Skin Basics 101 for Aestheticians: The Rubin Classification System

The Rubin Classification was invented by the noted cosmetic dermatologist Dr. Mark Rubin who simplified the Glogau system, addressing photoaging and bringing it down to only three levels. The categories addressed are pigmentation, texture, keratoses and wrinkling. The Rubin classification system evaluates pigment in three categories. It says that  pigment changes are related to sun damage, and includes freckles and lentines, which are referred to as senile lentigines in older clients. Rubin also shows texture as a strong condition marker of the skin. It is evaluated using adjectives to describe it that include dull, leathery, rough and pebbly to assist in classification of the patient in the right category.

Keratoses in Rubin is different from those changes that come from pigment. Keratoses relates to the response of the skin to the sun by forming rough, red, scale patches. Keratoses can advance into actinic keratoses or precancerous skin lesions and growths which can become skin cancers.  Wrinkling in some systems may be static or may be dynamic. It can be fine, moderate or coarse. Winking in the Rubin classification is not this detailed. The classification acknowledges that wrinkles exist and it notes the locations of the wrinkles.

The Rubin classification is very easy to use since it has only three specific definitions and each client will fall into one of the categories. Remember however that the classification will only relate to extrinsic aging patterns and the clinician will need to create an intrinsic aging analysis.

Rubin level one is defined as the “least severe” type of sun damage. Level one includes those who have some freckles, some lentigines and  beginnings of a thicker Stratum Corneum. Those people  in Rubin level one don’t usually have wrinkles and if they do have them, they will be fine static wrinkles. There is no defined chronological age for these patients. The  patient can be 20 years old or in her mid 40’s depending on the level of sun exposure.

Rubin level two is defined as the “more severe” type of sun damage. In addition to freckles and lentigines there will be a marked change and advancement of  irregularity of the color of the client’s skin. The Stratum Corneum is  thicker and more irregular. There are also more wrinkles, generally around the eyes and in the naso-labial fold also called the smile line. Additionally, Dr. Rubin believes the client’s  skin will begin to look “crinkled” at this level.

Rubin level three is defined as  the “most severe” type of sun damage. In this category the skin will be wrinkled even at rest. There  are many dyschromias,  the skin will be thick and leathery in appearance and even to the touch. The skin also  has a yellow, dull and  sometimes gray color that patients complain of as “dirty”. Histologic changes in level three penetrate to the reticular dermis. This level of sun damage also has some open comedones which make the surface more irregular.