6.2 Hair and Scalp Disorders, Diseases & Service Contraindications
Key Takeaways
- Noncontagious cosmetic disorders can often be serviced with a modified plan; contagious or infectious diseases are stop-and-refer conditions in Oklahoma.
- OAC 175:10-7-20 requires universal precautions; if you have reason to suspect a communicable or infectious disease, wash and disinfect your hands, discontinue services, and refer the patron to a physician.
- OAC 175:10-7-7: if head lice is detected, do not proceed; refer to a physician or health clinic; a physician’s signed statement that the person is no longer infected is required before services resume.
- Pityriasis (dandruff) is a disorder; tinea capitis, tinea favosa, pediculosis capitis, scabies, furuncles, and carbuncles are infectious and are not salon-treatable diseases.
- Alopecia types and shaft disorders such as trichoptilosis or canities change the service plan but are not treated as lice-style communicable infestations.
6.2 Hair and Scalp Disorders, Diseases & Service Contraindications
Quick Answer: If you have reason to suspect a communicable or infectious disease, Oklahoma rule is stop, wash and disinfect your hands, and refer to a physician (OAC 175:10-7-20). Head lice has its own procedure: do not proceed, refer, bag exposed linens, wipe exposed areas with an EPA-registered lice-killing product, and require a physician’s signed statement before the person returns (OAC 175:10-7-7). Split ends and gray hair are not that category.
Independent OpenExamPrep study for Oklahoma cosmetology splits this topic the way the written exam and the Board sanitation rules both split it: name the condition, then decide whether you may touch the client.
Disorder versus disease at the chair
A disorder is an abnormal condition of the hair or scalp. Many disorders are not contagious (gray hair, split ends, beaded hair). You still analyze them because they change cutting, chemical, and home-care plans.
A disease in this chapter is a pathological process — often infectious or parasitic — that you are not licensed to diagnose or treat as a physician. Your job is recognition plus referral. You do not confirm ringworm with a laboratory culture in a Tulsa salon. You do recognize a scaly, broken-hair patch as a reason to stop.
OAC 175:10-7-20 also requires universal precautions (treat blood and other body fluids as if infectious). No licensee, student, or apprentice shall massage a surface that is inflamed or has open cuts, lesions, or infection. A “tiny sore” at the nape is a massage and chemical-service stop on that skin, not a dare.
Owners and managers share the duty: a person in charge who is knowingly infected shall not work, and shall not permit a person infected with a communicable disease to work in the establishment or school (175:10-7-20(c)). The same owner/manager duty appears in the lice rule (175:10-7-7(e)), with license risk for noncompliance.
Pityriasis (dandruff)
Pityriasis is excessive shedding of the scalp’s dead epidermal cells — dandruff.
- Pityriasis capitis simplex — dry dandruff: dry, flaky scales, itch. Often managed with medicated shampoos and scalp care when the scalp is intact and there is no suspicion of fungus or infestation. If you are unsure whether flakes are dry dandruff or tinea, do not guess with a chemical service.
- Pityriasis steatoides — greasy or waxy dandruff: scales mixed with sebum, often yellowish and sticky. When redness and inflammation join greasy scales, textbooks discuss seborrheic dermatitis. Inflamed, weeping, or obviously infected scalps are refer, not “clarify and proceed.”
Dandruff is a disorder you will see weekly. It is not head lice and it is not ringworm. The exam wants the names and the dry versus greasy split, plus the judgment not to treat an inflamed scalp as a cosmetic flake problem.
Fungal, parasitic, and bacterial stop-and-refer conditions
These are not “recommend a tonic and continue the highlight.”
- Tinea capitis — ringworm of the scalp. Fungal. Red papules or patches, brittle or stubbly hair, often circular. Discontinue and refer (175:10-7-20).
- Tinea favosa (favus) — honeycomb ringworm. Dry, sulfur-yellow cuplike crusts (scutula), distinctive odor, risk of scarring alopecia. Discontinue and refer.
- Pediculosis capitis — head lice. Eggs (nits) cement to the hair; itching at the nape and behind the ears is common. Follow 175:10-7-7, not a home-remedy comb-out in the salon:
- Do not proceed with further services.
- Wash and disinfect your hands.
- Refer the person to a physician or health clinic.
- Wipe exposed areas with an EPA-registered lice-killing product.
- Seal exposed towels and linen in a plastic bag until laundered.
- The person should submit a statement signed by a practicing physician that they are no longer infected and free from the communicable episode before any services.
- The same immediate referral applies if a licensee, student, or apprentice has lice or another communicable condition.
- Scabies — itch mite. Highly contagious. Vesicles and itch in skin folds; not a “dry scalp shampoo.” Stop and refer.
- Furuncle — boil: staphylococcal infection of a follicle, painful pustule with a hair. Refer. Do not extract it as a “facial.”
