Study guide
An esthetician's scope of practice covers healthy and cosmetically impaired skin, not the diagnosis or treatment of disease. This chapter surveys the disorders and diseases you must be able to recognize, from oil and sweat gland problems to contagious infections, inflammations, pigment changes, and skin cancers, and it explains the contraindications and referral rules that tell you when to proceed, when to modify, and when to send a client to a physician.
Sebaceous and Sudoriferous Gland Disorders
Many of the conditions estheticians see involve the oil and sweat glands. Acne, clinically acne vulgaris, is a common disorder of the sebaceous glands in which follicles become clogged and inflamed. It begins with the comedone, a plug of sebum and dead cells: an open comedone is a blackhead, darkened by oxidation at the surface, and a closed comedone is a whitehead trapped beneath the skin. Inflamed lesions include papules and pustules, and deeper, more serious forms produce nodules and cysts. Milia are small, firm, whitish bumps of trapped keratin beneath a thin layer of skin, often described as tiny pearls. Seborrhea is an excess of sebum that produces an oily, sometimes shiny appearance, and seborrheic dermatitis is a related inflammatory condition with redness and flaking. A comedo that never opens can contribute to the appearance many clients simply call congestion. Among the sweat glands, common concerns include hyperhidrosis, which is excessive sweating, and anhidrosis, which is a deficiency of sweating and can be dangerous because it impairs cooling. Bromhidrosis refers to foul-smelling perspiration, and miliaria rubra, commonly called prickly heat, is a red, itchy eruption from blocked sweat ducts in hot conditions. An esthetician can treat mild acne and remove surface comedones, but a client such as Aisha with painful cystic nodules should be referred to a dermatologist, because that degree of involvement is a medical matter.
Contagious Diseases You Must Recognize
Because estheticians work skin to skin, recognizing contagious conditions protects everyone and is a frequent exam topic. Herpes simplex is a viral infection; the type that causes cold sores or fever blisters produces a cluster of small blisters, usually around the lips, and is contagious especially when active. Services over an active outbreak are contraindicated. Tinea is a fungal group: tinea corporis is ringworm, presenting as a red ring with a clearer center, and tinea pedis is athlete's foot. Fungal infections spread through contact and contaminated surfaces, so they are contraindications until resolved. Conjunctivitis, commonly called pinkeye, is an inflammation of the membrane lining the eyelid; the infectious forms are highly contagious and rule out eye-area services. Warts, caused by human papillomavirus, are contagious growths. Impetigo is a contagious bacterial skin infection marked by honey-colored crusts, more common in children. The practical rule is consistent: a contagious condition is a contraindication to service in the affected area, and often to service altogether, until a physician confirms it has cleared. If a client named Tom arrives with an oozing, crusted lesion of uncertain cause, the professional response is not to guess but to decline service tactfully, avoid contact, and suggest he see a physician. You are recognizing patterns and protecting people, not diagnosing.
Inflammations, Rosacea, and Pigment Disorders
Several noncontagious conditions call for gentle handling rather than avoidance. Dermatitis is a general term for inflammation of the skin, and it comes in several forms. Contact dermatitis results from touching an irritant or an allergen, such as a fragrance or a metal, and is one reason patch testing matters. Eczema, or atopic dermatitis, is a chronic condition with red, itchy, sometimes weeping or scaly patches; it is not contagious, but inflamed or broken skin should be treated cautiously and often warrants medical management. Rosacea is a chronic condition of the central face marked by persistent redness, visible blood vessels, and sometimes acne-like bumps; heat, harsh products, and strong stimulation can trigger flare-ups, so treatments are kept calm and cool. Psoriasis produces red patches covered with silvery scales and is also noncontagious. Pigment disorders form another group. Hyperpigmentation is an excess of melanin producing darker areas: examples include lentigines (sun-related dark spots), melasma (larger patches often linked to hormones and sun), and post-inflammatory marks left after a blemish heals. Hypopigmentation is a loss of pigment producing lighter areas; vitiligo is a condition in which patches lose pigment entirely, and albinism is a congenital absence of pigment. For a client named Grace troubled by melasma, an esthetician can offer brightening care and, above all, diligent sun protection, while recognizing that stubborn or changing pigmentation may need a physician's evaluation.
