Skin Conditions and Disorders

The Esthetician's Legal Boundary

Before any disorder vocabulary, fix the most important rule in your mind: a Texas esthetician analyzes the surface appearance of skin but never diagnoses, prescribes for, or treats a disease. Diagnosing is the practice of medicine. Your job is to recognize when something is outside normal, refer the client to a physician or dermatologist, and decline services that would be unsafe. The written exam repeatedly tests this scope-of-practice line, and the safe answer is almost always "refer to a dermatologist."

Primary vs. Secondary Lesions

A lesion is a mark or change in the skin from disease or injury. The exam divides them into two groups.

Primary lesions appear first, in the early stage of a condition:

• Macule — a flat, discolored spot (e.g., a freckle), no elevation.
• Papule — a small, solid, raised bump under ~1 cm (e.g., a pimple without pus).
• Pustule — a raised lesion containing pus.
• Vesicle — a small blister filled with clear fluid.
• Wheal — an itchy, raised area (hive) from an allergic reaction.
• Tubercle / nodule — a solid bump larger and deeper than a papule.

Secondary lesions develop later, as a condition progresses or heals:

• Crust — dried serum or pus (a scab).
• Scar (cicatrix) — fibrous tissue left after healing.
• Fissure — a crack in the skin (e.g., chapped lips).
• Excoriation — a scrape or scratch.
• Ulcer — an open lesion with loss of tissue depth.

Acne: Structure and Grading

Acne vulgaris is the most common skin disorder you will see. It begins with a comedone — a clogged hair follicle (pore) filled with sebum and dead cells:

1. Open comedone (blackhead) — the plug reaches the surface and the sebum oxidizes, turning dark. The color is oxidation, NOT dirt.
2. Closed comedone (whitehead) — the plug is sealed beneath the surface, appearing as a small white bump.

When the bacterium Cutibacterium acnes (formerly Propionibacterium acnes) multiplies in the trapped sebum, inflammation produces papules, then pustules, then deeper nodules and cysts. Acne is commonly graded:

• Grade I — mostly open comedones (blackheads).
• Grade II — closed comedones (whiteheads) with some papules.
• Grade III — many papules and pustules; red and inflamed.
• Grade IV — cystic acne with nodules and cysts; high scarring risk.

Trap: Grade IV (cystic) acne must be referred to a dermatologist. Estheticians do NOT extract or aggressively treat cysts — doing so can spread infection and scar the client.

Common Non-Infectious Disorders

• Rosacea — chronic redness, flushing, and visible capillaries (telangiectasia) usually on the central face; aggravated by heat, spicy food, and alcohol. Use gentle, calming care; avoid stimulating treatments.
• Eczema (dermatitis) — red, itchy, inflamed, sometimes weeping skin; often allergic or genetic.
• Psoriasis — thick, silvery-white scaly patches from rapid skin-cell turnover; an autoimmune condition.
• Hyperpigmentation — dark patches from excess melanin: melasma (often hormonal, the "mask of pregnancy"), lentigines (sun/age spots), and post-inflammatory hyperpigmentation after injury or acne.
• Milia — small, white, keratin-filled cysts trapped under the skin.

Vascular and Pigment Disorders

Two more groups appear regularly on the written exam.

Vascular conditions involve blood vessels near the surface:

• Telangiectasia (couperose) — small, dilated, visible capillaries, common with rosacea and sun damage.
• Erythema — diffuse redness from dilated vessels or inflammation.

Pigment (melanin) disorders divide into too much or too little pigment:

• Hyperpigmentation (too much) — melasma/chloasma, lentigines (sun/age spots), nevus (mole), and post-inflammatory hyperpigmentation.
• Hypopigmentation (too little) — vitiligo (patchy loss of pigment from melanocyte destruction), albinism (genetic absence of melanin), and leukoderma (general light patches).

Note the prefixes: hyper- = excess/over, hypo- = under/deficient. Mixing these up is one of the most common mistakes on pigment questions.

Hypertrophies (Abnormal Growths)

Hypertrophies are overgrowths of skin or tissue. Know these terms:

• Keratoma (callus) — a thickened patch from repeated pressure or friction.
• Verruca — a wart (viral; contagious).
• Skin tag (acrochordon) — a small, benign flap of skin.
• Mole (nevus) — a pigmented growth; harmless unless it shows ABCDE warning signs.
• Keloid — a raised, thick scar that grows beyond the original wound.

Estheticians never cut, remove, or chemically destroy any growth — that is a medical procedure. You describe it and refer if anything looks suspicious.

Contagious Infections (Decline and Refer)

Any active, contagious infection is a contraindication — you must NOT provide service and you must refer out:

• Bacterial — impetigo (honey-colored crusts), folliculitis, furuncles (boils).
• Viral — herpes simplex (cold sores/fever blisters), verruca (warts), herpes zoster (shingles).
• Fungal — tinea (ringworm, tinea corporis), tinea versicolor.

Recognizing Skin Cancer Warning Signs

Estheticians never diagnose cancer, but you should know the ABCDE rule to know when to refer a mole: Asymmetry, Border irregularity, Color variation, Diameter over 6 mm, and Evolving (changing). If a mole or lesion meets these, calmly recommend the client see a dermatologist promptly — and never attempt to remove or treat it yourself.