Skin Typing Assesment Quiz

One of the most important factors in deciding which Laser/IPL (and settings) to use is the patient skin type. Skin typing is determined by genetics, reaction of the skin to sun exposure and tanning habits. The following skin type quiz is intended as a sample only to provide additional help in the evaluation of an individual skin type. Lumenis takes no liability on that document and it's content is not intended to be a substitute for professional medical diagnosis.

Appointment Information

Physician name

Appointment date

Questions

Genetic Predisposition:

What is the color of your eyes?

Light Blue, grey, green

Blue, grey or green

Blue

Dark brown

Brownish black

What is the natural color of your hair?

Sandy red

Blond

Chestnut, dark blond

Dark brown

Black

What is the color of your skin? (non-exposed areas)

Reddish

Very Pale

Pale w/ beige tint

Light brown

Dark brown

Do you have freckles on non-exposed areas?

Many

Several

Few

Incidental

None

Total score for genetic prediposition:

Add number from each row in section for total score.

Reaction to Sun Exposure:

What happens when you stay in the sun for too long?

Painful redness, blistering, peeling

Blistering followed by peeling

Burns sometimes followed by peeling

Rare burns

Never had burns

To what degree do you turn brown?

Hardly or not at all

Light color tan

Reasonable tan

Tan very easy

Turn dark brown quickly

Do you turn brown within several hours after sun exposure?

Never

Seldom

Sometimes

Often

Always

How does your face react to the sun?

Very sensititve

Sensitive

Normal

Very Resistant

Never had a problem

Total score for reaction to sun exposure:

Add number from each row in section for total score.

Tanning Habits:

When did you last expose your body to sun? (Includes artificial sunlamp/self tanning cream)

More than 3 months ago

2-3 months ago

1-2 months ago

Less than a month ago

Less than 2 weeks ago

Did you expose the area to be treated to the sun?

Never

Hardly ever

Sometimes

Often

Always

Total score for tanning habits:

Add number from each row in section for total score.

Add up the total scores for each of the three sections for your Skin Type Score:

Skin Type Score

Score, Skin Type, and Features

0-7- I

Caucasion/freckles; Always burns, never tans

8-16- II

Caucasian/freckles; Burns easily and tans minimally

17-25- III

Darker Caucasian; Burns moderately, tans gradually

25-30- IV

Mediterranean, Asian, Hispanic; Burns minimally, tans well

Over 30- V

Middle Eastern, Latin, light-skinned black, Indian; Rarely burns, tans profusely

Over 30- VI

Never Burns; deeply pigmented dark brown to black skin

Assessment Date:

Contact Information

If you would like us to follow up with you to discuss your experience, fill out your contact information below.

Yes, please follow up with me to discuss my experience

Patient name

Phone number

Email address

Additional comments

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