Chapter 4: Skin Disorders and Diseases
Scope and importance of knowledge about skin disorders for aestheticians
Skin disorders and diseases are complex and require thorough knowledge for safe practice.
Aestheticians must not diagnose skin diseases; however, being able to recognize common medical conditions helps in working safely with clients and in referring when needed.
The goal is to help clients safely and effectively, including addressing emotional effects of visible skin problems.
Clients may be vulnerable when exposing their skin; use positive language and discuss skin concerns tactfully.
If you do not recognize a condition or lesion, stop the service and refer or advise clients to seek medical evaluation.
Do not post client photos online asking for treatment advice; seek proper medical guidance.
Recognizing potentially contagious skin disorders helps stop the spread of infection and protect both client and technician.
Learning when to stop a service and refer to medical professionals can save lives (e.g., potential malignancies or contagious conditions).
Aesthetician–dermatologist collaboration is important: dermatology is the medical field that studies and treats the skin and its disorders; a dermatologist is a physician who treats these disorders.
Estheticians are not licensed to diagnose skin disorders or diseases, but can support clients with common conditions such as rosacea, acne, and hyperpigmentation after diagnosis.
Contagious or infectious diseases disqualify service until medical clearance; estheticians should know the limits of practice.
The importance of caution and infection control when working with skin disorders.
Estheticians can be part of the dermatology team to alleviate symptoms through appropriate skin care treatments.
See the figure references and tables in the text (e.g., Figure 4-1 on page 123; Table 4-1; Table 4-2; Table 4-3) for lesion classifications and cancer references.
The chapter emphasizes safety, ethics, and professional boundaries in clinical settings.
Recognizing and managing skin conditions: general precautions
When in doubt, refer to a medical professional before treating a suspected condition.
Do not diagnose; refer for medical evaluation when necessary.
Be aware that some lesions can be contagious or infectious; protect yourself and other clients.
Maintain strict infection control and hygiene practices at all times.
Understand that some skin conditions can be exacerbated by treatments or products; know contraindications.
Some lesions may fit more than one category or have multiple names; maintain a broad differential when assessing.
Clients with diagnosed skin conditions may benefit from esthetic treatments to manage symptoms, under medical supervision.
Oncologic aesthetics: a medical niche focusing on skin care for clients undergoing cancer treatments; requires deeper knowledge about skin changes from radiation and chemotherapy and appropriate product choices.
Anatomy of skin lesions: primary, secondary, and tertiary (vascular) lesions
Lesions are structural changes in tissue from damage or injury; any marked wound or abnormality is a lesion.
Primary lesions: initial stages of development or change; may include fluid-filled or color changes.
Secondary lesions: arise from the progression or healing of primary lesions (e.g., crust, scar, ulcer).
Tertiary lesions (often called vascular lesions in some references): involve blood or circulatory system components.
See Table 4-1 for descriptions and examples of primary lesions (described below) and Tables 4-2/4-3 for secondary and cancer-related details.
Primary lesions (definitions and examples)
Beula/Bulla (large blister with watery fluid)
Requires medical referral.
Examples given: contact dermatitis, large second-degree burn, bullous impetigo, pemphigus.
Cyst and tubercle
Cyst: closed, abnormal sac containing pus, semiliquid, or morbid matter; can drain; may be medical referral.
Tubercle: similar but cannot be drained; requires medical referral.
Macule
Flat spot or discoloration; e.g., freckle or age spot.
Nodule
Solid bump >
1 ext{ cm}; easily felt; may indicate swollen lymph nodes or rheumatoid nodules; requires medical referral.
Papule
Small elevation without fluid; may develop pus (e.g., acne, warts, elevated nevi).
Pustule
Raised, inflamed papule with a white or yellow center containing pus.
Vesicle
Small blister containing clear fluid; located within or just beneath the epidermis; medical referral if cause is unknown or untreatable OTC.
Wheal
Itchy, swollen lesion due to allergy or insect bite; resolves spontaneously; refer if lasting >3 days (e.g., hives, mosquito bites).
Tumor
Any abnormal mass; varied size/shape/color; not always cancer; medical referral required.
Note: The text mentions references to Figure 4-1 (page 123) for lesion examples and notes that some lesions may have multiple names or categories.
Secondary lesions (descriptions and examples)
Crust/scab: dried residue of dead cells, sebum, pus; part of healing; examples include excoriations (skin sore from scratching).
Excoriation: skin sore or abrasion from scratching or scraping.
Fissure: crack penetrating the dermis; e.g., severely cracked hands or lips.
