12.3 Skin Disorders, Diseases & Contraindications

12.3 Skin Disorders, Diseases & Contraindications

Quick Answer: Name the lesion, decide if it is infectious, inflamed, or outside scope, then either modify the facial or stop and refer. Oklahoma OAC 175:10-7-20 is the communicable-disease rule; OAC 175:10-7-29 is the scope rule that forbids puncturing skin and removing moles or skin tags.

NIC Scientific Concepts asks you to recognize signs of skin conditions, disorders, and diseases. NIC Skin Care asks you to recognize contraindications. The Board will not grade you for playing physician. It will grade you for servicing a pink eye, a weeping impetigo patch, or a blistering cold sore.

Disorder in salon language often means a condition that may be non-contagious (acne, rosacea, many eczemas, pigment change). Disease on exam items often flags a pathologic process — especially contagious bacterial, viral, or fungal infections. When in doubt, treat unknown open, weeping, or vesicular lesions as do not service.

Primary lesions

Primary lesions arise on previously unaltered skin. Memorize the object, not a poem.

A comedone is a plugged follicle: open (blackhead) or closed (whitehead). Textbook facial extraction, when appropriate, is aimed at comedones, not at pustules, cysts, vesicles, or moles.

Secondary lesions

Secondary lesions develop from primary ones, from picking, or from disease progression.

Acne, conceptually graded

You will see acne described by severity rather than by a prescription pad.

• Mild / grade-style 1 — mostly open comedones, few papules.
• Grade-style 2 — many closed comedones plus papules and pustules.
• Grade-style 3 — obviously red and inflamed, many papules and pustules, occasional cysts.
• Grade-style 4 — cystic, nodular, highly inflamed.

Exact grade numbers vary by textbook; the exam idea is consistent: more inflammation and cysts means less extraction and more referral. You may cleanse and soothe non-inflamed oily skin. You do not crush cystic acne. Isotretinoin history is a classic reason to avoid waxing and aggressive exfoliation because the skin tears.

Rosacea, eczema/dermatitis, psoriasis

Rosacea presents as central-face redness, flushing, possible papules, and visible vessels. Heat, spice, alcohol, steam, rotary brushes, and stimulating massage make it worse. It is not contagious, but it is inflamed — no massage on the inflamed surface (175:10-7-20(d)), and you do not treat it as ordinary oily acne.

Eczema / dermatitis is inflamed, often itchy skin that may weep or crust. Product allergy (including fragrance or preservative) can cause contact dermatitis. Stop the offending product, do not interpret weeping skin as a "detox," and refer when it is undiagnosed or infected-looking.

Psoriasis classically shows silvery scale on red plaques (elbows, scalp, and sometimes face). It is not treated as a salon fungus. Do not pick scale off. If you are unsure it is not tinea, you refer — because tinea is contagious and psoriasis is not something you confirm with a clay mask.

Contagious stop-and-refer list

These names are high-yield. Visible, suspected infection means OAC 175:10-7-20: wash and disinfect hands, discontinue, refer to a physician. The person in charge also must not allow a knowingly infected worker to serve patrons.

• Herpes simplex — vesicles, often on the lip border (cold sore). Viral and contagious. No facial, no waxing over it, no "drying it with high frequency" as a complete-the-service trick.
• Tinea — fungal (ringworm family). Round, scaly, itchy patches possible. Contagious. Not a moisturizer problem.
• Impetigo — bacterial, honey-colored crusts, common around nose and mouth in teaching photos. Highly contagious. Stop.
• Conjunctivitis — pink, draining, or stuck-together eyes. Contagious. No eye-area service, no shared towels, discontinue.
• Verruca (wart) — viral hypertrophy. Contagious. You do not cut, burn, or acid-remove warts in the salon. Document and work around or refer.

OAC 175:10-7-20(d) is broader than infection: no massage when the surface is inflamed or has open cuts, lesions, or infection. That sentence alone fails a lot of "just do a light effleurage" wishful thinking.

Pigment: hyperpigmentation and hypopigmentation

Hyperpigmentation is extra melanin or leftover hemosiderin color — sun spots, post-inflammatory marks after acne, melasma-type patches. You may discuss sun protection and gentle care. You do not promise to bleach a patch into the dermis, and you do not peel beyond Oklahoma's corneum limits to "fix" pigment.

Hypopigmentation is loss or reduction of pigment (vitiligo-type patches, some scars). It is not a stain you even out with foundation as a medical plan. Sudden pigment loss is a refer.

Neither is a Fitzpatrick type. Phototype is sun response; pigment disorders are local color change.

Hypertrophies — look, do not remove what the rule forbids

A hypertrophy is an overgrowth of tissue.

• Keratoma (callus) — thickened corneum from pressure, more a foot/hand item than a facial item, but it is a hypertrophy of keratin.
• Mole (nevus) — pigmented or flesh-colored spot. Observe for change; never remove.
• Verruca — wart; viral; do not remove.
• Skin tag (acrochordon) — small outgrowth, often on neck or eyelids. Observe; never remove.

OAC 175:10-7-29 states that services that puncture the skin or that fall in the healing arts are beyond a cosmetology or facialist/esthetician license. The rule's puncture list includes dermabrasion and the removal of tattoos, skin tags, moles, or angiomas. Client consent does not create a surgical privilege. Ligating a tag with string, snipping it, or burning it with a salon device is still removal.

Your job is to see the mole, chart it, work around it, and refer if it is changing, bleeding, or the client wants it gone.

Contraindication decision tree for facials

Use this order on both the written exam and the chair:

1. Suspected communicable disease (herpes, tinea, impetigo, conjunctivitis, lice on the scalp from other chapters) → stop, hygiene, physician referral (175:10-7-20).
2. Open skin, weeping, or inflammation in the work area → no massage; skip extract/peel/steam as indicated.
3. Scope (moles, tags, dermabrasion, Class 3 microdermabrasion, puncturing) → refuse the illegal part even if the rest of the facial can proceed.
4. Product/medication fragility (isotretinoin, raw retinoid irritation, recent medical peel) → modify or decline exfoliation and wax.
5. If none of the above → continue with type-appropriate protocol and records.

A pustule next to a cluster of open comedones is a mixed picture: you may still cleanse, but you do not "get them all" by treating pus as a blackhead.