In the first section we discussed preliminary information on basic acne care and general causes that contribute to its onset. Most acne occurs as a skin condition that results from the action of hormonal changes on the skin’s oil glands that often leads to plugged pores and outbreaks of legions commonly called pimples. The resulting inflammation, blockage of natural oil flow, and excess cellular build-up will result in varying degrees or grades of acne. P.acnes bacteria will often proliferate here and even thrive specially in an alkaline ph environment. Genetically we are all different and we also have varying degrees of melanin (the pigment released by the melanocytes that are responsible for our skin color). Those with more melanin and a higher grade of acne could suffer from skin discolorations so a skin typing classification system and acne grade level came into being to serve as a guide for skin care treatments by professionals in the field. Skin products could also be recommended accordingly for follow up programs for the clients. Skin stimulation from treatments to include acne inflammation could result in the release of extra melanin from the melanocytes at the basal layer often discoloring the surrounding tissues and producing brown spots. Ethnic or darker skin color individuals have more melanin and over stimulation (either internal or external from strong products)often leads to the extra release of Melanin from melanocytes leading to this process called hyperpigmentation.

An effective skin classification system for skin typing and guide for skin care treatments was developed in 1975, by Thomas B. Fitzpatrick, MD from Harvard medical school. This system is based on a person’s complexion or degree of melanin deposits at the basal layer under the epidermis (the outer skin) and responses to sun exposure. The UVA rays that jeopardize collagen and elastin production and the UVB “skin burning rays” which cause skin burning and redness stimulate Melanin to be released in order to protect the dermis from the possible damage. For successful skin care treatments, laser or light therapy it is necessary to determine a client’s correct skin type so as to avoid possible discolorations. The forms given before a skin care treatment serves as a guide for treatment planning and will have notes to include the Fitzpatrick skin type. Below is a summary and some basic descriptions after each one that help an individual find his or hers skin type classification. Fitzpatrick skin type and Descriptions:

1. Fitzpatrick skin type I –extremely fair skin (less melanin at basal layer under the epidermis), Skin always burns (note: melanin acts to block UV rays and its potential damage). Skin never tans with ease.
2. Fitzpatrick skin type II –Fair skin (a bit more melanin at basal layer compare to type I) Skin always burns, sometimes tans).
3. Fitzpatrick skin type III –medium skin color, sometimes burns, always tans.
4. Fitzpatrick skin type IV –Olive skin, rarely burns, always tans (since it rarely burns we could conclude that has lots more melanin at basal layer than types I, II, III and that during aggressive inflammation either by acne or a skin stimulating treatments the excess release of melanin pigments could cause skin discoloration, darkening or brown spots into the surrounding tissues.
5. Fitzpatrick skin type V – moderately pigmented skin, never burns, always tans.
6. Fitzpatrick skin type VI – markedly pigmented black skin, never burns, always tans.

This information along with a client profile and history will help the clinician or esthetician design or recommend the best products or treatments. Please answer all questions on client form to the best of your ability. Prior to a stimulating treatment or to prevent discoloration from acne inflammation a melanin suppressor would be indicated for Fitzpatrick skin types, IV, V, VI and at times even skin type III . Below are the different grades or levels of acne described and serves a guide as to what type of treatments to use to include which type of chemical peel solutions, products or if dermatologist referral may be indicated.
1. Grade 1- has open comedones (black heads); mild red spots and is easiest to treat. May be labeled acne cosmetica if due from make-up use or poor home care of skin.
2. Grade II-has closed comedones with no inflammation.
3. Grade III-has papules, pustules, inflammation, open and closed comedones
4. Grade IV-Is the most severe with a combination of all of the above, however with lots more large closed comedones and bumps of many sizes. Grade IV will most often be referred to a dermatologist. These clients respond well to Jessner peel solutions since they have a soothing effect on the skin from the anti-inflammatory ingredients salicylic acid.

We could see that by going over preliminary basic information of acne and skin treatment classification systems it becomes easier to manage and understand skin treatments, product recommendations and effective acne solutions. Patient or client education is the first step at insuring a successful outcome. Knowing the skin Type in the Fitzpatrick classification system and what grade of acne an individual has will serve as a map or guide in achieving more success in resolving the skin conditions and follow up treatments.