5.1 Hair and Scalp Disorders and Diseases
Key Takeaways
- N.J.A.C. 13:28-3.3(d) forbids serving a patron you know, or have reasonable grounds to believe, has a communicable, contagious, or infectious disease that could reasonably be transmitted during services.
- Tinea capitis, pediculosis capitis, and scabies are refuse-and-refer findings; ordinary pityriasis (dandruff) without open sores is proceed-with-caution, not the same as ringworm.
- N.J.A.C. 13:28-2.15(b)6 forbids any service that claims to cure or remedy a disease or illness, including salon tonics sold as alopecia or dandruff cures.
- Alopecia names (androgenetic, areata, traction, telogen/postpartum, totalis/universalis) describe patterns you may style around; scaly, pustular, or broken-hair rings are treated as possible tinea until a physician says otherwise.
- Trichorrhexis nodosa and canities are non-infectious shaft or pigment changes: caution with chemicals and heat, not a contagious stop, and never a medical diagnosis.
Why scalp findings are safety items, not dermatology trivia
Quick Answer: On the NIC New Jersey Cosmetologist-Hair Stylist theory exam, Domain 1.B.2 tests whether you can recognize signs and symptoms of hair and scalp conditions, disorders, and diseases and choose stop, proceed with caution, or refer. You do not diagnose or treat. N.J.A.C. 13:28-3.3(d) forbids serving a patron you know, or have reasonable grounds to believe, has a communicable, contagious, or infectious disease that could reasonably be transmitted during services. N.J.A.C. 13:28-2.15(b)6 forbids any service that claims to cure or remedy any disease or illness.
A New Jersey cosmetologist-hairstylist is a licensed beauty professional, not a physician. Recognition language is observational: flakes that slide, nits cemented to a shaft, a round scaly patch of broken hairs, pustules at follicular openings, a sudden smooth bald spot. Diagnosis language is medical: naming the organism, prescribing an oral antifungal, or promising a cure. Stay on the salon side of that line. The candidate who finishes a shampoo through tinea capitis, picks nits as a billed scalp treatment, or sells a bottle as an alopecia cure is the candidate the Board and the blueprint are written to fail.
N.J.A.C. 13:28-3.3(c) is the mirror rule for you: do not serve if you have a communicable, contagious, or infectious disease that could reasonably spread during the service. Handwashing or a waterless agent before and after each patron (13:28-3.3(a)) does not authorize working through an obvious infestation.
Three lanes: stop, caution, refer
Use the same three lanes for every scalp finding.
- Refuse / stop (contraindication). Visible signs of a contagious or infectious condition that could move on combs, capes, shampoo bowls, clippers, or close contact. Also stop for open, weeping, or undiagnosed inflamed lesions you cannot distinguish from infection. Under 13:28-3.3(d), reasonable grounds are enough. You do not wait for a lab report that says ringworm before you fold the cape.
- Proceed with caution. Non-infectious disorders that still change the work: dry dandruff without open sores, gray hair, brittle knotted shafts, patterned thinning with an intact scalp. Adjust product, tension, chemicals, and heat. Note what you saw and what you declined.
- Refer out. Possible infection you cannot manage, unexplained sudden hair loss, or a lesion that is more than cosmetic scale. Refer means see a licensed physician or other medical professional. It does not mean I diagnosed you with tinea. Selling a treatment plan that claims to cure the disease still violates 13:28-2.15(b)6.
Pityriasis (dandruff): common, usually not a refuse-all finding
Pityriasis is the textbook name for dandruff. Two presentations show up on theory items:
- Pityriasis capitis simplex — dry dandruff. Small, dry, white or grayish scales that shed onto hair and shoulders. The scalp may itch. The skin is not typically oily.
- Pityriasis steatoides — greasy or waxy dandruff. Scales mix with sebum and can form yellowish, sticky crusts. The scalp often looks oily. If greasy scale also involves the face or chest, older texts move toward seborrheic dermatitis language. You still do not diagnose it. Inflamed, cracked, or oozing skin is no longer a routine shampoo.
A common salon explanation is overgrowth of Malassezia (a yeast already living on skin) plus oil and shedding. That is not the same story as tinea capitis, a dermatophyte infection that spreads person-to-person and on shared tools. Classic theory teaching treats ordinary dandruff as not contagious in the lice-or-ringworm sense. Proceed with caution: use a labeled anti-dandruff shampoo as a cosmetic product, do not scratch the scalp raw, skip harsh chemical services on an irritated scalp, and stop if you see pustules, open sores, thick honeycomb crusts, or a clearly circular patch of broken hairs.
A cosmetic shampoo is not a disease remedy. Telling the client you have cured their dandruff is the 13:28-2.15(b)6 problem, even if the flakes look better next week.
Scabies versus dandruff
Scabies is infestation with the mite Sarcoptes scabiei. It is contagious through prolonged skin contact and, less often, shared linens. Exam signs: intense itching (often worse at night), thin burrows, and small red bumps, classically in finger webs, wrists, and other folds. Scalp involvement is less typical in healthy adults than in some other groups, but the tested skill is the decision, not a dermatology residency. If you have reasonable grounds to believe the patron has a contagious mite infestation, 13:28-3.3(d) says you do not serve.
