Section 6.4: Skin Disorders and Facial Contraindications

Skin Disorders and Facial Contraindications

A professional barber must be able to identify common skin disorders, lesions, and infectious diseases of the face and neck. Recognizing these conditions is critical for client safety, as many skin disorders are contraindications—meaning the barber must refuse shave or facial services to prevent spreading infection, causing pain, or exacerbating a medical condition.

Identifying Skin Lesions

Skin lesions are structural changes in the tissues caused by injury, disease, or aging. They are classified into primary and secondary lesions.

Primary Lesions

Primary lesions are physical changes in the skin color or structure that are present at the onset of a disease.

• Macule: A flat spot or discoloration on the skin (such as a freckle or liver spot). It is neither raised nor sunken.
• Papule: A small, solid elevation on the skin containing no fluid but can develop pus (such as a pimple without a head).
• Vesicle: A small blister containing clear fluid, lying within or just beneath the epidermis (such as a cold sore).
• Pustule: An inflamed, raised papule with a white or yellow center containing pus (such as an acne pimple).
• Wheal: An itchy, swollen lesion that lasts only a few hours (such as a mosquito bite or hives [urticaria]).
• Nodule: A solid bump larger than 0.4 inches (1 cm) that can be felt easily under the skin.
• Bulla: A large vesicle or blister containing fluid, larger than 0.5 inches (such as a second-degree burn blister).

Secondary Lesions

Secondary lesions develop in the later stages of a disease, often as a result of scratching, picking, or healing.

• Scale: Any thin, dry, or oily plate of epidermal flakes (such as excessive dandruff or psoriasis flakes).
• Crust: An accumulation of sebum, pus, and dead cells mixed with blood, forming a scab over an open wound or sore.
• Excoriation: A skin sore or abrasion produced by scratching or scraping.
• Fissure: A linear crack or tear in the skin that penetrates into the dermis (such as chapped lips or cracked hands).
• Ulcer: An open lesion on the skin or mucous membrane, accompanied by pus and loss of skin depth.
• Keloid: A thick, raised scar resulting from excessive growth of fibrous tissue.

Disorders of the Sebaceous and Sudoriferous Glands

Glandular disorders can cause cosmetic concerns or painful skin conditions.

• Acne Vulgaris: A chronic inflammatory disorder of the sebaceous glands, characterized by comedones, papules, pustules, and cysts. It ranges from Grade I (mild, mostly blackheads) to Grade IV (severe cystic acne with deep nodules and scarring).
• Acne Rosacea: A chronic inflammatory congestion of the cheeks and nose, characterized by persistent redness, dilated capillaries (telangiectasia), and sometimes papules or pustules.
• Comedones: Sebum plug in a hair follicle. An open comedo is a blackhead (sebum exposed to oxygen oxidizes and turns dark). A closed comedo is a whitehead (covered by epidermis, sebum remains white).
• Seborrhea: Severe oiliness of the skin due to overactive sebaceous glands.
• Milia: Tiny, white keratin-filled cysts that appear under the epidermis, having no visible opening.
• Asteatosis: A condition of dry, scaly skin characterized by a deficiency of sebum.
• Steatoma: A sebaceous cyst or fatty tumor filled with sebum, varying in size from a pea to an orange.
• Anhidrosis: A lack of perspiration due to sweat gland failure. Can be life-threatening as the body cannot cool itself.
• Hyperhidrosis: Excessive sweating, often caused by heat, genetics, or general body weakness.
• Bromhidrosis: Foul-smelling perspiration, usually noticeable in the armpits or feet, caused by bacteria breaking down sweat.
• Miliaria Rubra (Prickly Heat): An acute inflammatory disorder of the sweat glands, characterized by small red vesicles and burning, itchy skin.

Infectious Diseases and Contraindications

Infectious diseases are highly contagious and require the barber to immediately decline all shaving, massage, and facial services.

• Tinea Sycosis (Tinea Barbae): A fungal infection of the bearded area of the face and neck, caused by dermatophytes. It causes deep, inflamed pustules and crusts. State board exams often distinguish this from folliculitis barbae: tinea barbae is fungal, whereas folliculitis barbae is bacterial.
• Folliculitis Barbae: An inflammation of the hair follicles in the bearded area, usually caused by bacterial infection (specifically Staphylococcus aureus) from shaving too close or using dull blades.
• Sycosis Vulgaris: A chronic bacterial infection of the hair follicles on the face, causing large pustules.
• Impetigo: A highly contagious bacterial infection characterized by weeping, honey-colored crusts, usually on the face.
• Herpes Simplex 1 (Cold Sores): A viral infection causing blister-like vesicles on the lips and nostrils. It is highly contagious through touch or tools.
• Pediculosis Capitis: Infestation of the hair and scalp with head lice.

Shaving and Massage Contraindications

Barbers must never perform services when the following conditions are present:

• Active Acne Cysts/Pustules: Shaving over active pustules will rupture the lesions, spreading bacteria to other areas of the face, causing bleeding, and increasing the risk of permanent scarring.
• Inflamed or Broken Skin: Shaving over eczema, psoriasis, or open cuts causes pain and exposes the client and barber to infection.
• Systemic Conditions: Massage is contraindicated for clients with high blood pressure, heart disease, active cancer, or diabetes unless they provide a written clearance from their physician, as massage increases circulation and can stress the cardiovascular system.