A Five-Color Scale Aims to Replace Outdated Skin Type Labels for People with Skin of Color

A simple card of five colors, running from very light beige to very dark brown, is being proposed as a new standard way to classify the skin tone of people with skin of color. The tool, called the Colorimetric Scale for Skin of Color (CSSC), assigns each color a numerical skin color type: very light beige is type 1, light brown is type 2, medium brown is type 3, dark brown is type 4, and very dark brown is type 5. According to a commentary published in the journal Dermatology and Therapy, the scale is inexpensive, easy to use, and rapidly performed, and it requires minimal training for the person carrying out the evaluation. Unlike the classifications most widely used in dermatology today, it is based purely on color rather than on how skin reacts to the sun, and it avoids racial and ethnic labels altogether.

The commentary, written by Philip R. Cohen, makes clear from the outset that it is a commentary rather than an original research study. No datasets were generated or analyzed in its preparation, and the author emphasizes that the expected reliability and reproducibility of the scale remain to be validated by prospective studies. What the article offers, therefore, is an argument for a new approach and a summary of the scale’s design and its anticipated uses, rather than experimental evidence of its performance. That distinction matters, because the scale has already been described in earlier publications, and its proponents argue that the field has waited long enough for a classification system that treats patients with dark skin on their own terms.

The case for a replacement rests on the history of the classification system that dermatology has relied on for decades. In 1975, Fitzpatrick was conducting clinical trials on patients with psoriasis and created a classification of sun-reactive skin types in order to determine the initial ultraviolet A dose for those trials. The purpose was narrow and practical: to standardize light dosing in a specific therapeutic context. Fitzpatrick himself later commented that the classification was never intended to be used to categorize patients with skin of color. Despite that origin, the six sun-reactive skin types became a routine shorthand across dermatology, applied to patients whose skin tones the system was never designed to describe.

According to the commentary, many researchers who have made substantial academic contributions to the study and treatment of patients with skin of color have adamantly recommended that the Fitzpatrick classification of sun-reactive skin types no longer be applied to categorize patients with dark skin. The argument is not merely technical. A non-racial and non-ethnic, simple, and rapid method for classifying individuals with darker skin is needed, the article contends, to provide healthcare equity and diminish racial disparities, as well as to categorize both dermatology patients and forensic decedents. Several investigators have attempted to provide an adequate solution, but the commentary judges that most of these earlier attempts are not ideal.

The CSSC emerged from an unusual collaboration. In 2023, a dermatologist working with three forensic pathologists developed a scale that can be universally used to evaluate individuals, whether living or deceased, who have skin of color. The scale was previously published in the journal Cureus by Cohen and colleagues, and the color chart reproduced in the new commentary shows the five tones side by side, each paired with its numerical type. The published figure carries a practical caveat: the reproduced colors may vary by printing conditions or display conditions, or both. Notably, the scale does not include individuals with white skin; under this classification, a type 0 skin color would be assigned to a person with white skin who does not have skin of color. White and black categories are deliberately excluded, in contrast to some previously proposed classification systems for skin of color.

The design choices are central to the scale’s claimed advantages. Because the scale includes only colors, it is dependent on neither ethnicity nor race. Because it discards sun-reactivity as the organizing principle, it excludes the Fitzpatrick framework entirely, along with non-color endpoints such as white and black categories. The evaluation itself is described as quick to accomplish and simple to perform, and the scale is inexpensive. Using the CSSC to assess people with skin of color is anticipated to be rapid, reliable, and reproducible, although the commentary is careful to frame these qualities as expectations rather than demonstrated findings. The existing foundational CSSC publications primarily describe the scale and its purpose, and the previously published CSSC articles do not report formal inter-rater or intra-rater validation.

