4.4 Contagious Diseases: Conjunctivitis, Herpes Simplex, Tinea, Impetigo, and More

Why contagious conditions are high-stakes

A contagious condition is one that can pass from person to person by direct contact, by contaminated objects (fomites such as towels, brushes, and tweezers), or by droplets. In a treatment room, the esthetician's hands, implements, linens, and products can all carry it to the next client. Missouri's sanitation rule requires anyone serving a patron known to have a communicable disease to take all proper precautions to prevent its spread (20 CSR 2085-11.020(2)(E)). RSMo 329.140.2(15) makes "failure or refusal to properly guard against contagious, infectious or communicable diseases" a ground for discipline.

The practical rule: when a contagious condition is active in or near the treatment area, do not perform the service. Reschedule, refer the client to a physician without diagnosing, and disinfect everything the client touched.

The conditions the NIC outline names

Bacterial conjunctivitis ("pink eye")

• What it is: a bacterial infection of the conjunctiva, the membrane covering the white of the eye and lining the eyelids. Viral and allergic forms also exist.
• Signs: red, irritated eyes; discharge or crusting on the lashes; tearing; often both eyes.
• Spread: extremely contagious through hands, towels, eye pads, makeup, and lash tools.
• Service decision: no facial, lash extension, lash lift, tint, or eye makeup until it has cleared. Throw away any eye product or disposable that touched the area, and launder linens.

Herpes simplex

• What it is: herpes simplex virus type 1 (HSV-1), which causes recurring fever blisters or cold sores, usually on the lips, nostrils, or chin. The virus stays dormant in nerve cells and reactivates with sun exposure, stress, illness, or skin trauma.
• Signs: tingling, then a cluster of small fluid-filled vesicles on a red base, which later crust.
• Spread: direct contact with the lesion or its fluid, and contaminated implements.
• Service decision: postpone facials, waxing near the mouth, and exfoliation while a lesion is active. Waxing, peels, and microdermabrasion can trigger outbreaks in clients with a history of cold sores, which is why intake forms ask about them.

Tinea (ringworm)

• What it is: a contagious fungal infection of the skin, hair, or nails caused by dermatophytes, not by a worm.

• Signs: a red, scaly, itchy patch with a raised, ring-shaped border that spreads outward, often clearing in the center.
• Spread: direct contact and shared items such as towels, headbands, and brushes.
• Service decision: do not treat the affected area, and refer the client. Tinea versicolor (pityriasis versicolor) is an exception: it is caused by an overgrowth of Malassezia yeast that normally lives on the skin and is not considered contagious. It shows up as lighter or darker patches on the chest and back that become more noticeable after tanning.

Other contagious conditions to recognize

Recognition without diagnosis

You must notice these conditions without naming them as a diagnosis. Compare:

• Unprofessional: "You have impetigo."
• Professional: "I'm seeing some crusted areas around your nose that I'm not able to work on today. I'd recommend having a physician look at them, and we can reschedule once they've cleared."

Write down what you observed and what you recommended on the client record, without a diagnosis.

After a contagious condition is discovered mid-service

1. Stop the service and remove gloves without touching your own face.
2. Set aside every implement that touched the client so it can be cleaned and disinfected according to Missouri's rule: clean first, then full immersion for at least five minutes and the label's contact time in an EPA-registered bactericidal, virucidal, and fungicidal disinfectant.
3. Discard single-use items and any product that may have been contaminated. A mascara wand or brow pencil that touched an infected eye area must not be reused.
4. Put linens in a closeable, leakproof container for laundering.
5. Disinfect the bed, the magnifying lamp handle, and the trolley surfaces, then wash your hands.
6. Document the incident and reschedule after medical clearance.

Scenario: a quiet consultation finding

A client arrives for a lash lift. During consultation, the esthetician notices that both eyes are red with yellowish crust at the lash line. The client says, "It's just allergies." The esthetician cannot diagnose, but the signs are consistent with conjunctivitis, which is highly contagious and directly in the service area. The correct response is to decline the lash lift, explain that she cannot work near irritated, crusted eyes, suggest a physician visit, discard anything that touched the eye area, disinfect the room, and reschedule once the eyes are clear.