Lesions, Growths, and Skin Cancers
The exam expects you to speak the language of lesions, which are the visible marks of altered skin. Primary lesions appear in the early phase of a condition. A macule is a flat, discolored spot such as a freckle. A papule is a small raised bump, and a nodule is larger and deeper. A pustule contains pus, a vesicle is a small fluid-filled blister, a bulla is a larger blister, a wheal is a temporary raised area as in hives, and a tumor is an abnormal mass. Secondary lesions develop later, as a condition progresses or heals: a crust is dried residue such as a scab, a scale is a flake of shed cells, an excoriation is a scratch or scrape, a fissure is a crack, and a scar is fibrous tissue left after healing. Growths may be harmless, such as many moles (nevi) and skin tags, but some are dangerous, and skin cancer awareness is a professional responsibility. Basal cell carcinoma is the most common and least aggressive, often appearing as a pearly, sometimes ulcerated bump. Squamous cell carcinoma may look like a rough, scaly, raised or crusted lesion and can grow more quickly. Melanoma is the most serious skin cancer, arising in pigment cells and potentially spreading. The ABCDE warning signs help you flag suspicious moles: Asymmetry, irregular Borders, uneven Color, Diameter larger than a pencil eraser, and Evolving change over time. Estheticians do not diagnose, but if you notice a lesion with these features on a client such as David, you gently recommend he see a dermatologist promptly.
Contraindications and Refer-to-Physician Rules
A contraindication is a reason to withhold or modify a treatment because it could harm the client. Contraindications fall along a spectrum. Some are absolute, meaning the service should not be performed at all, such as working over an active herpes outbreak, a contagious infection, an open wound, or a suspicious lesion. Others are relative, meaning you can proceed with modifications, such as choosing gentler products for very sensitive or rosacea-prone skin, or avoiding a specific area. Certain conditions and medications call for a physician's clearance before treatment. Clients taking the acne medication isotretinoin, or using strong prescription retinoids, generally should not receive waxing, exfoliation, or aggressive treatments because their skin is fragile and can tear or scar; in most states, estheticians wait until a physician confirms it is safe. Pregnancy, uncontrolled diabetes, recent facial surgery or laser work, and the use of blood thinners are further situations where you either modify care or obtain medical release, and the exact expectations vary by state, so you follow your board's rules and the client's physician. A physician release, or release form, is written confirmation from a doctor that a client may safely receive a given service. The unifying principle is humility about scope: estheticians care for healthy and cosmetically impaired skin, recognize what falls outside that scope, and refer. When an esthetician named Nina is unsure whether a mole or a medication changes the plan, the safe and professional choice is always to pause and refer rather than proceed.
Key terms
- Comedone
- — A plug of sebum and dead cells in a follicle; an open comedone is a blackhead and a closed comedone is a whitehead.
- Milia
- — Small, firm whitish bumps of keratin trapped beneath a thin layer of skin.
- Seborrhea
- — An excess secretion of sebum resulting in oily or shiny skin; seborrheic dermatitis is the related inflammatory condition.
- Herpes simplex
- — A contagious viral infection; the cold-sore type causes clustered blisters and contraindicates service over an active outbreak.
- Tinea
- — A group of contagious fungal infections including ringworm (tinea corporis) and athlete's foot (tinea pedis).
- Rosacea
- — A chronic, noncontagious condition of the central face with redness and visible vessels, aggravated by heat and harsh products.
- Hyperpigmentation
- — Excess melanin producing darker areas such as lentigines, melasma, and post-inflammatory marks.
- Hypopigmentation
- — A loss of melanin producing lighter areas, as in vitiligo (patchy loss) or albinism (congenital absence).
- Primary lesion
- — An early-stage skin change such as a macule, papule, pustule, vesicle, wheal, nodule, or tumor.
- Secondary lesion
- — A later-stage change such as a crust, scale, excoriation, fissure, or scar.
- Melanoma
- — The most serious skin cancer, arising in pigment cells; the ABCDE signs help flag suspicious moles for referral.
- Contraindication
- — A condition that makes a treatment inadvisable; absolute contraindications forbid service, while relative ones require modification.
Exam tips
- Estheticians recognize and refer; they never diagnose or treat disease. When a question describes a suspicious or contagious condition, the correct answer is usually to refer to a physician.
- Learn the ABCDE melanoma signs: Asymmetry, Border irregularity, Color variation, Diameter over about 6 mm, and Evolving change.
- Distinguish primary lesions (early: macule, papule, pustule, vesicle, wheal, nodule) from secondary lesions (later: crust, scale, fissure, scar).
- Active herpes simplex, contagious fungal or bacterial infections, open wounds, and unidentified lesions are contraindications to service in the area.
- Clients on isotretinoin or strong retinoids should not be waxed or aggressively exfoliated; in most states you wait for physician clearance.