The anticipated applications span clinical medicine, cosmetics, and forensics. The scale is described as useful for evaluating both living patients with dermatologic conditions and dead victims in the forensic setting, a dual purpose that reflects the involvement of forensic pathologists in its development. In dermatology, the scale is anticipated to assist with improving diagnosis of dermatologic conditions, determining appropriate cosmetic procedures and devices, assessing the risk of skin cancer development, and establishing skin type-directed photoprotection. Integration of the scale is also hypothesized to promote healthcare equity, enable culturally appropriate assessment of individuals, and provide categorization of people with dark skin for research evaluations. The commentary further suggests that the scale could become an integral component in forensic pathology for individuals with dark skin.

One forward-looking possibility stands out in the commentary: the simplicity of the CSSC allows for the potential development of an artificial intelligence-linked system to establish more objective parameters for the classification system. Because the scale reduces skin tone to a small set of defined colors with numerical labels, the argument goes, it could serve as a foundation for automated or semi-automated classification tools that are more consistent than human visual assessment. The commentary frames this as a potential rather than an existing capability, and no such system has been built or tested in the work described. Still, the prospect of pairing a deliberately simple visual scale with computational methods illustrates how the authors envision the tool evolving beyond a printed chart.

The limitations section of the commentary is unusually candid, and it catalogs the obstacles that stand between the scale’s design and its adoption. Beyond the fact that the manuscript is a commentary rather than an original research study, the author notes that it is postulated that the CSSC is reliable, reproducible, improves diagnosis and clinical outcomes, and promotes healthcare equity, but that expanded use of the scale is anticipated to provide the validation data needed to support these conclusions. The visual nature of the scale presents the possibility of inter-observer and intra-observer variability. Numerous variables can influence visual color matching: it can vary with ambient lighting, anatomic site, recent sun exposure or tanning, erythema or inflammation, observer perception, and whether the scale is viewed on a screen or printed. The effects of lighting, body site, tanning, and dyspigmentation in the person performing the evaluation are also flagged as factors that may influence the assessment.

Two further limitations complete the picture. The proposed benefits of the scale, such as improving diagnosis and clinical outcomes, determining skin cancer risk, guiding photoprotection and cosmetic interventions, and promoting healthcare equity, are anticipated to result only after widespread use of the CSSC, and these benefits remain to be validated. In addition, prospective studies utilizing the CSSC have yet to be performed, which means that comparisons with other objective measures of skin pigmentation are currently not available for evaluation. In other words, there is as yet no head-to-head evidence showing how the five-color scale performs against instrumental or alternative classifications of skin pigmentation.

The commentary closes on a confident note, tempered by the same caveats. The CSSC is described as an ideal tool for classifying individuals with dark skin: a simple assessment that can be rapidly performed to provide reliable categorization of patients with dark skin, potentially enhancing the evaluation, diagnosis, and treatment of cutaneous conditions as well as the elective management of cosmetic skin concerns. It is anticipated to eliminate racial disparities and promote healthcare equity in patients with skin of color, but the author states plainly that prospective studies to confirm these potential advantages have not yet been conducted. For now, the five-color scale stands as a proposal with a clear rationale and an honest list of unknowns, awaiting the prospective research that will determine whether its promised benefits are realized in clinics and mortuaries alike.

Subject of Research: A proposed five-color colorimetric scale for classifying skin tone in people with skin of color as an alternative to the Fitzpatrick sun-reactive skin type system.

Article Title: The Colorimetric Scale for Skin of Color (CSSC) can Provide a Standardized Classification System for Patients with Diverse Skin Tones

Article References: Cohen, P. R. (2026). The Colorimetric Scale for Skin of Color (CSSC) can Provide a Standardized Classification System for Patients with Diverse Skin Tones. Dermatology and Therapy. https://doi.org/10.1007/s13555-026-01939-z

Image Credits: AI Generated

DOI: 10.1007/s13555-026-01939-z

Keywords: Colorimetric Scale for Skin of Color, CSSC, skin of color, Fitzpatrick skin types, dermatology, skin color classification, healthcare equity, racial disparities, forensic pathology, photoprotection, skin cancer risk, artificial intelligence