- Carbuncle — larger staph infection of subcutaneous tissue, multiple follicles. Refer.
- Folliculitis — inflammation of follicles, often bacterial; barber’s itch (folliculitis barbae) is the beard/neck version. If it presents as infection — pustules, spreading redness — do not shave or wax through it. Intact-skin cosmetic folliculitis from an ingrown hair is still a reason to avoid irritating that site; spreading infection is a physician problem.
| Condition | Category | Oklahoma service decision |
|---|---|---|
| Pityriasis capitis simplex (dry dandruff) | Disorder | May proceed if scalp is intact and not suspicious for fungus or lice; adjust shampoo |
| Pityriasis steatoides (greasy dandruff) | Disorder | May proceed only if no inflammation/infection; inflamed scalp → refer |
| Trichoptilosis, canities, monilethrix | Noncontagious shaft disorders | May proceed with a modified mechanical/chemical plan |
| Androgenetic, areata, postpartum, traction alopecia | Hair-loss disorders | May proceed on remaining hair; do not claim a medical cure; refer unusual/sudden medical loss |
| Tinea capitis / tinea favosa | Fungal disease | Stop, hands washed/disinfected, refer to physician |
| Pediculosis capitis | Parasitic infestation | 175:10-7-7: stop, refer, EPA lice product on exposed areas, bag linens, physician clearance |
| Scabies | Parasitic | Stop and refer |
| Furuncle, carbuncle, infectious folliculitis | Bacterial | Stop on that tissue; refer |
Alopecias you will name on the exam
Alopecia means abnormal hair loss. You are not the dermatologist of record, but you must recognize patterns so you do not chemically cook miniaturized hair or ignore a traction problem you are making worse.
- Alopecia areata — sudden round or oval patches; autoimmune. Smooth, usually non-scarred bald spots. Refer for medical evaluation; you may style remaining hair. Do not promise “the protein pack will refill the patch.”
- Androgenetic alopecia — hereditary miniaturization (male-pattern and female-pattern). Terminal hairs become vellus-like. Density drops at the crown, temples, or midline. Consultation honesty matters: a tight ponytail and a high-volume bleach on already miniaturized hair is a breakage plan.
- Postpartum alopecia — a telogen shift after childbirth. Clients often notice handfuls of shed around months after delivery. Textbook teaching is that density often recovers over subsequent months as follicles re-enter anagen; still refer if loss is patchy, scarred, or accompanied by scalp disease.
- Traction alopecia — loss from prolonged tension (tight braids, ponytails, weaves). Early, it can reverse if tension stops; chronic traction can scar. If your style is the cause, change the style. That is a consultation duty, not an upsell.
Shaft disorders that are usually cosmetic, not contagious
You may generally proceed on these, with a plan that respects fragility:
- Trichoptilosis — split ends. Only removal of the split (cut) truly removes it. Oils coat; they do not weld keratin back together.
- Trichorrhexis nodosa — knotted hair: brittle swellings/nodes, hair breaks at the node. Often from mechanical or chemical abuse. Gentle handling; avoid more harsh chemical services until integrity improves.
- Monilethrix — beaded hair: periodic narrowing, breaks easily. Congenital. Short styles and low-stress finishing beat aggressive chemicals.
- Canities — gray hair. Congenital (at birth) or acquired (age, genetics). Gray hair can be coarser or more resistant; that is an analysis/color issue, not an infection.
- Hypertrichosis — superfluous hair (abnormal amount). Removal methods must stay inside Oklahoma cosmetology scope (no electrolysis under the esthetician definition used elsewhere in Title 175). Do not treat hypertrichosis as lice.
- Fragilitas crinium — brittle hair. Shorten, reduce chemical/thermal load, reconstructive care.
Exam traps: calling pityriasis a fungus; treating nits as “dry dandruff”; proceeding with a chemical service on tinea “because the client drove from Lawton”; inventing a Board-published list of which shampoos cure favus. The Board’s published move is stop and refer, not a treatment protocol.
When in doubt on an Oklahoma clinic floor: intact, non-inflamed, non-contagious cosmetic problem → proceed with a recorded plan. Suspicion of infection, infestation, open lesions, or inflammation on the surface you would service → 175:10-7-20 (and 175:10-7-7 if lice).
During a shampoo consultation in an Oklahoma salon you see nits cemented to hair at the nape. What does OAC 175:10-7-7 require you to do first regarding the service?
Which scalp condition is a fungal disease that requires you to discontinue services and refer the patron under OAC 175:10-7-20 rather than treat it as ordinary dry dandruff?
A client has trichoptilosis and wants a trim plus a gloss. There is no redness, no open lesions, and no sign of lice or ringworm. What is the correct Oklahoma service posture?
OAC 175:10-7-20 says that if a licensee has reason to suspect a patron is suffering from a communicable or infectious disease, the licensee shall wash and disinfect the hands and then: