5.3 Skin Lesions, Non-Contagious Skin Disorders, Pigmentation Changes and Skin Cancer Warning Signs
Key Takeaways
Primary skin lesions are the first signs of a condition (macule, papule, vesicle, bulla, pustule, wheal, nodule, tumor, cyst); secondary lesions develop later (scale, crust, excoriation, fissure, ulcer, scar, keloid).
A macule is a flat spot, a papule is a small raised bump without fluid, a vesicle is a small blister of clear fluid, and a pustule is a raised lesion containing pus.
Acne, rosacea, eczema, psoriasis and contact dermatitis are not contagious, but inflamed or broken skin is still a reason to modify or postpone shaving and facial services.
Basal cell carcinoma is the most common skin cancer, squamous cell carcinoma is the second most common, and melanoma is the most dangerous.
The ABCDE warning signs for melanoma are Asymmetry, irregular Border, uneven Color, Diameter larger than about 6 mm and Evolving size, shape or color.
Why Lesions and Disorders Are Tested
The NIC Barber 1 outline asks you to identify signs and symptoms of conditions, disorders and diseases related to skin, with their types and treatments, and to recognize contraindications before facial hair and skin care services. Contagious infections (tinea, impetigo, herpes, folliculitis) are covered in Section 4.4. This section covers the vocabulary of lesions and the common non-contagious conditions. A barber identifies and describes what they see, adjusts or postpones the service, and refers the client. Diagnosis and treatment belong to physicians.
Primary Lesions
These are the first lesions to appear.
| Lesion | What it looks like | Example |
|---|---|---|
| Macule | Flat, discolored spot, neither raised nor sunken | Freckle, flat age spot |
| Papule | Small, solid, raised bump with no fluid | Inflamed acne bump without a head |
| Vesicle | Small blister of clear fluid, under about 1 cm | Herpes simplex (fever blister), poison ivy |
| Bulla | A larger blister | A burn blister |
| Pustule | Raised lesion containing pus | Acne pustule, folliculitis |
| Wheal | Itchy, swollen, short-lived welt | Hives (urticaria), insect bite |
| Nodule or tubercle | Solid, raised lump that extends deeper than a papule | Cystic acne nodule |
| Tumor | Abnormal mass that varies in size, shape and color | Any growth that needs medical evaluation |
| Cyst | Closed, fluid- or semi-solid-filled sac above or below the skin | Sebaceous cyst (steatoma) |
Secondary Lesions
These develop in later stages.
| Lesion | What it looks like |
|---|---|
| Scale | Flakes of dead skin (dandruff, psoriasis) |
| Crust | Dried serum, blood or pus (a scab; impetigo's honey-colored crust) |
| Excoriation | A scratch or abrasion, often from scratching or a razor scrape |
| Fissure | A crack in the skin (chapped lips, cracked hands) |
| Ulcer | An open lesion that has lost skin depth; may weep |
| Scar (cicatrix) | Mark left after healing |
| Keloid | A thick, raised overgrowth of scar tissue that extends beyond the original wound. People prone to keloids, often with tightly curled beards, need extra care to avoid nicks and ingrown hairs on the neck |
Disorders of the Sebaceous (Oil) Glands
- Comedo (plural comedones). A follicle plugged with sebum and dead cells. An open comedo is a blackhead: the plug darkens on exposure to air, not because of dirt. A closed comedo is a whitehead.
- Milia. Tiny, firm, white keratin cysts, often around the eyes and cheeks.
- Acne vulgaris. Chronic inflammation of the oil glands with comedones, papules, pustules and sometimes nodules and cysts. Shave lightly over mild acne, never slice through raised lesions, and refer severe acne to a dermatologist.
- Rosacea. Chronic redness of the central face with visible small blood vessels and sometimes papules, worsened by heat, alcohol and spicy food. Avoid hot towels and steam; use cool towels and gentle products.
- Seborrhea (excessive oil) and asteatosis (too little oil, dry scaly skin). Steatoma is a sebaceous cyst.
