4.2 Hair, Skin & Scalp Disorders
Key Takeaways
- Barbers must RECOGNIZE disorders but never diagnose or treat — that is outside the barber's scope of practice and reserved for physicians
- Contagious conditions that require REFUSING service and referring to a physician: tinea (capitis, corporis, barbae), pediculosis capitis (head lice), scabies, impetigo, folliculitis barbae, active herpes simplex lesions, and warts (verruca)
- Non-contagious conditions that generally may be served: pityriasis (dandruff), seborrheic dermatitis, psoriasis, acne (unless broken/open), alopecia areata and androgenic alopecia, canities (gray hair), hypertrichosis, and ingrown hairs
- Pseudofolliculitis barbae (razor bumps) is a non-contagious ingrown-hair condition most common in clients with tightly curled hair; adjust technique rather than refuse service
- Impetigo's honey-colored crusts and head lice nits cemented to hair shafts are classic exam recognition clues
4.2 Hair, Skin & Scalp Disorders
Quick Answer: Learn each disorder's name, appearance, and whether it is contagious. Contagious conditions — tinea, lice, scabies, impetigo, folliculitis barbae, active herpes, and warts — mean STOP: refuse service, disinfect anything touched, and refer the client to a physician. Non-contagious conditions like dandruff, psoriasis, alopecia, and ingrown hairs usually mean you may serve, sometimes with adjusted technique.
Every haircut starts with a visual inspection of the hair, skin, and scalp — this is a professional duty, not a courtesy. Two scope rules anchor every exam question in this area:
- Recognize, never diagnose. Barbers identify what they see to decide whether it is safe to work; naming a disease and prescribing treatment is the practice of medicine and outside a barber's license.
- When in doubt, refer. Any condition you cannot identify, or anything inflamed, oozing, or open, gets referred to a physician/dermatologist.
Contagious Disorders — Refuse Service
| Disorder | Cause | What You See | Decision |
|---|---|---|---|
| Tinea capitis | Fungus | Round, scaly scalp patches, broken hairs, possible black dots | Refuse; refer |
| Tinea corporis | Fungus | Ring-shaped scaly lesion on the body | Refuse on affected area; refer |
| Tinea barbae | Fungus | Ringworm patches in the beard | Refuse shaving; refer |
| Pediculosis capitis | Head lice | Itching; live lice; nits (eggs) glued to hair shafts | Refuse; refer for treatment |
| Scabies | Itch mite | Intense itching, burrows between fingers/wrists | Refuse; refer |
| Impetigo | Bacteria (staph/strep) | Weeping blisters that dry into honey-colored crusts, often around the mouth | Refuse; refer |
| Folliculitis barbae | Bacterial infection of beard follicles | Inflamed, pus-filled bumps in the beard | Refuse shaving; refer |
| Herpes simplex | Virus | Clustered cold sores/fever blisters near the lips | Refuse during active outbreak; refer |
| Verruca (warts) | HPV virus | Rough, raised growths on hands, face, or neck | Avoid contact; refuse if in the service area; refer |
Why refusal matters twice over: these conditions spread by direct contact and by contaminated tools — serving one infected client can expose every client after them. After any refusal, wash your hands and disinfect anything the client or their hair touched before the next service. Present the refusal politely and privately: explain that you are not permitted to work on the condition and that a physician can clear it quickly.
Non-Contagious Disorders — Generally Safe to Serve
| Disorder | What You See | Service Guidance |
|---|---|---|
| Pityriasis (dandruff) | White or gray flaky scales shedding from the scalp | May serve; suggest appropriate scalp care |
| Seborrheic dermatitis | Red, irritated skin with greasy, yellowish scales | May serve gently; refer if severe or inflamed |
| Psoriasis | Thick, red patches with silvery-white scales (scalp, elbows, knees) | May serve; do not scrape or pick scales; refer if irritated |
| Acne | Pimples/blackheads from clogged follicles | May serve; avoid breaking or lancing lesions; refer severe cases |
| Alopecia areata | Sudden smooth, round bald patches | May serve; non-contagious autoimmune hair loss |
| Androgenic alopecia | Pattern baldness (receding hairline, crown thinning) | May serve; most common hair-loss type in men |
| Canities | Gray or white hair from loss of pigment (melanin) | Normal; may serve |
| Hypertrichosis | Excess hair growth beyond the normal pattern | May serve; grooming only |
| Pseudofolliculitis barbae (PFB) | Ingrown beard hairs forming razor bumps | May serve with adjusted technique (below) |
The Exam's Favorite Traps
- Impetigo vs. acne: both are facial eruptions, but impetigo's honey-colored crusts are contagious (refuse) while acne is not (serve carefully). Crust = refuse.
- Dandruff vs. tinea capitis: both flake, but dandruff sheds loose dry scales while tinea capitis shows defined round patches with broken hairs — refuse the tinea.
- Folliculitis barbae vs. pseudofolliculitis barbae: folliculitis is a bacterial infection (contagious — refuse shaving); pseudofolliculitis is mechanical ingrown hairs (non-contagious — adapt technique). One word changes the whole answer.
- Nits vs. dandruff: dandruff brushes off the hair; nits are cemented to the shaft and slide only with force. Cemented = lice = refuse.
Pseudofolliculitis Barbae: Adapt, Don't Refuse
Pseudofolliculitis barbae (PFB), or razor bumps, occurs when tightly curled beard hairs are cut below the skin line and curl back into the skin, causing inflamed bumps. It is most common in clients with very curly facial hair and is not contagious. The barber's correct response is technique adjustment: soften the beard thoroughly, shave with the grain, avoid stretching the skin, do not shave too closely, and consider clippers leaving slight stubble instead of a straight razor. Recommending medical evaluation is appropriate for severe, infected-appearing cases, but ordinary PFB does not require refusal.
Documentation Habit
Note refusals on the client record where your shop keeps them. A brief entry (date, what was observed, that the client was referred) protects you, supports consistent decisions across barbers, and demonstrates the professional standard Texas expects under TDLR sanitation rules (16 TAC Chapter 83).
During a pre-service inspection you notice weeping blisters around a client's mouth that have dried into honey-colored crusts. The correct action is to:
Which statement about pseudofolliculitis barbae (razor bumps) is correct?
A regular client's scalp shows loose white flakes that brush easily off the hair, with no redness or broken hairs. You should: