6.4 Skin Disorders, Diseases, Lesions & Contraindications

Skin Disorders, Diseases, and Lesions

Estheticians are not licensed to diagnose medical conditions, but they must be able to recognize skin disorders, diseases, and lesions. Recognizing these abnormalities is essential for knowing when to proceed with a treatment and when to refuse service and refer the client to a dermatologist (medical contraindication).

Lesions of the Skin

A lesion is any mark, symptom, or abnormality on the skin that indicates damage or disease. They are categorized into primary, secondary, and tertiary (vascular) lesions.

Primary Lesions

Primary lesions are lesions in the early stages of development or change. They are characterized by flat, non-palpable changes in skin color or by elevations formed by fluid in a cavity.

• Macule: A flat, distinct, discolored area of skin less than 1 cm wide (e.g., a freckle or age spot).
• Papule: A small, solid elevation on the skin that contains no fluid but may develop pus (e.g., a small pimple).
• Pustule: An inflamed papule with a white or yellow center containing pus (a mixture of white blood cells, bacteria, and debris).
• Vesicle: A small blister or sac containing clear fluid, lying within or just beneath the epidermis (e.g., poison ivy reaction, herpes simplex).
• Wheal: An itchy, swollen lesion caused by a blow, scratch, insect bite, or allergy (e.g., hives/urticaria).
• Tumor: A large nodule; an abnormal cell mass resulting from excessive cell multiplication.
• Nodule: A solid bump larger than 0.5 cm that can be easily felt.

Secondary Lesions

Secondary lesions develop in the later stages of disease and change the structure of tissues or organs. They are often the result of scratching or the progression of a primary lesion.

• Crust: Dead cells that form over a wound or blemish while it is healing; an accumulation of sebum and pus (e.g., a scab).
• Excoriation: A skin sore or abrasion produced by scratching or scraping.
• Fissure: A crack in the skin that penetrates the dermis (e.g., severely chapped lips or heels).
• Keloid: A thick scar resulting from excessive growth of fibrous tissue (collagen).
• Scale: Thin, dry, or oily plates of epidermal flakes (e.g., dandruff or psoriasis).
• Ulcer: An open lesion on the skin or mucous membrane, accompanied by pus and loss of skin depth.

Acne and Comedones

Acne is a chronic inflammatory skin disorder of the sebaceous glands characterized by comedones and blemishes.

• Open Comedones (Blackheads): Follicles filled with excess sebum and dead cells. The dark color is due to the oxidation of the sebum when exposed to oxygen, not dirt.
• Closed Comedones (Whiteheads): Follicles blocked with debris but trapped under a layer of skin cells, preventing oxygen exposure.
• Sebaceous Hyperplasia: Benign lesions frequently seen in oilier areas of the face. They look like doughnut-shaped bumps and cannot be extracted.

Acne Grades

Acne is classified into four grades based on severity:

• Grade I: Minor breakouts, mostly open comedones, some closed comedones, and a few papules.
• Grade II: Many closed comedones, more open comedones, and occasional papules and pustules.
• Grade III: Red and inflamed, many comedones, papules, and pustules.
• Grade IV: Cystic acne. Cysts with comedones, papules, pustules, and inflammation are present. Scar formation from tissue damage is common. Note: Estheticians do not treat Grade IV acne; the client must be referred to a physician.

Common Skin Disorders

• Eczema: An inflammatory, painful, itching disease of the skin; acute or chronic in nature, with dry or moist lesions. Avoid treatment on inflamed areas.
• Contact Dermatitis: An inflammatory skin condition caused by contact with a substance or chemical (allergic or irritant).
• Psoriasis: A chronic skin disease characterized by red patches covered with silver-white scales; usually found on the scalp, elbows, knees, chest, and lower back. Caused by an over-proliferation of skin cells.

Skin Cancer and the ABCDE Guide

Skin cancer is caused by damage to DNA, primarily from UV radiation. The three main types are:

1. Basal Cell Carcinoma: The most common and least severe type. Appears as light, pearly nodules.
2. Squamous Cell Carcinoma: More serious than basal cell; characterized by scaly red pink papules or nodules.
3. Malignant Melanoma: The most serious form of skin cancer as it can metastasize quickly. Appears as black or dark patches on the skin, usually uneven in texture, jagged, or raised.

Use the ABCDE Guide to help identify potential melanomas:

• A - Asymmetry: One half of the mole does not match the other half.
• B - Border: The edges are irregular, ragged, notched, or blurred.
• C - Color: The color is not uniform and may have varying shades of brown, black, red, white, or blue.
• D - Diameter: The spot is larger than 6mm (about the size of a pencil eraser).
• E - Evolving: The mole is changing in size, shape, or color.

Medical Contraindications

A contraindication is a condition that requires you to refuse service or modify a treatment to prevent harm. Common contraindications for facial treatments include:

• Contagious diseases (e.g., active Herpes Simplex Virus/cold sores, pink eye, ringworm).
• Skin disorders in active, inflamed stages (severe eczema, psoriasis, grade IV cystic acne).
• Use of prescription acne drugs like Isotretinoin (Accutane) within the last 6 months.
• Recent cosmetic surgeries, injectables, or chemical peels without a doctor's clearance.
• Sunburn or severely compromised skin barriers.