Skin Typing Assessment 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 quiz1 is intended as a sample only to provide additional help in the evaluation of an individual skin type. Skin typing of the area to be treated is to be assessed. Lumenis takes no liability on that document and its content is not intended to be a substitute for professional medical diagnosis.Genetic predispositionWhat is the colour of your eyes?* Light blue, grey, green Blue, grey or green Blue Dark brown Brownish black What is the natural colour of your hair?* Sandy red Blond Chestnut, dark blond Dark brown Black What is the colour of your skin (non-exposed areas)?* Reddish Very pale Pale with beige tint Light brown Dark brown Do you have freckles on non-exposed areas?* Many Several Few Incidental None Total score for genetic predisposition:Reaction to sun exposureWhat happens when you stay in the sun 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 colour tan Reasonable tan Tan very easy Turn dark brown quickly Do you turn brown within several hours after sun exposure?* Never Seldom Sometimes Sometimes Often Always How does your face react to the sun?* Very sensitive Sensitive Normal Very resistant Never had a problem Total score for reaction to sun exposure:Tanning habitsWhen did you last expose your body to sun (or 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 up the total scores for each of the three sections for your Skin Type Score: Skin Type Score Skin Type Features 0-7 I Caucasian / frecklesAlways burns and never tans (pale white skin) 8-16 II Caucasian / frecklesBurns easily and tans minimally (white skin) 17-25 III Darker CaucasianBurns moderately and tans gradually (light brown skin) 25-30 IV Mediterranean, Asian, HispanicBurns minimally and always tans well (moderate brown skin) Over 30 V Middle Eastern, Latin, light-skinned black, IndianRarely burns and tans profusely (dark brown skin) VI Never burns (deeply pigmented dark brown to black skin) Report total skin type score:*Skin Type I Caucasian / freckles Always burns and never tans (pale white skin)Skin Type II Caucasian / freckles Burns easily and tans minimally (white skin)Skin Type III Darker Caucasian Burns moderately and tans gradually (light brown skin)Skin Type IV Mediterranean, Asian, Hispanic Burns minimally and always tans well (moderate brown skin)Skin Type V Middle Eastern, Latin, light-skinned black, Indian Rarely burns and tans profusely (dark brown skin)Skin Type VI Never burns (deeply pigmented dark brown to black skin)Has a consent form been signed?* Yes No Has an additional pre-treatment compliance checklist been completed?* Yes No Date of assessment: MM slash DD slash YYYY Name of patient:* First Last Signature of patient:*(I attest hereby that I have answered the above to the best of my knowledge)