Keloid: thick scar from excessive fibrous tissue growth; can occur anywhere; not always removable by extraction.
Scale: thin, dry/oily plate of epidermal flakes (e.g., dandruff, psoriasis).
Scar/Sykotrix: raised or depressed area from healing; post-injury or post-surgical.
Ulcer: open lesion with loss of skin depth and potential weeping; medical referral especially with underlying conditions (e.g., diabetes).
Page references: Tables 4-2 and 4-4 illustrate and classify secondary lesions and acne grades.
Tertiary (vascular) lesions and cautions
Vascular lesions discussed as part of the broader category of skin changes; context notes that some references call certain lesions vascular or tertiary.
Emphasis on cautious evaluation and referral when vascular lesions are suspected or when skin changes could indicate deeper issues.
Skin cancer awareness and oncology aesthetics
Skin cancer risk factors: cumulative UV exposure increases risk; non-melanoma and melanoma forms vary in severity.
DNA damage underlies carcinogenesis; cancers can be deadly if not detected early; early removal improves outcomes.
Key statistics (from transcript):
91{,}270 new melanomas diagnosed per year.
9{,}320 melanoma deaths per year.
Melanoma causes >90% of skin cancer deaths; melanoma is the deadliest form.
About 1/5 Americans will be diagnosed with skin cancer in their lifetime.
A single blistering sunburn in childhood doubles melanoma risk later; one hour of sun exposure can lead to fatalities if untreated (illustrative).
Non-melanoma cancers are caused by UV exposure; early detection improves prognosis.
Tanning bed use in teens/twenties increases melanoma risk by about 75 ext{%}.
ABCDE melanoma detection checklist (Figure 4-2):
A: Asymmetry of two sides of the lesion.
B: Border irregularity.
C: Color variation or uneven color.
D: Diameter typically at least the size of a pencil eraser (D \geq 6 ext{ mm}).
E: Evolution or change in appearance over time.
Oncologic aesthetics: specialized niche for beauty professionals certified in oncology aesthetics; care for skin affected by radiation/chemotherapy; avoid products that are contraindicated with cancer treatments; emphasize soothing and calming touch.
Professionals may detect malignant changes; estheticians can refer to dermatology when changes are evident; annual medical skin checks recommended for everyone; contact resources: American Cancer Society, Impact Melanoma Organization for education resources (e.g., Skinny on Skin program).
Pre-cancerous lesions: actinic keratosis is pink/flesh-colored, rough, precancerous; should be evaluated by a dermatologist.
Moles (nevi): not cancer per se; monitor for changes using ABCDE; not every mole is cancerous.
Acne: definition, pathophysiology, and morphology
Acne is an inflammatory disorder of the sebaceous glands (acne simplex or acne vulgaris).
Key mechanism:
Excess sebum production + dead skin cell buildup + clogged follicles (comedones) lead to bacterial growth (Propionibacterium acnes, now Cutibacterium acnes).
Follicles become inflamed; bacteria and debris cause immune response; white blood cells respond; redness and swelling occur; papules form; progression leads to pustules and cysts.
Cystic acne is deep in the dermis and should be treated by a medical professional.
The polysebaceous unit: hair shaft + sebaceous gland + sebaceous duct; main follicle involved in acne.
Causes of clogged follicles: excess oil, retention hyperkeratosis, sebaceous filaments; sometimes the ostium is too small to allow impactions out.
Types of clogged follicles:
Comedo: non-inflamed buildup inside the follicle (open vs closed): open comedo = blackhead; closed comedo = whitehead; open comedo appears dark due to oxygen exposure (oxidation).
Sebaceous filaments: similar to open comedones; small solidified oil impactions; common on the nose.
Milia: tiny epidermal cysts (firm white papules) with pearly appearance; not identical to whiteheads; more common in dry skin; can be present at birth in newborns; may form after trauma or UV exposure; can be treated differently.
Milia treatment (salon/spa options): increase exfoliation; retinoids to thin stratum corneum; extraction of milia with a tiny opening; if not popping, allow them to resolve with cleansing and retinoid use.
Retention hyperkeratosis: hereditary buildup of dead skin cells in follicles; contributes to comedones; treatment includes exfoliation and retinoids.
Other sebaceous gland conditions:
Sebaceous hyperplasia: benign yellow/white/y flesh-colored papules in oilier areas; donut-shaped with a central indentation; not removable by extraction; may require cryotherapy or laser; not to be confused with comedones or milia.
Seborrhea/seborrheic dermatitis: excessive oiliness; can occur on scalp or face; not acne, but can coexist with inflammatory skin conditions.
