9.2 Skin Conditions, Disorders & Diseases

9.2 Skin Conditions, Disorders & Diseases

Quick answer: Learn primary vs secondary lesions, acne grades, rosacea, hyperpigmentation (melasma, PIH) and hypopigmentation, dermatitis/eczema/seborrheic dermatitis, and contagious stop signs (impetigo, tinea, herpes, conjunctivitis). Use ABCDE cues to refer suspicious lesions—you analyze and protect, you do not diagnose medical disease. Skin Analysis is about 13% of the PSI Massachusetts aesthetician theory exam.

Section 9.1 classified lasting type and UV response. This section covers what you see on the skin today: lesions, common disorders, pigment changes, and infectious red flags. The professional standard for a Massachusetts aesthetician is consistent: observe, document, choose safe service parameters, or stop and refer. PSI items reward that judgment, especially when a stem tempts you to “just wax over” an open sore or “extract” a suspicious growth.

Primary and Secondary Lesions (Overview)

A lesion is any mark, wound, or abnormality. Textbooks split lesions into primary (first visible change) and secondary (develop from primary lesions or from scratching, infection, or healing).

High-yield definitions candidates should own:

• Macule — flat spot of color change (freckle-like teaching example); not raised.
• Papule — small, solid elevation (no visible pus).
• Pustule — raised lesion containing pus.
• Vesicle — small fluid-filled blister; bulla is larger.
• Nodule / tumor — deeper or larger solid growths (size thresholds vary by text; recognize “deeper/solid” vs surface pustule).
• Wheal — itchy, swollen elevation (hive-like).
• Crust — dried sebum, pus, or blood (scab-like).
• Scale — flaky epidermal cells.
• Fissure — crack in the skin.
• Excoriation — scratch or scrape of the epidermis.
• Ulcer — open lesion with loss of epidermis (and possibly dermis); not a casual facial extraction target.
• Scar — fibrous tissue after healing.

Exam logic: matching words to descriptions matters, but so does service decision. Vesicles on the lip border may signal herpes risk; honey-colored crusts may signal impetigo-type contagion; ulcers and suspicious growths are refer, not treat.

Acne: Grades and Esthetics Judgment

Acne involves follicles, sebum, cells, and often Cutibacterium acnes (formerly P. acnes) in inflammatory pathways. Esthetics theory commonly uses a graded severity model:

You are not a dermatologist writing prescriptions. You are expected to recognize when inflammation is too severe for aggressive esthetic trauma and when home-care education (non-comedogenic products, gentle cleanse, not picking) is the right contribution.

Rosacea

Rosacea is a chronic disorder often featuring facial redness, flushing, visible vessels, and sometimes papules/pustules that clients mistake for acne. Triggers may include heat, spicy food, alcohol, stress, and harsh products (individual patterns vary).

Esthetics implications:

• Avoid treating rosacea like ordinary oily acne with hot steam, heavy scrubbing, and harsh oils.
• Use calming, barrier-friendly products; reduce heat and friction.
• Active inflammatory rosacea may need medical management—refer when uncertain or severe.
• Do not promise a “cure” with one facial.

Hyperpigmentation and Hypopigmentation

Hyperpigmentation is excess color. Common esthetics-relevant forms:

• Melasma — often patchy brown facial pigmentation; associated with hormonal influences and UV; strict sun protection is central to any care plan discussion.
• Post-inflammatory hyperpigmentation (PIH) — dark marks after acne, injury, waxing, or irritation; more concerning in medium-to-deeper Fitzpatrick types (Section 9.1).
• Sun-related freckling / solar lentigines (as taught) — UV-driven spots; reinforce SPF and refer changing lesions.

Hypopigmentation is reduced pigment (lighter patches). Causes range from post-inflammatory lightening to medical conditions (e.g., vitiligo is a medical diagnosis territory). Your job: note color change, avoid promising pigment “correction” beyond scope, protect from further injury, and refer unexplained or progressive pigment loss.

Dermatitis, Eczema, and Seborrheic Dermatitis

Dermatitis is inflammation of the skin—redness, itching, sometimes vesicles or scaling. Contact dermatitis relates to allergens or irritants (product, fragrance, glove chemicals, plants). Eczema (atopic dermatitis and related patterns in teaching) often involves chronic dry, itchy, inflamed skin; barriers are fragile.

Seborrheic dermatitis commonly affects oily areas (scalp, brows, sides of nose, beard area) with redness and greasy-looking scale. Clients may call it “dandruff on the face.”

Service rules of thumb:

• Do not layer fragranced acids on actively weeping or severely inflamed dermatitis.
• Identify possible product triggers on intake (Chapter 7 consultation links here).
• Refer severe, infected-looking, or non-improving presentations.
• Keep tools and products sanitary—broken skin raises infection risk.

Contagious Diseases: Service Stop Signs

Certain conditions are contraindications for services in the affected area because of contagion risk to the client, you, and the next guest.

Also stay alert for other infection-control red flags taught in Safety chapters (MRSA-like open infection, lice/mites). Pattern for PSI:

1. Recognize contagious presentation.
2. Do not diagnose with false certainty if unsure—describe what you see.
3. Refuse or postpone service that contacts the area.
4. Refer to a physician or appropriate care.
5. Disinfect surfaces and follow Standard Precautions if exposure occurred.

When to Refer: Suspicious Lesions and ABCDE Awareness

Massachusetts aestheticians must not diagnose cancer or other medical disease. You must protect clients by referring concerning findings. Teaching tool for pigmented lesion awareness is ABCDE:

Any lesion that is new, changing, bleeding, non-healing, or “just does not look right” is a refer situation—even if it fails only one letter of ABCDE. Do not dig, extract, or peel over a suspicious mole to “improve it.” Document that you advised medical evaluation.

Other automatic referral/modification categories:

• Undiagnosed rashes covering the treatment area
• Open wounds, undiagnosed sores, or severe inflammation
• Client reports of medical skin disease under active doctor care with restrictions
• Eye infections, active oral herpes in the service zone, suspected impetigo or tinea

Worked Exam Scenario

A client books a full facial and lip/chin wax. You see clustered vesicles on the upper lip with a tingling history of cold sores, plus a large asymmetrical dark mole on the cheek that the client says “has been getting darker this year.” The client asks you to “work around everything and extract the chin.”

Correct path: stop services that contact active herpetic lesions; explain contagion and comfort risk without over-claiming a medical diagnosis; do not treat or traumatize the changing mole—refer for medical evaluation using professional, calm language; offer to reschedule facial/wax when the lip is fully healed and after medical clearance if needed for the mole area; clean/disinfect as required. That answer pattern scores both infection control and analysis judgment.

Common Traps

• Treating rosacea as standard acne with heat and harsh exfoliation
• Aggressive cystic acne extractions that worsen scarring and PIH
• Ignoring impetigo/tinea/herpes/conjunctivitis stop signs
• Using ABCDE to diagnose melanoma instead of to refer
• Confusing primary and secondary lesion vocabulary on matching items
• Promising to “erase melasma in one peel” without UV/hormone realism and scope limits

Study Routine

• Flash primary vs secondary lesion pairs
• Recite acne grades I–IV with one service caution each
• List four contagious stop signs and the action verb refuse/refer
• Memorize ABCDE as referral awareness, not diagnosis authority

Final Check

Without notes: Give one primary and one secondary lesion example. State why active herpes stops a lip wax. Explain melasma vs PIH in one sentence each. Say what each ABCDE letter stands for and what you do when a mole is evolving. Ready answers unlock Section 9.3’s hands-on analysis workflow.