8.2 Skin Disorders & Diseases

Why This Matters for the Exam

The Hair, Scalp, Skin, and Nail Analysis domain includes skin conditions and disorders, because every cosmetologist is legally responsible for deciding whether a service is safe to perform. Questions typically show a lesion name and ask for its definition, name a condition and ask whether you may perform a service, or test the whitehead-versus-blackhead distinction. The unifying rule is simple and heavily tested: cosmetologists recognize and refer — they never diagnose or treat disease.

Lesions of the Skin

A lesion is any structural change in the tissue caused by damage or injury. The exam divides lesions into two groups.

Primary lesions are the initial changes, present at the onset of a condition, before the skin is altered by scratching, infection, or healing:

Secondary lesions develop later — from the natural evolution of a primary lesion or from outside trauma such as scratching:

• Scale — thin, dry or oily plates of epidermal flakes, as in psoriasis or dandruff
• Crust — dead cells that form over a wound or blemish while healing; a scab
• Excoriation — a skin sore or abrasion produced by scratching or scraping
• Fissure — a crack in the skin that penetrates the dermis, as in chapped hands or lips
• Ulcer — an open lesion of the skin or mucous membrane with loss of skin depth and possibly weeping fluids or pus
• Scar (cicatrix) — lightly raised mark formed after a wound or lesion has healed

A classic exam pairing asks you to distinguish a macule (flat) from a papule (raised), or a vesicle (small fluid blister) from a bulla (large one).

Pigment Disorders

Disorders of pigmentation involve melanin, the pigment produced by melanocytes in the stratum germinativum:

• Albinism — a rare congenital absence of melanin in the skin, hair, and eyes
• Vitiligo — a hereditary condition producing milky-white patches (leukoderma) caused by loss of pigment-producing cells
• Melasma (chloasma) — patches of brown discoloration, often triggered by hormonal changes such as pregnancy or birth control use; sometimes called the mask of pregnancy
• Lentigines — the technical term for freckles; small yellow-to-brown spots on sun-exposed skin
• Nevus — the technical term for a mole; a small, pigmented malformation of the skin
• Leukoderma — any light, abnormal patch of depigmented skin, often from congenital causes or acquired conditions
• Tan — increased pigmentation from sun exposure, which is actually visible skin damage

Hypertrophies of the Skin

A hypertrophy is an abnormal overgrowth of skin:

• Callus (callosity) — a thickening of the skin from continued pressure or friction, as on feet or hands
• Verruca — the technical term for a wart, caused by a virus; it is contagious and can spread, so work around it or refer the client
• Skin tag — a small, benign, flesh-colored or brown outgrowth of skin, common on the neck and underarms

Common Skin Conditions

Acne is a chronic inflammatory disorder of the sebaceous glands. Its building blocks are comedones — masses of hardened sebum and dead cells in a hair follicle. A closed comedo is a whitehead, a plugged follicle that stays beneath the surface and has no visible opening. An open comedo is a blackhead, a follicle plugged at the surface whose dark color comes from oxidation of the sebum, not from dirt — the exam loves that distinction. Milia are small, pearly white, keratin-filled cysts that sit just under the epidermis with no visible opening; they are common around the eyes and cheeks.

Rosacea is a chronic inflammatory condition with visible vasodilation of the blood vessels, producing persistent redness and flushing across the cheeks, nose, and chin, sometimes with papules and pustules. Heat, sun, spicy food, alcohol, and stress aggravate it. Because heat dilates the vessels further, cosmetologists should avoid steam, hot towels, and vigorous massage on rosacea-prone clients.

Eczema and dermatitis are inflammatory conditions with dry or moist lesions, itching, and redness. Contact dermatitis is an allergic or irritant reaction to a substance that touches the skin — a major salon concern, since chemicals in hair color, relaxers, nail products, and disinfectants can trigger it. This is one reason patch tests and gloves matter.

Psoriasis produces red patches covered with silver-white scales, usually on the scalp, elbows, knees, and chest. It is not contagious, but it is a medical condition: work gently around affected areas and refer when in doubt.

Contagious Infections — Refuse Service

Tennessee regulations and the exam agree: a cosmetologist must refuse service and refer the client to a physician when a contagious condition is present. The infections most often named on the exam:

• Impetigo — a highly contagious bacterial infection with weeping lesions and crusts, common in children
• Conjunctivitis — pink eye; a contagious inflammation of the membrane around the eye
• Herpes simplex — a viral infection causing fever blisters or cold sores, usually on the lips or nostrils
• Tinea corporis — ringworm of the body; a contagious fungal infection forming red, ring-shaped patches

Performing a service over any of these spreads infection to other clients and violates sanitation law.

Skin Cancer Awareness

Cosmetologists see skin up close every day, so the exam expects basic cancer awareness — strictly at the recognize-and-refer level:

• Basal cell carcinoma — the most common and least severe skin cancer; often a pearly nodule or sore that does not heal
• Squamous cell carcinoma — more serious than basal cell; scaly red patches, open sores, or wart-like growths that may crust or bleed
• Melanoma — the most dangerous form; a dark, changing lesion. Use the ABCDE checklist: Asymmetry, irregular Border, uneven Color, Diameter larger than a pencil eraser, and Evolving (changing) appearance

Never tell a client a spot is cancer. Say that you noticed a change and recommend a physician look at it.

Service or Refer: Quick Decision Table