3.6 Skin Disorders & Diseases: Glands, Inflammation, Pigment, Growths & Contagious Conditions
Key Takeaways
Milia are small, white keratin-filled cysts with no follicular opening, while sebaceous hyperplasia appears as a yellowish, doughnut-shaped papule with a central pore.
Hyperhidrosis is excessive sweating, anhidrosis is the inability to sweat, bromhidrosis is foul-smelling sweat, and miliaria rubra is prickly heat.
Psoriasis causes thick, silvery-scaled plaques and is not contagious; impetigo, herpes simplex, tinea, and bacterial conjunctivitis are contagious and require postponing service.
Vitiligo is an acquired loss of melanocytes causing white patches, while albinism is an inherited absence or reduction of melanin production.
WAC 308-20-110 bars services on a client with visible open sores, inflamed skin, rash, or parasitic infestation, and requires cleaning and disinfecting the area afterward.
How the Exam Frames Disorders
The NIC Combined Practice outline lists disorders by category: sebaceous glands, sudoriferous glands, contagious diseases, inflammations, pigmentation, growths, skin cancers, and primary and secondary lesions. Section 3.4 covers acne grading, rosacea, melasma, lesion terms, and skin cancer screening. This section completes the list. Every exam question about a disorder really asks one of three things: treat, modify, or refer?
Sebaceous Gland Disorders
| Disorder | What it looks like | Esthetic response |
|---|---|---|
| Open comedo (blackhead) | Follicle plug of sebum and keratin, darkened by oxidation at the opening | Soften and extract (section 5.5) |
| Closed comedo (whitehead) | Plug trapped under a thin layer of epidermis | Soften; extract gently if trained |
| Milia | Small, firm, white keratin cysts with no follicular opening, often around the eyes and cheeks | Usually requires a lancet opening; refer when near the eye margin or numerous |
| Seborrhea | Excess sebum production; shiny, oily skin | Oil control, exfoliation, clay masks |
| Seborrheic dermatitis | Red, greasy, flaking patches on the scalp, brows, and sides of the nose | Soothe; refer for diagnosis and medical treatment |
| Sebaceous hyperplasia | Yellowish, doughnut-shaped papule with a central depression, common in mature skin | Do not extract; refer for medical removal options |
| Steatoma (sebaceous cyst) | Soft or firm subcutaneous lump | Do not extract; refer |
| Asteatosis | Dry, scaly skin from too little sebum, often with aging | Hydrate and protect the barrier |
Sudoriferous (Sweat) Gland Disorders
- Hyperhidrosis: excessive sweating, especially the palms, soles, and underarms. Refer for medical evaluation if it is new or severe.
- Anhidrosis: inability to sweat, which can cause overheating. Avoid heat treatments and refer.
- Bromhidrosis: foul-smelling sweat, usually apocrine sweat broken down by bacteria (section 3.3).
- Miliaria rubra (prickly heat): small red, itchy bumps from blocked sweat ducts after heat exposure. Cool the skin and avoid occlusive products and heat.
Inflammations
- Contact dermatitis is either irritant (direct damage, such as from over-exfoliation) or allergic (immune reaction to fragrance, preservatives, nickel, or hair dye). Stop the trigger and refer if severe. Practitioners who handle chemicals daily are at risk of occupational dermatitis, so wear gloves.
- Eczema (atopic dermatitis) causes dry, itchy, inflamed patches. It is not contagious. Use gentle, fragrance-free products and avoid active flare areas.
- Psoriasis causes thick, red plaques with silvery scales, often on the elbows, knees, and scalp. It is not contagious. Avoid treating active plaques and never pick scales.
- Urticaria (hives) produces itchy wheals. Stop the service and remove the possible allergen; call 911 if breathing or swallowing is affected.
- Rosacea and acne are covered in section 3.4.
