7.2 Skin & Scalp Diseases, Disorders & Contraindications

7.2 Skin & Scalp Diseases, Disorders & Contraindications

Quick Answer: Know primary vs. secondary lesions, common disorders (acne, eczema, psoriasis, dermatitis, herpes, impetigo), contagious vs. non-contagious risk, and pigment disorders (vitiligo, chloasma/melasma, albinism) at recognition level. On the Ohio Cosmetology Theory TIP, this knowledge sits inside Anatomy & Physiology (27%) and overlaps infection-control judgment: when in doubt of contagion or open infection, refuse service and refer to a physician — cosmetologists do not diagnose.

Recognizing abnormal skin is a professional duty, not a medical specialty. Ohio candidates must show they can protect the public: identify suspicious signs, stop services that could spread infection or worsen injury, and communicate calmly without alarming or diagnosing. Theory items often pair a lesion description with the correct professional action.

Scope of Practice: Recognize, Do Not Diagnose

Use client-friendly language: “I see an open area I’m not able to work over today; please check with a doctor before we reschedule chemical services.” That protects the client, your license, and public health.

Primary Lesions

Primary lesions are the first visible changes on previously normal skin. High-yield terms:

• Macule — Flat spot of color change (e.g., freckle); no elevation.
• Papule — Small, elevated solid bump (no fluid).
• Pustule — Inflamed elevation containing pus (acne pustules are classic examples).
• Vesicle — Small blister with clear fluid (e.g., some herpes lesions start as vesicles).
• Bulla — Larger blister than a vesicle.
• Wheal — Itchy, swollen lesion often from allergy or insect bite (hive-like).
• Tubercle / nodule / tumor — Deeper or larger solid masses; tumors may be benign or malignant — refer any unexplained growth.

Exam stems often give a one-line definition (“elevated lesion containing pus”) and expect pustule.

Secondary Lesions

Secondary lesions develop from the evolution of primary lesions or from external damage (scratching, infection, healing):

• Scale — Thin dry or oily plate of epidermal flakes (dandruff-like shedding can present as scales).
• Crust — Dried sebum, pus, or blood (scab).
• Fissure — Crack in the skin reaching into the dermis (painful; contraindication for many services).
• Ulcer — Open sore with loss of skin depth; always avoid service over ulcers and refer.
• Scar / cicatrix — Fibrous tissue after healing; generally not contagious, but recently healed or tender scars need gentle handling.
• Excoriation — Scratch or scrape from mechanical trauma.

Practical rule: Secondary lesions that are open, crusted with active infection signs, or weeping are service stop signs until medically cleared or fully healed per professional judgment and school/salon policy.

Common Disorders: Recognition and Salon Action

Acne

Acne involves pilosebaceous units — excess oil, retained cells, bacteria, and inflammation. Cosmetologists see comedones (blackheads/whiteheads), papules, and pustules. Mild, non-infected cosmetic concerns may allow careful cleansing services within scope; inflamed, cystic, or open infected lesions are not “extra extraction days.” Do not dig, lance, or promise medical acne cures. Avoid aggressive products that strip the barrier and worsen inflammation.

Eczema and Dermatitis

Eczema is often used in cosmetology texts for itchy, inflamed, dry or weeping dermatitis patterns. Dermatitis means skin inflammation; contact dermatitis can be from allergens or irritants (including professional products). Salon action: avoid services that further irritate active flares; review product ingredients if a client reports sensitivity; stop a service if burning/itching escalates. Chronic dry patches that are intact may allow modified gentle services — active oozing or cracked bleeding areas do not.

Psoriasis

Psoriasis classically presents as silvery scales on red plaques (elbows, knees, scalp common). It is generally considered non-contagious. Still, do not scrape scales off or perform aggressive scalp treatments on inflamed plaques. Refer for medical management; offer only services that do not traumatize lesions.

Herpes (including cold sores)

Herpes simplex lesions (often around the mouth as cold sores) are contagious, especially when vesicular or open. Refuse facial services, lip waxing, and makeup near active lesions. Implements and towels must never transfer from a lesion-bearing area to another client. Even after crusting begins, many salons wait until fully healed — follow conservative infection-control judgment taught in your program and Board sanitation standards.

Impetigo

Impetigo is a highly contagious bacterial infection, more common in children but possible in adults: honey-colored crusts, often on the face. Refuse service and refer. Do not perform services near lesions; disinfect thoroughly if accidental exposure pathways existed.

Contagious vs. Non-Contagious — Decision Table

Ohio infection-control domain content (24%) and A&P (27%) meet here: the theory exam rewards candidates who protect the next client as carefully as the current one.

Pigment Disorders (Recognition Level)

• Vitiligo — Patchy loss of pigment (hypopigmentation) from melanocyte dysfunction; not contagious. Avoid promising repigmentation with salon products; be sensitive about coverage makeup if requested and appropriate.
• Chloasma (often discussed with melasma) — Hyperpigmented patches, frequently on the face, associated with hormones/sun; not contagious. Chemical peels beyond license scope and unsupervised aggressive bleaching are not appropriate cosmetology practice.
• Albinism — Congenital lack of melanin; not contagious. Extreme sun sensitivity — counsel gently about UV protection; never market tanning or harsh lightening as solutions.

Also know related vocabulary: lentigines (freckle-like spots), nevus (birthmark/mole — refer changing moles), stain (abnormal brown/wine-colored skin discoloration).

When to Refuse Service and Refer

Refuse and refer when you observe:

1. Signs of contagious infection (impetigo, active herpes, fungal scalp infection suspicion, parasites).
2. Open sores, weeping lesions, or bleeding fissures in the service area.
3. Undiagnosed growths or rapidly changing pigmented lesions.
4. Severe inflammation where products, heat, or friction would clearly worsen tissue injury.
5. Client discloses a condition their physician said prohibits the planned service.

Document the refusal factually. Offer to reschedule after medical clearance when appropriate. Never pressure a client to “just cover it with makeup” so you can finish a ticket.

Study Strategy

• Make two flashcard decks: primary lesions and secondary lesions — definition on front, name on back.
• For each disease name in this section, write one line: contagious? yes/no/unknown and salon action.
• Practice polite refuse-and-refer scripts aloud; exam scenarios test judgment as much as vocabulary.

Next, section 7.3 applies the same recognition-and-contraindication mindset to the nail unit — another high-yield A&P and nail-care overlap for Ohio theory.