9.3 Skin Conditions and When to Refuse Service

9.3 Skin Conditions and When to Refuse Service

Nails sit in skin. Domain 2 therefore tests conditions of the skin of the hands and feet as hard as it tests plates. Washington does not ask you to sort eczema from psoriasis from fungus with a laboratory brain. WAC 308-20-110(1)(e) gives a visual list: a licensee must not perform or continue services on a client with visible open sores, inflamed skin, rash, or parasitic infestations. WAC 308-20-110(1)(f) turns the same list on the worker. If you know those four client findings and you know that you cannot work with them either, you can pass the law overlay and you can keep a Seattle suite from becoming an infection story.

Chapter 2 already introduced this rule as scope. This section is the floor application: what those findings look like on hands and feet, what diabetes changes about a pedicure, what monomer does to skin, and how you refuse without practicing medicine.

The four client stops in WAC 308-20-110(1)(e)

Learn the four as a checklist you run before the soak, not after the feet are white and unreadable.

1. Visible open sores. Broken skin, ulcers, fissures, draining hangnails, blister roofs that have torn, cuticle nicks that are still open. Open tissue is an entry point for bacteria and a blood-exposure risk for you. Do not put it in a bowl. Do not put product on it. Do not cover it with a wrap and hope.
2. Inflamed skin. Red, hot, swollen, tender tissue. Inflammation is how infection and many dermatoses announce themselves. You do not have to know which one. Red-hot folds around an ingrown toenail, a shiny swollen finger, and a spreading red patch on a dorsal foot are all inflamed.
3. Rash. Scale, vesicles, papules, weeping patches, or a geographic red area the client calls dry skin. Athlete's foot, eczema, contact dermatitis, and psoriasis can all present as a rash. The rule names rash, not a diagnosis.
4. Parasitic infestations. Visible lice, mites, or other parasites on the client. You do not treat parasites with cuticle oil. You stop. You refuse. You refer. You clean and disinfect the area that person occupied, including equipment and implements that could have been touched, and the work and waiting areas, as the sanitation chapter already requires after (e) and (f) symptoms.

The rule says perform or continue. If you notice the condition at consultation, do not start. If you notice it after the client is already in the chair, stop. A shorter service is not a workaround. Gloves are not a workaround. A wedding this weekend is not a workaround.

The licensee stop in WAC 308-20-110(1)(f)

No licensee who knowingly has open sores, or who is exhibiting symptoms of an infectious or contagious disease, a disorder of the skin, or a parasitic infestation, shall provide manicuring services while those symptoms are present. A draining hangnail on your working finger, a vesicular monomer rash on your dominant hand, herpetic whitlow, or a visible infestation is not solved with a bandage and a full book.

Stay off the floor. Seek medical care. Subsection (f) protects every client you would have touched, including the ones who never see your sore because you kept your palm down. A finger cot over an open lesion is not the exception the WAC writes.

Salon scenario — Seattle monomer rash. After weeks of holding a wet acrylic brush, a manicurist has a red, vesicular rash on the sides of her dominant fingers. She has five fills booked. She does not glove and push through. She cancels or transfers the book, she stays off the floor while the inflamed rash is present, and she sees a physician. That is (1)(f), not a weak work ethic.

How to refuse without diagnosing

The script stays short in a Bremerton or Federal Way suite. I am a licensed manicurist. I cannot diagnose this. Washington rules do not allow me to perform a service on visible open sores, inflamed skin, rash, or a parasitic infestation. Please see a physician. I will be glad to reschedule when the skin is intact. You may point to what you see — weeping between the toes, a red hot fold, a cracked heel that is open — without naming eczema, cellulitis, or scabies.

Write the same observation on the card. Weeping inflamed rash on dorsal feet and web spaces; service refused; referred to physician. That sentence helps the next licensee, helps you if DOL asks why a ticket was not completed, and does not pretend you ran a lab.

If the client already sat in a filled basin, treat the exposure as real: drain, scrub, disinfect the basin per WAC 308-20-110, discard single-use items, process multi-use tools, and wash your hands. Sanitation after the fact does not authorize the service you should have refused.

Eczema and dermatitis

Eczema and dermatitis are inflamed, itchy, often dry or weeping skin conditions. On hands they show up as red patches, scale, cracks on the finger pads, and sometimes vesicles. On feet they can mimic athlete's foot. Occupational wet work and soaps aggravate many pictures. You do not have to separate atopic eczema from irritant dermatitis to refuse.

If the service area is inflamed, open, or showing a rash, refuse. Do not soak cracked hands in a hot bowl until they look softer; maceration splits them further. Do not put monomer, primer, or acid callus reducer on eczematous skin. If the skin is fully intact, pale, and only mildly dry with no rash, a gentle cosmetic service with moisturizer on intact skin may be possible. Borderline dryness that is actually a red, itchy patch is a rash. When unsure, refuse. Domain 2 and WAC both reward caution.

Psoriasis plaques

Psoriasis plaques on elbows, hands, or legs are classically red with silvery scale in medical texts. On hands and feet they may crack and bleed. Nail pits and oil-drop changes from section 9.2 may appear with them. Do not diagnose psoriasis. A plaque that is inflamed or open is a WAC refuse. Do not pick scale off. Do not e-file a plaque as callus. Do not tell the client that gel will seal the patches. Refer. If a physician later clears intact skin and the plaques are not in the service field, you still look again on the day of service, because plaques change.

