaire with their clients in conjunction with their electronic skin sensor so as to accurately determine their skin tone. We use an enhanced questionnaire format that also accounts for recent sun exposure so our quiz measures three key components (i) their genetic disposition, (ii) their reaction to sun exposure and also (iii) their recent tanning habits.
Skin Types range from the very fair (Type I) to the very dark (Type VI).
So grab a piece of paper, keep score as you go along and get your client to answer all of the following questions honestly (you should keep this as a record and this questionnaire is available from us a free branded document from us for all our technicians):
PART ONE: GENETIC DISPOSITION
(1) What is your eye color?
Light blue, light gray or light green = 0
Blue, gray or green = 1
Hazel or light brown = 2
Dark brown = 3
Brownish black = 4
(2) What is your natural hair colour?
Red or light blonde = 0
Blonde = 1
Dark blonde or light brown = 2
Dark brown = 3
Black = 4
(3) What is your natural skin colour (i.e. before sun exposure)?
Ivory white = 0
Fair or pale = 1
Fair to beige, with golden undertone = 2
Olive or light brown = 3
Dark brown or black = 4
(4) How many freckles do you have on unexposed areas of your skin?
Many = 0
Several = 1
A few = 2
Very few = 3
None = 4
Total score for genetic disposition: _______
PART TWO: SUN EXPOSURE
(1) How does your skin/face respond to the sun?
Always burns, blisters and peels = 0
Often burns, blisters and peels = 1
Burns moderately = 2
Burns rarely, if at all = 3
Never burns = 4
(2) Does your skin tan?
Never – I always burn = 0
Seldom = 1
Sometimes = 2
Often = 3
Always = 4
(3) How deeply do you tan?
Not at all or very little = 0
Lightly = 1
Moderately = 2
Deeply = 3
My skin is naturally dark = 4
(4) How sensitive is your face to the sun?
Very sensitive = 0
Sensitive = 1
Normal = 2
Resistant = 3
Very resistant/Never had a problem = 4
Total score for reaction to sun exposure: _______
PART THREE: TANNING HABITS
(1) When did you last expose your body to sun / tanning cream / tanning injections / sunbeds?
More than 3 months ago = 0
2-3 months ago = 1
1-2 months ago = 2
Less than a month ago = 3
Less than 2 weeks ago = 4
(2) Did you expose the area you wish to be treated by Plasma Pen with to the sun?
No/Never = 0
Hardly = 1
Sometimes = 2
Often = 3
Always = 4
Total score for Tanning Habits: _______
TOTAL SCORE FOR PART ONE, PART TWO AND PART THREE: _________
Now correlate the above score to the following to determine their skin type:
Type I: 0 to 6 points (light, pale white)
Always burns easily, never tans.
Type II: 7 to 12 points (white, fair)
Always burns easily, tans minimally.
Type III: 13 to 18 points (medium white to olive)
Burns moderately, tans gradually.
Type IV: 19 to 24 points (olive, moderate brown)
Burns minimally, tans well.
Type V: 25 to 30 points (brown, dark brown)
Burns rarely, tans profusely.
Type VI: 31+ points (very dark brown to black, black)
Never burns, deep pigmentation.
Remember, you may only treat skin types I, II and III with Plasma Pen.