Disorders of the Sudoriferous (Sweat) Glands
- Anhidrosis: lack of sweating.
- Hyperhidrosis: excessive sweating.
- Bromhidrosis: foul-smelling sweat.
- Miliaria rubra: prickly heat, a rash of small red bumps from blocked sweat ducts.
Inflammatory Conditions (Not Contagious)
| Condition | Signs | Service decision |
|---|---|---|
| Contact dermatitis | Red, itchy, sometimes blistering skin where a product touched it. Irritant type is caused by harsh chemicals; allergic type is caused by sensitivity, for example to a dye ingredient | Identify and avoid the product. A patch (predisposition) test before an aniline-derivative hair color, as the product label directs, reduces the risk |
| Eczema | Dry, itchy, inflamed patches that may weep or crust | Avoid shaving or massaging over active, broken patches; use gentle, fragrance-free products |
| Psoriasis | Thick, red plaques with silvery-white scales, often on the scalp, elbows and knees | Not contagious. Cut and shampoo gently, and do not pick or scrape the scales. Avoid bleeding plaques |
| Seborrheic dermatitis | Greasy, yellowish scaling and redness on the scalp, brows, beard and nasolabial folds | Medicated shampoo can help; refer persistent cases |
| Urticaria (hives) | Wheals, often allergic | Stop any product that may have triggered it |
Pigmentation and Growth Changes
- Hyperpigmentation (too much pigment): lentigines (freckles), chloasma or melasma (patchy brown areas, often hormonal), and post-inflammatory hyperpigmentation (darkening after acne or razor bumps, common in deeper skin tones).
- Hypopigmentation (too little pigment): vitiligo (milky-white patches from loss of melanocytes), albinism (congenital lack of melanin, very sun-sensitive skin) and leukoderma (light patches in general).
- Growths: a nevus is a birthmark or mole; a skin tag is a small flap of skin; a keratoma is a callus-like thickening; a verruca is a wart (viral, so contagious). Never shave over raised moles, tags or warts. Stretch the skin and work around them.
Skin Cancer: Recognize and Refer
| Type | Typical appearance | Key fact |
|---|---|---|
| Basal cell carcinoma | Pearly or waxy bump, sometimes with visible blood vessels, or a sore that won't heal | Most common; rarely spreads |
| Squamous cell carcinoma | Scaly red patch, crusted or raised growth, often on sun-exposed skin such as the scalp, ears and neck | Second most common; can spread |
| Malignant melanoma | A dark, irregular, changing mole or spot | Most dangerous; can spread quickly |
Barbers see the scalp, the back of the neck and the tops of the ears, which clients cannot see themselves. Use the ABCDE checklist:
- Asymmetry: one half does not match the other.
- Border: irregular, ragged or blurred edges.
- Color: uneven shades of brown, black, red, white or blue.
- Diameter: larger than about 6 mm (a pencil eraser).
- Evolving: changing in size, shape or color, or starting to bleed or itch.
If you notice a lesion with these signs, say so privately and suggest the client have a dermatologist look at it. Do not name a disease.
During a beard consultation, a barber sees a small, raised bump on the client's cheek that contains pus. What is this primary lesion called?
Macule
Pustule
Vesicle
Wheal
A client with central-face redness and visible small blood vessels says his face flushes with heat and spicy food. Which service modification is most appropriate?
Use extra-hot steam towels to open the pores
Apply an alcohol-based astringent immediately after shaving
Skip warm towels and steam, and use cool towels and gentle, fragrance-free products
Refuse all services because the condition is highly contagious
While cutting, a barber notices a mole on the back of a client's neck with uneven color, a ragged edge and a diameter larger than a pencil eraser. What should the barber do?
Privately mention the spot and suggest the client have a dermatologist examine it, without naming a disease
Shave the mole off with the straight razor so it can heal flat
Tell the client the spot is definitely melanoma
Ignore it, because barbers have no role in noticing skin changes
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