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Reliability of skin-type self-assessment: agreement of adolescents’ repeated Fitzpatrick skin phototype classification ratings during a cohort study


  • Funding sources
    The research was conducted at the University of Newcastle.

  • Conflict of interest
    The authors do not have any conflicts of interest or potential conflicts of interest.

P. Magin.


Background  The Fitzpatrick Skin Phototype Classification (FSPC) is the most commonly used measure of skin type. In questionnaire-based surveys, self-rated FSPC is often used as a measure of respondents’ skin type.

Objective  The objective of this analysis was to assess test-retest reliability of the self-rated FSPC within a 12-month cohort study that examined the psychological sequelae of acne.

Methods  Participants were students aged 14–17 years in four Australian secondary schools; two-government system schools and two private schools. The primary outcomes were a number of psychological measures. The FSPC was assessed by a single concise questionnaire item. Test-retest agreement (as measured by quadratic weighted kappa) of participants’ self-rated FSPC at three time-points (baseline, 6 and 12 months) was calculated.

Results  Of the 244 participating students, 209 students (86%) completed all three rounds of data collection. A further 26 students (11%) completed two rounds. Quadratic weighted kappa for Rounds 1 and 2 was 0.757 (95% CI 0.663–0.831). For Rounds 2 and 3 it was 0.805 (95% CI 0.659–0.893). Between Rounds 1 and 3 it was 0.767 (95% CI 0.698–0.832). This represents good-to-very-good agreement.

Skin type was retained as an independent variable in 8 of the16 regression models built to explain psychological outcomes in this study.

Conclusion  Skin type appears to be a significant factor in psychological morbidity in acne. The FSPC is a reliable method for assessing skin phenotype, even when elicited via a concise questionnaire item suitable for assessing skin type as a potential confounder in studies of other outcome factors.