5.2 Skin Disorders and Diseases

Skin findings: same Board rules, different map

Quick Answer: Recognize signs and symptoms, then stop, caution, or refer. Herpes simplex with active blisters, impetigo, and infectious conjunctivitis are contagious contraindications. Dermatitis, eczema, and psoriasis are usually not contagious but become stops when skin is open or weeping. N.J.A.C. 13:28-3.3(d) still governs transmissible disease. N.J.A.C. 13:28-2.15(b)6 still bans cure claims. 13:28-2.15(b)1–2 ban lancets and work below the stratum corneum. 13:28-2.15(b)9 bans skin-tag removal. 13:28-2.15(b)7 bars medical services such as laser hair removal and Botox or Restylane injections.

Facials, makeup, waxing, and lash work put you on facial skin and near the eye. The exam will not give you a biopsy report. It will give you a vesicle on the lip, honey-colored crusts on the chin, red watery eyes, silvery plaques on the elbows, or a changing mole on the cheek. Your job is the service decision, spoken without a medical title.

Contagious skin and eye conditions: stop

Herpes simplex (typically HSV-1 on the face) shows as grouped vesicles on an erythematous base, often on or near the lips (cold sore / fever blister). The blister stage is highly contagious through direct contact and through implements or fingers that then touch another site. Stop facials, makeup, lash services, and waxing that would contact or stretch the area. Do not extract, lance, or dry the vesicle with a salon tool. Do not offer a cream as a cure. When lesions are fully healed and the skin is intact, ordinary cosmetic work may resume after consultation; an active cluster is not a cover-with-concealer problem.

Impetigo is a bacterial infection (commonly staphylococcal or streptococcal) with honey-colored crusts, often around the mouth, nose, or elsewhere on the face. It is highly contagious. Stop all services that would touch the crusts or nearby skin. Refer to a physician. Disinfect anything that may have contacted the area per 13:28-3.2. This is not acne. Treating honey crusts as Grade II breakouts is a classic wrong answer.

Conjunctivitis (pink eye) may be viral, bacterial, or allergic. Infectious forms are contagious. Signs: redness, discharge, itching or burning, crusted lids. Stop eye makeup, lash extensions or strips, brow services that sit on the lid, and facial steps that drag product into the eye. Allergic, non-infectious irritation is a clinical distinction you are not licensed to make when discharge and redness are present—reasonable grounds under 13:28-3.3(d) still mean do not serve around the eyes.

Dermatitis, eczema, psoriasis: usually caution, sometimes stop

Dermatitis means inflamed skin. Contact dermatitis is the salon-relevant split:

• Irritant contact dermatitis from overexposure to shampoo, acetone, relaxer, or disinfectant—dry, burning, cracked skin where the product sat.
• Allergic contact dermatitis from a true allergy (for example a fragrance or monomer)—redness, itching, sometimes vesicles, that can extend beyond the contact site.

You do not run patch tests to issue an allergy diagnosis in this chapter; predisposition testing belongs with chemical services. For a client already inflamed, stop services that would re-apply the suspected product or further damage the barrier. Intact, mildly dry skin with no open cracks can be caution: switch products, shorten the service, skip massage on angry plaques.

Eczema (often used in textbooks for atopic or chronic inflammatory dermatitis) shows dry, itchy, sometimes lichenified patches. It is not contagious. Weeping, cracked, or infected-looking eczema is a stop. Intact dryness is caution: no aggressive exfoliation, no hot steam on flares, no claiming a facial will cure eczema.

Psoriasis shows well-demarcated red plaques with silvery scale, commonly on elbows, knees, and scalp. It is an immune-mediated disorder, not an infection you catch from a cape. Proceed with caution on intact plaques (gentle, no picking scale). Stop if plaques are cracked, bleeding, or pustular. Do not scrape scale with a credo blade or skin scraper—13:28-2.15(b)1 forbids those implements even when the client asks you to clean the psoriasis.

None of these three is a license to practice medicine. A soothing mask is a cosmetic service. A posted claim that the shop remedies psoriasis is a 13:28-2.15(b)6 violation.

Acne: textbook grades versus medical disease

Cosmetology texts still sort acne by grade. That grading is a teaching scale, not a Board medical protocol and not a prescription.

Grade III–IV is not a New Jersey extraction day. 13:28-2.15(b)1 forbids lancets. 13:28-2.15(b)2 forbids massaging, cleansing, or stimulating below the stratum corneum. Popping a cyst is both an infection-control failure and a scope failure. Do not tell the client their cystic acne will be cured by a salon peel.

Hyperpigmentation and hypopigmentation

Hyperpigmentation is extra melanin: chloasma / melasma (mask-like patches, often hormonally associated), lentigines (freckle-like spots), and post-inflammatory darkening after acne or injury. Proceed with makeup and gentle cosmetic care on intact skin. Caution with heat, fragrance, and harsh exfoliation that can worsen pigment. Refer unexplained dark patches that are new, irregular, or changing—those may not be melasma.

Hypopigmentation is reduced pigment: vitiligo (sharply bordered light patches), albinism, and leukoderma. Proceed with cosmetic camouflage if the skin is intact. Do not diagnose autoimmune disease. Do not sell a tonic as a cure for vitiligo. Offer shade and general sun-smart product talk as cosmetics, not as treatment of illness.

Pigment change next to a changing mole is no longer a concealer chapter. Move to refer-out language below.

Basal cell, squamous cell, melanoma: recognize to refer, never to diagnose

You will be tested on warning signs, not on staging a tumor. You do not tell a patron you have diagnosed cancer. You do refuse to treat or remove the lesion, describe what you observed, and refer to a physician. 13:28-2.15(b)9 already forbids skin-tag removal; moles, ulcers, and pearly nodules are not yours either.

Basal cell carcinoma warning picture (recognition only): a pearly or waxy bump, rolled border, visible small blood vessels (telangiectasia), often on sun-exposed face; may bleed or crust and not heal. Stop any service on that lesion. Refer. Do not cauterize, pick, or cover as ordinary blemish care.

Squamous cell carcinoma warning picture: a scaly, crusted, or indurated growth that may ulcerate; can enlarge faster than the classic pearly bump. Stop and refer. Do not file it like a skin tag.

Melanoma warning picture uses the ABCDE teaching mnemonic as a refer trigger, not as a diagnosis you announce:

• Asymmetry
• Border irregularity
• Color variation
• Diameter larger than a pencil eraser (commonly taught as about 6 mm)—any suspicious lesion still gets referred even if smaller
• Evolving (changing size, shape, color, or symptoms)

Stop. Refer. Do not diagnose. Saying this looks like melanoma and I will freeze it off is both a diagnosis and a medical procedure. Saying I cannot treat this lesion; please see a physician this week is the licensed response.

Exam traps

• Trap: Cover a cold sore with concealer and continue the bridal makeup. Active herpes vesicles are a stop.
• Trap: Honey crusts are Grade II acne. That is impetigo until a physician says otherwise—refuse.
• Trap: A facial will cure psoriasis or eczema. 13:28-2.15(b)6.
• Trap: Lancet extraction of cysts is advanced esthetics in New Jersey. Lancets are prohibited.
• Trap: Name the cancer at the chair. Recognition is refer-out, not diagnosis.