Dandruff is loose scale on the scalp without burrows and without that mite-driven night-itch story. Flakes on a dark shirt after a blow-dry are not scabies. Nits are not dandruff either: nits cement to the shaft; dandruff slides. If you cannot tell flakes from mites or nits, stop and refer. Guessing it is just dandruff while burrows sit on the hands is how infection-control items are written.
Tinea capitis: refuse
Tinea capitis is a fungal infection of the scalp and hair (ringworm of the scalp). Signs: one or more round or irregular scaly patches, hairs broken off close to the scalp (a black-dot look in some cases), redness, itching, and sometimes a swollen, boggy mass (kerion) that can ooze. It is contagious. Shared brushes, uncleaned clipper blades, and trying to exfoliate the ring with a shampoo brush are how shops spread it.
Stop the service. Do not apply a home antifungal as a salon procedure. Do not clip the patch to let it breathe. Refer to a physician. After a refused service, clean and disinfect implements per N.J.A.C. 13:28-3.2. The first action the exam wants is still do not proceed.
Pediculosis capitis: refuse
Pediculosis capitis is head lice. Look for nits (eggs) glued to the hair shaft, often near the nape and behind the ears, and for live lice crawling. Itching is common. Combs, brushes, and close head contact move lice.
Stop. Do not pick nits as a billed scalp treatment. Do not send the client to the next chair. Refuse, explain that you cannot provide a service while a contagious infestation is reasonably apparent, and refer them to a pharmacist or physician for medical treatment. Lice control is not a Board-authorized cure service.
Folliculitis: pustules around follicles are not just irritation
Folliculitis is inflammation of the hair follicle, often with small pustules or red bumps at follicular openings. Bacterial cases (commonly Staphylococcus) can spread on unclean tools. The old barber's itch story for the beard is folliculitis barbae and related follicular infection, not a branding opportunity. If lesions are pustular, widespread, or clearly infectious, stop services that would clip, shave, tweeze, or chemically process that skin. Mild, isolated, non-pustular irritation after a tight ponytail is a caution story: loosen tension, do not add chemical on an irritated scalp. That is not a license to diagnose staph.
Alopecia: name the pattern, do not sell a cure
Alopecia means hair loss. Naming the pattern is theory language. Claiming to reverse it with a salon tonic is a 13:28-2.15(b)6 problem.
| Type | What you typically see | Salon decision |
|---|---|---|
| Androgenetic (pattern) alopecia | Receding hairline, vertex thinning, miniaturized hairs; gradual | Proceed with cut and style; caution with tight tension and harsh chemicals on a sensitive scalp; no cure claims |
| Alopecia areata | Smooth, round bald patches; often sudden | Caution if the scalp is intact and not infected; refer for medical evaluation; do not inject, work below the stratum corneum, or promise regrowth |
| Alopecia totalis / universalis | All scalp hair, or all body hair, gone | Cosmetic styling or wigs as requested; refer medical questions; no disease-cure products |
| Traction alopecia | Thinning at the hairline or part from tight braids, ponytails, extensions | Proceed with caution: change tension, do not add more pull; document |
| Telogen / postpartum shedding | Diffuse extra shed after stress, fever, or childbirth | Proceed with caution; refer if sudden, patchy, or paired with scalp disease |
| Alopecia prematura | Pattern loss younger than expected | Same as pattern alopecia: cosmetic help, no medical claims |
If the bald patch is scaly, pustular, or broken-off hairs in a ring, you are no longer in areata-versus-pattern trivia. You are in possible tinea, which is stop.
Trichorrhexis nodosa and canities
Trichorrhexis nodosa is a shaft disorder: grayish nodes where the cuticle has split, so hair bends or breaks at the weak point. Salon causes are usually mechanical and chemical—over-processing, tight elastics, harsh brushing—not a fungus. Proceed with caution: stop further bleach, relaxer, or high heat until the hair can tolerate it. Do not market a miracle oil as a cure. It is not a contagious refuse-the-chair finding unless the scalp itself is infected.
Canities is gray or white hair from reduced melanin. Congenital canities appears from youth; acquired canities is ordinary or premature graying. Gray hair is not a disease you refuse. Color proceeds only after ordinary consultation and the predisposition and strand tests taught in later color chapters. Covering gray is not treatment of an illness.
Other non-infectious shaft findings that appear on items: trichoptilosis (split ends) and excess hair (hypertrichosis / hirsuties). Those are cosmetic management, not infection control.
Exam traps
- Trap: Dandruff is ringworm. Pityriasis is scale; tinea capitis is a contagious fungal patch with broken hairs.
- Trap: Finish the cut if you bag the cape. 13:28-3.3(d) is about not serving, not improvising isolation.
- Trap: A scalp serum will cure alopecia areata. That is a disease-cure claim.
- Trap: Nits are dandruff. Nits cement to the shaft; dandruff slides.
A New Jersey cosmetologist-hairstylist sees a round, scaly scalp patch with hairs broken off close to the scalp. What is the correct first action?
Which statement correctly separates pityriasis from tinea capitis for salon decision-making?
Under N.J.A.C. 13:28-3.3(d), when must a practicing licensee refuse to serve a patron?
A client has grayish nodes on the hair shaft where strands bend and break, and the scalp is intact with no pustules or scale rings. What is the best NJ-salon response?