Contagious Conditions: Postpone and Refer
| Condition | Cause | Signs |
|---|---|---|
| Herpes simplex | Virus | Grouped fluid-filled blisters, often on the lip |
| Impetigo | Bacteria (staph or strep) | Weeping lesions with honey-colored crusts |
| Bacterial conjunctivitis (pinkeye) | Bacteria | Red, itchy, discharging eye |
| Tinea (ringworm) | Fungus | Red, ring-shaped scaly patch |
| Verruca (wart) | Human papillomavirus | Rough, raised growth |
| Folliculitis | Usually bacteria | Inflamed pustules at hair follicles |
| Scabies and lice | Parasites | Intense itch, burrows, or nits |
WAC 308-20-110(1)(e) says a licensee must not perform or continue services on a client with visible open sores, inflamed skin, rash, or parasitic infestations. If such a client or licensee is found, the area where services were given, and all equipment and implements that could have been touched, must be cleaned and disinfected, including work and waiting areas.
Pigmentation Disorders
Hyperpigmentation (too much pigment):
- Lentigines (solar lentigos): flat brown sun spots, also called age or liver spots.
- Ephelides: freckles that darken with sun.
- Chloasma or melasma: patchy, symmetric facial pigment linked to hormones and UV (section 3.4).
- Post-inflammatory hyperpigmentation (PIH): darkening after injury or inflammation (section 5.4).
- Nevus: a birthmark or mole; a stain is an abnormal brown or wine-colored patch, such as a port-wine stain.
Hypopigmentation (too little pigment):
- Vitiligo: an acquired loss of melanocytes that leaves milky-white patches. It is not contagious. The patches burn easily, so protect them from UV.
- Albinism: an inherited absence or reduction of melanin production in the skin, hair, and eyes, with very high UV sensitivity.
- Leukoderma: a general term for light patches from decreased pigment, including scarring after injury.
Growths and Hypertrophies
- Skin tags (acrochordons): small, soft, flesh-colored growths on the neck, underarms, and eyelids. Do not cut, wax, or tweeze over them; refer for removal.
- Moles (nevi): brown to black spots. Screen with the ABCDE criteria and refer any change.
- Seborrheic keratosis: waxy, "stuck-on" brown growth in mature skin. Do not extract or abrade; refer.
- Keratoma: a callus, an area of thickened skin caused by pressure or friction.
- Cherry angioma: a small, bright red dome of blood vessels.
- Telangiectasia: visible dilated capillaries. Avoid heavy pressure, heat, and steam.
- Keloid: thick scar tissue that grows beyond the original wound edges. A hypertrophic scar is raised but stays within the wound boundary.
Putting It Together
| Situation | Best response |
|---|---|
| Non-contagious, non-inflamed condition in the esthetic scope (comedones, dehydration, mild PIH) | Treat |
| Sensitive or chronic condition (eczema, psoriasis, rosacea, telangiectasia) | Modify: avoid active areas, heat, and friction |
| Contagious, infected, undiagnosed, or changing lesion | Postpone the service and refer to a physician |
Caution
Estheticians do not diagnose. Describe what you see in the client record, explain why you are postponing, and recommend a medical evaluation.
A client has a yellowish, doughnut-shaped papule with a central depression on the forehead. What is the best response?
Steam it for ten minutes, then lance it and express the contents
Treat it as contagious, postpone service, and disinfect the room
Extract it with a comedone extractor after softening it with steam
Leave it alone; it suggests sebaceous hyperplasia, so refer the client
Which condition is NOT contagious?
Impetigo
Herpes simplex
Tinea
Psoriasis
What distinguishes vitiligo from albinism?
Vitiligo spreads by contact; albinism does not spread to other people
Vitiligo is a type of hyperpigmentation; albinism is a skin growth
Vitiligo is acquired melanocyte loss; albinism is inherited lack of melanin
Vitiligo affects only hair color; albinism affects only eye color
Sections you finish are checked off in the contents.