4.5 Skin Inflammations: Dermatitis, Eczema, Psoriasis, and Rosacea

What "inflammation" means on the exam

Inflammation is the body's response to injury, irritation, or infection, marked by redness, heat, swelling, and pain or itching. Dermatitis is the general term for inflammation of the skin. The NIC outline names three examples: dermatitis, eczema, and rosacea. Psoriasis and urticaria belong in the same group. Most of these conditions are not contagious, but all of them are made worse by the wrong treatment, so recognizing them is a safety skill.

Contact dermatitis

Two exam points matter here:

1. Sensitization: an allergy can develop after many uneventful exposures. A client who has used a product for years can still become allergic to it. Practitioners can be sensitized too, which is one reason to wear gloves.
2. The patch test (Section 5.3) screens for allergy before services that use common allergens, such as lash and brow tints.

Occupational dermatitis is contact dermatitis that a worker develops from workplace exposure. Estheticians get it on their hands from wet work, disinfectants, and gloves. Prevent it with gloves, gentle cleansers, and hand moisturizer, and remember Missouri's rule: practitioners with dermatitis or other non-intact skin on the hands must wear disposable gloves (20 CSR 2085-11.020(2)(E)).

Atopic dermatitis (eczema)

• What it is: a chronic, relapsing, intensely itchy inflammatory condition. It often runs in families with asthma and hay fever, and the skin barrier is impaired.
• What it looks like: dry, red, scaly patches. In adults these appear on the face, neck, hands, and the creases of the elbows and knees. Scratching can leave the skin thickened or weeping.
• Contagious? No. Broken, weeping, or scratched eczema can become infected, though.
• Service approach: postpone exfoliation, heat, and stimulating treatments on flaring areas, and avoid fragrance and harsh surfactants. Calm, fragrance-free, barrier-supporting products are appropriate on intact skin. Weeping, cracked, or infected areas are a reason to refer and to avoid the area.

Seborrheic dermatitis

• What it is: inflammation in oily areas, associated with Malassezia yeast that normally lives on the skin. On the scalp it is commonly called dandruff.
• What it looks like: redness with greasy yellowish or white flakes in the eyebrows, the folds beside the nose (nasolabial folds), the hairline, behind the ears, and on the scalp.
• Service approach: gentle cleansing, and no aggressive scrubbing of the flakes. Refer persistent cases for medical care.

Psoriasis

• What it is: a chronic, immune-mediated condition in which skin cells build up much faster than normal.
• What it looks like: well-defined red patches covered with silvery-white scales, typically on the scalp, elbows, knees, and lower back.
• Contagious? No.
• Service approach: do not pick off or exfoliate the scales. Avoid trauma, because injury can trigger new patches at the injured site. Plaques that are open or bleeding are a contraindication for treatment in that area, and the client should be referred.

Rosacea

Rosacea, introduced in Section 4.1 with the vascular lesions, is a chronic inflammatory condition of the central face (cheeks, nose, chin, and forehead):

• Signs: flushing, persistent redness, visible capillaries, and sometimes papules and pustules without comedones. In some people the nose thickens (rhinophyma).
• Common triggers: heat (including steam and hot towels), sun, spicy food, hot drinks, alcohol, stress, and harsh products.
• Service approach: cool or tepid products; no steam, no vigorous massage or friction, no stimulating electrical treatments, and gentle exfoliation only if any. Recommend daily sun protection, and refer for medical diagnosis and treatment.

Other inflammatory conditions to recognize

A service decision tree for inflamed skin

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Scenario: the red cheeks that aren't acne

A client books an "acne facial" for bumps and redness across the nose and cheeks. Under magnification, the esthetician sees persistent central redness, visible capillaries, and small papules, but no comedones. The client flushes after hot coffee. These signs point toward rosacea rather than acne vulgaris. The esthetician should not use steam, friction, or extractions. A calming, cool treatment and an explanation of common triggers are appropriate, and the client should be referred to a physician for diagnosis and treatment. Note the observations, not a diagnosis, on the record.