3.3 Scalp Diseases and Disorders

Scalp diseases and disorders are the last named histology bucket on the Oregon Barbering bulletin (still inside those 14 hair-and-scalp items). The Laws & Rules exam will not ask you to prescribe ketoconazole. It will ask whether you safeguard the next client. ORS 690.005(2) again: cosmetic purposes, not medical diagnosis or treatment of disease. OAR 817-120-0005: practice in a manner that safeguards health, safety, and welfare; you are responsible for knowing if a practice is prohibited; unsafe or harmful services can be unprofessional conduct. The practical test in a Eugene or Bend chair is the same as in Salem: is this ordinary flaking you can shampoo, a non-infectious plaque you should not pick, or a contagious condition you must not spread?

Dandruff, seborrheic dermatitis, and psoriasis

Dandruff is the everyday name for pityriasis capitis: dry, white or gray flakes with little redness. It is a disorder of scalp shedding, often discussed with Malassezia yeast in textbooks, but Oregon shops do not treat it as tinea. On intact skin you may perform a regular shampoo and cut. You do not diagnose a medical cause. You do not sell a prescription.

Seborrheic dermatitis is the inflammatory cousin of greasy dandruff. Expect oily, yellowish scale plus redness, often at the hairline, brows, sides of the nose, and behind the ears—not only on the crown. The scalp can itch and look oily rather than powdery. This is not ringworm. It is also not a condition you treat with a prescription steroid. If the scalp is intact and the client already uses a cosmetic anti-dandruff shampoo they purchased themselves, you may still cut. If the skin is cracked, bleeding, or you cannot tell seborrheic scale from tinea, stop and refer.

Psoriasis of the scalp presents as well-defined plaques with silvery scale. If scale is forcibly removed, pinpoint bleeding can appear (the textbook Auspitz sign)—which is exactly why you do not pick, scrape, or "clear" plaques with a razor. Psoriasis is not contagious. An Oregon barber may cut hair around stable plaques on intact skin if the client is comfortable. Do not shave through plaques. Do not claim a tonic will cure psoriasis. New, spreading, or painful plaques get a physician referral.

Tinea capitis, tinea favosa, and scabies

Tinea capitis is fungal ringworm of the scalp. Circular patches, broken hairs, black-dot stubble, scaling, and itch are the hallmarks. Children and close household contacts are classic in public-health language, but adults sit in barber chairs too. Stop. Refer. Do not "cut it short to dry it out."

Tinea favosa (favus) is a more destructive fungal infection associated with cup-shaped yellow crusts called scutula, a distinctive odor in textbook descriptions, and a real risk of scarring alopecia. It is contagious. Stop. Refer. This is not dandruff. Scutula are not flakes you shampoo away.

Scabies is infestation with the mite Sarcoptes scabiei. You may see burrows, intense itching (often worse at night), and excoriations that can extend beyond the scalp to wrists, finger webs, and belt line. It is contagious through close contact and contaminated linens. An Oregon barber does not treat scabies. Stop, refer, bag linens as soiled, wash hands before and after per OAR 817-010-0008, and disinfect tools. There is no "scabies exception" analogous to the head-lice discretion rule.

Folliculitis, furuncle, carbuncle, and shaving scars

Folliculitis is inflammation or infection of hair follicles. You see pustules centered on follicle openings, often where a razor or clipper has been. Staphylococcal bacteria are the usual textbook villain. Do not shave through a field of pustules. That spreads bacteria on the skin and on your blade. Refer if lesions are painful, spreading, or draining.

A furuncle (boil) is a deeper abscess of one follicle: red, hot, painful, often with a core. A carbuncle is a cluster of adjoining furuncles with multiple draining points and a higher risk of systemic illness. Both are infectious. Stop. Refer. Do not lance a boil. Do not express pus. Do not finish a head shave "around" a draining carbuncle and then use the same razor on the next neck.

Close shaving, ingrown hairs, and repeated folliculitis can leave scars. A hypertrophic scar is a raised scar that stays inside the original injury. A keloid grows beyond the original injury and can keep enlarging. Neither is contagious. Do not shave over an active, tender, or inflamed keloid. Do not sell a razor technique as keloid treatment. Refer clients with spreading keloids after shaving to a physician. Choose a longer guard over a skin shave when the skin is already scarring. That is still barbering: cosmetic, protective, and inside OAR 817-120-0005.

Head lice under OAR 817-015-0075

Oregon writes a rule other states often leave to textbooks. OAR 817-015-0075 (Head Lice), adopted BOC 5-2019 and effective 1/1/2020, states in full: head lice may be treated at the discretion of the authorization holder. Compliance with OAR Chapter 817, Division 10 Safety and Infection Control Rules and Facility Standards must be observed and followed. That is the current Secretary of State text. It is not a command to treat lice, and it is not a command to refuse. Discretion sits with the authorization holder. If you decline, you still wash your hands and keep soiled articles off the next client. If you proceed, Division 10 is mandatory: hand washing immediately before and after (OAR 817-010-0008), gloves when blood or other potentially infectious materials are a routine risk, disinfection of tools, and no soiled cape, comb, or neck strip reused (OAR 817-005-0005). Pediculicide drugs that require a prescription are outside barbering. You are not a pharmacist and not a physician.

When Oregon rules require you to stop and refer

Stop and refer when the service would spread infection or harm the client: tinea capitis, tinea favosa, scabies, draining furuncles or carbuncles, open or weeping undiagnosed lesions, and pustular folliculitis you would have to shave through. Head lice are the documented exception of discretion, not an invitation to ignore infection control. Non-infectious dandruff, stable psoriasis plaques on intact skin, and old quiet scars can usually be adapted. Never treat with prescription drugs. Never apply a leftover antibiotic ointment "from the first-aid kit" as therapy for a carbuncle. Never tell a client you have cured their psoriasis. Record observations, not diagnoses. Refer.

Bend shop scenario. A client wants a full head shave. You find two tender, draining boils at the nape and a few scattered pustules in the hairline. That is carbuncle/furuncle territory, not "ingrowns you can shave off." You stop, you do not put a razor through draining lesions, you refer, you wash immediately before and after, and every article that touched the nape is soiled until cleaned and disinfected. A different client has dry white flakes, no redness, no rings, no nits. That is ordinary dandruff. Shampoo, cut, and move on—without calling it a disease you treated.