Contact dermatitis from monomer and other products

Contact dermatitis from monomer, gel, cyanoacrylate, or nickel is a salon occupational classic. Irritant contact dermatitis is a direct chemical burn-or-dry picture from overexposure. Allergic contact dermatitis is an immune reaction after sensitization; it can appear as a red, itchy, vesicular rash on the fingers of a licensee or around the nails of a client who has had acrylics for years and then suddenly cannot.

Stop the product that is in contact with the rash. Do not work through it. A client with a vesicular rim around every enhanced nail does not get another fill on top of the allergy. Remove product only if you can do so without grinding inflamed skin; often the honest answer is refuse, refer, and let a physician direct removal. A licensee with the same rash is in (1)(f). Switch to gloves and better source-capture later, after medical clearance — not as a same-day patch so you can finish Saturday.

Chapter 6 covers SDS first aid for a splash. This section is the chronic rash that walks in looking like a request for more product. More product is how sensitization gets worse.

Diabetic skin and the Washington pedicure

Diabetes changes feet: reduced sensation (neuropathy), poorer circulation, slower healing, and higher infection risk. A client may not feel a nick you would feel. A small fissure can become an ulcer. You will not diagnose diabetes. Many clients will tell you on the intake. Ask. Document. Plan a conservative pedicure, or refuse.

Hard limits:

• No razor-edged callus tools. WAC 308-20-110(16) prohibits any razor-edged tool which is designed to remove calluses for every client, diabetic or not. Credo blades, razor paddles, and similar shavers are out. Diabetes makes that ban even more important because a slice on a neuropathic heel may not be felt until it is infected.
• No aggressive callus work. Do not rasp living skin until it is thin and shiny. Do not chase a smooth-heel photograph.
• No long hot soaks that macerate already-fragile skin.
• No nipping living tissue or cutting cuticles down to bleeding.
• Refuse open cracks, ulcers, inflammation, or rash. An open heel fissure on a diabetic foot is not a callus-reducer candidate. Refer to a physician or podiatrist.

If skin is intact, a light cosmetic pedicure with careful nail trimming (straight across, no digging), gentle work on dry intact callus with lawful implements, and no heroics can be appropriate. When anything is open, stop. Federal Way beach-trip pressure does not override neuropathy.

Salon scenario — Federal Way credo request. A client with diabetes wants an aggressive callus shave with a credo blade. The heels are thick, and one has a small open crack. You do not touch the blade — it is banned. You refuse because of the open crack. You refer. You may discuss a future conservative pedicure only after the skin is intact and a physician is in the loop if the client has a complicated foot.

Visible parasites

Visible parasites are an automatic refuse. You are looking for infestation signs you can actually see — crawling insects, obvious nits in a hair-bearing area that is in view, or a client who presents with a parasitic picture the rule already named. You do not have to complete an entomology identification. You do not provide the manicure, you do not use the same linens, and you clean and disinfect the occupied area. A Kent client with visible infestation at the wrists and hairline is not a candidate for a paraffin dip first so you can see if it washes off.

The same rule applies to the licensee. Work is not a place to wait out an infestation until the weekend.

Look first, soak second, document third

A practical order that keeps Domain 2 and WAC aligned:

1. Health history and visual exam of the skin you will touch, including webs, heels, folds, and both palms or both soles.
2. Decision: service, modify, or refuse.
3. If refuse: say the visual reason, refer to a physician, write the card, sanitize anything already touched.
4. If service: wash or wipe the client's skin per WAC 308-20-110(1)(l), then begin.
5. If something appears mid-service: continue is forbidden once (1)(e) findings show. Stop.

Do not hide a rash under polish, dip powder, or a toe separator. Do not accept a signed waiver as permission to violate WAC 308-20-110. DOL did not write an exception for waivers, deposits, or influencer appointments.

Washington floor pictures

Everett winter feet. A client has a weeping, inflamed rash on the dorsal feet and between the toes and calls it dry skin. You refuse under (1)(e). You do not soak longer. You do not diagnose tinea or eczema. You refer.

Olympia plaque. Silvery scale over red patches on the hands, some fissured and open. You refuse. You do not pick. You do not diagnose psoriasis even if the client already uses that word — you still describe what you see and you still stop on open, inflamed skin.

Yakima parasite scare. Visible infestation. Stop before implements leave the clean drawer. Refuse. Disinfect the chair and waiting area contact surfaces. Do not finish one nail so the ticket is not a no-show.

Tacoma licensee hangnail. Your own sidewall is open and draining. You do not wrap it and take a walk-in. Subsection (1)(f) already scheduled your day off the floor.

Put the whole chapter on one card for Prov: infectious nail disease — usually refuse; noninfectious plate change — often modify; any open sore, inflamed skin, rash, or parasite — always refuse; licensee with those symptoms — do not work; never diagnose; never dig, drill, or razor callus; always refer. That is Domain 2 plus WAC 308-20-110(1)(e)–(f) and (16), which is exactly what this chapter is for.