6.7 Fungal Infections, Infestations and Bacterial Infections

Fungal Infections, Infestations and Bacterial Infections

Exam Focus: Everything in this section ends the same way: stop, protect privacy, decontaminate, refer. The examinable content is identification — distinguishing nits from dandruff by whether they slide, recognising the sulphur-yellow scutula of favus, and knowing that a furuncle is staphylococcal and a carbuncle is the larger deep-seated version.

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1. Contagious Infections & Infestations: Strict Contraindications

Cosmetologists must NEVER perform any salon service on clients presenting with active fungal infections, parasitic infestations, or acute bacterial lesions. Performing services risks spreading pathogens across the scalp and to other clients via shared tools.

┌─────────────────────────────────────────────────────────────────────────────┐
│                     STRICT SALON CONTRAINDICATIONS                          │
├─────────────────────────────────────────────────────────────────────────────┤
│ 1. FUNGAL (Tinea)     │ Tinea Capitis (Ringworm), Tinea Favosa (Scutula)    │
│ 2. PARASITIC          │ Pediculosis Capitis (Lice), Scabies (Itch Mite)     │
│ 3. BACTERIAL (Staph)  │ Furuncles (Boils), Carbuncles (Deep Abscesses)      │
│ 4. OPEN LESIONS       │ Abrasions, Weeping Eczema, Impetigo, Active Herpes  │
└─────────────────────────────────────────────────────────────────────────────┘

1. Fungal Dermatophyte Infections (Tinea)

• Tinea: Technical term for ringworm, a contagious fungal infection caused by dermatophytes.
• Tinea Capitis: Ringworm of the scalp. Presents as small red papules or pustules at follicle openings. Hair becomes brittle, lusterless, and breaks off at scalp level, leaving bald patches with black dots. Highly contagious among school-aged children.
• Tinea Favosa (Favus): Severe fungal infection characterized by dry, sulfur-yellow, cup-like crusts on the scalp called scutula. The scalp emits a characteristic foul, "mousy" odor. Scutula destroy follicles, leading to permanent pink or white scarred bald patches (cicatricial alopecia).

2. Parasitic Infestations

• Pediculosis Capitis (Head Lice): Infestation of the scalp and hair with wingless parasitic insects (Pediculus humanus capitis). Lice feed on human blood from the scalp, producing intense itching. Female lice cement tiny, oval, pearly-white eggs (nits) firmly to hair shafts near the scalp. Unlike dandruff flakes (which brush away easily), nits are firmly glued and cannot be shaken loose.
• Scabies: Highly contagious skin disease caused by the microscopic itch mite (Sarcoptes scabiei). Female mites burrow beneath the epidermal skin layers to lay eggs, producing intense nocturnal itching and elevated vesicle burrows on the scalp, neck, and webbed fingers.

3. Bacterial Staphylococcal Infections

• Folliculitis: Mild bacterial infection of the hair follicles characterized by small, pustular eruptions.
• Furuncle (Boil): Acute, localized staphylococcal bacterial infection of a hair follicle producing constant, throbbing pain, localized swelling, erythema, and a central core of pus.
• Carbuncle: A severe, deep-seated staphylococcal infection involving multiple hair follicles and subcutaneous tissue. A carbuncle is essentially a cluster of boils and is significantly larger and deeper than a single furuncle.

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2. Professional NYS Salon Protocols & Client Management

When a cosmetologist discovers an infectious disease, parasitic infestation, or open inflamed lesion during consultation:

1. Stop Immediately and Tactfully: Discreetly halt the service. Never embarrass or shame the client in front of other salon patrons.
2. Provide Clear, Non-Diagnostic Explanation: State what is visually observed (e.g., "I am seeing some scalp irritation and flaking that requires evaluation by a medical professional before we can safely perform your service"). Never state a formal medical diagnosis.
3. Refer to a Physician: Recommend that the client schedule an appointment with a licensed dermatologist or medical practitioner.
4. Decontaminate Workstation & Implements:
   • Isolate all capes and towels used in a sealed plastic laundry bag; wash at high temperature (minimum 140°F) with detergent and bleach.
   • Thoroughly clean all brushes, combs, clips, and shears with warm soapy water, then immerse completely in an EPA-registered hospital-grade disinfectant for the full manufacturer contact time (typically 10 minutes).
   • Wipe down chairs, shampoo bowls, and countertops with EPA-registered disinfectant wipes.

3. The New York Protocol When You Find One

19 NYCRR § 160.27(c) bars diagnosis and treatment, and Chapter 1's ethics duty requires discretion. Together they produce a fixed sequence.

1. Stop the service immediately. Do not continue "just to finish the cut". Every additional pass spreads the organism onto implements, capes and the station.
2. Protect the client's privacy. Speak quietly, at the chair, without an audience. Never announce a finding across a salon floor.
3. Describe, do not diagnose. "I'm seeing something on the scalp that needs a doctor's opinion before I can safely provide chemical or heat services" is accurate and within scope. Naming ringworm or lice is not.
4. Refer to a physician, dermatologist or pharmacist as appropriate.
5. Decontaminate everything.
   • Discard all single-use items — neck strips, emery boards, orangewood sticks, applicators.
   • Bag all linens immediately in the covered receptacle required by § 160.24; wash and dry on the hottest setting the fabric allows.
   • Clean and disinfect every reusable implement through the full § 160.17(c) sequence: wash in warm water with soap or detergent, rinse, dry, immerse for 10 minutes or more in an EPA hospital-grade disinfectant, rinse, dry, store covered.
   • Clean and disinfect the chair, headrest, trolley, station surface and any tool that touched the client, per § 160.22(e).
   • Vacuum and dispose of hair clippings in a covered waste container under § 160.16(b)(4).
6. Wash your hands with soap and water under § 160.20(e), and check your own skin.
7. Document the date, what you observed, that you stopped the service, and that you referred — without recording a diagnosis.
8. Rebook conditionally. The client may return with medical clearance. Say so warmly; a client who feels humiliated does not come back and does not get treated.

4. Rapid Identification Table

The distinguishing test candidates are asked about most

Nits versus dandruff. Both look like small pale specks on the hair. Dandruff flakes sit loosely and slide freely along the shaft or fall away when the hair is moved. Nits are cemented by the louse to the base of the hair shaft and will not slide — they must be pulled off. That single mechanical difference is the identification, and it can be made in seconds without touching the client's scalp with bare hands.