Acne triggers (factors to assess in consult): genetics, hormones, environment, lifestyle, product ingredients, and diet.
Acne management strategies:
Regular consultation to identify triggers and tailor a treatment plan.
Education about healthy skin care and non-comedogenic products.
Treatments to thin stratum corneum and reduce oil (exfoliation, chemical peels, microdermabrasion, high-frequency therapy) to improve oxygenation and reduce bacteria.
Topical antibiotics may be used with benzoyl peroxide to reduce resistance risk; avoid long-term antibiotic monotherapy.
Hormonal management: anti-androgen therapies; birth control pills; spironolactone; may require medical supervision.
Home care ingredients: avoid comedogenic ingredients; choose light emulsions rather than heavy oil-based products; ensure proper hygiene with makeup brushes and disposables.
Grade-based acne severity (Grades 1–4):
Grade 1: mild; mostly open and closed comedones; few papules.
Grade 2: more comedones; some papules/pustules.
Grade 3: many comedones; inflamed; more papules/pustules.
Grade 4: cystic acne with comedones, papules, pustules; higher risk of scarring.
Acne triggers detail (from the transcript):
Genetics: familial acne influence; not fully curable; managed with holistic approach.
Hormones: puberty, menstrual cycle, pregnancy, perimenopause; androgens increase oil production; changes may occur with birth control or hormonal therapy.
Environment: exposure to pollutants, air quality, seasonal/climate changes; occupational exposures (oils, chemicals, ink); cleansing after workday recommended; occlusive products can trap bacteria; use exfoliation and oxygenation to counteract bacteria.
Lifestyle: stress, sleep, relationships, home life; stress can increase hormone production and oil.
Fragrances and cosmetics: certain ingredients can aggravate acne; avoid heavy comedogenic products; cosmetics and skincare products discussed in Chapter 6; makeup brushes hygiene important.
Diet: glucose index foods, dairy, iodine content; not definitive; advise healthy diet and water intake; refer to nutrition specialist if needed.
Medicated treatment options for acne (overview):
Topical antibacterial agents to reduce Propionibacterium acnes; use in combination to reduce resistance.
Benzoyl peroxide often combined with topical antibiotics.
Retinoids (vitamin A derivatives) to thin stratum corneum and increase turnover; adapalene, tretinoin, tazarotene.
Salicylic acid and azelaic acid have antibacterial and keratolytic effects; salicylic acid is lipophilic and helps digest sebum.
Hormonal therapies for hormonal acne: spironolactone; birth control pills.
Oral antibiotics as short-term agents; risk of antibiotic resistance limits long-term use.
Isotretinoin (oral retinoid) for severe acne; requires medical oversight.
Home care products: low comedogenic moisturizers; benzoyl peroxide; retinoids; vitamin A derivatives; careful product selection as discussed in Chapter 6.
Home-care and product considerations for acne patients
Light emulsions (oil-in-water) preferred over heavy, oil-based moisturizers for acne-prone skin.
Sunscreen: essential; some retinoids are photosensitizing and should be used with caution and appropriate sunscreen.
Gentle cleansing to avoid irritation and further inflammation.
Special considerations: clients on acne medications may require scheduling adjustments depending on skin sensitivity and treatment plans.
Polycystic ovarian syndrome (PCOS) and related skin issues
PCOS: a hormonal condition affecting about 1 in 20 women in childbearing years; genetic component suspected.
Common symptoms: increased androgens causing ovarian cysts, irregular menses, infertility, insulin resistance, weight management challenges, sleep apnea, acne, hair thinning/baldness patterns, and hirsutism (facial/body hair growth).
Psychological impact: body image concerns; clients may feel a loss of control; emotional support is important.
Management strategies (in aesthetics and medical support):
Hormonal regulation: birth control pills; antiandrogen medications to control hair growth and acne.
Hair removal strategies: waxing and laser to manage unwanted hair.
Skincare focusing on comedone prevention and keeping stratum corneum thin (e.g., chemical peels, microdermabrasion, high-frequency).
Treatments to address acne breakouts and other skin issues on PCOS patients.
Emotional support and counseling as part of holistic care.
PICO symptoms commonly associated with PCOS (Figure 4-4): excessive hair growth, weight change, ovarian cysts, low sex drive, irregular periods, male-pattern baldness, high testosterone, insulin resistance, fatigue, acne, mood changes, infertility.
Key note: PCOS is not cured, but symptoms can be managed with medical and skincare interventions; client education and collaboration with medical professionals are essential.
Vascular conditions and pigment disorders: overview and management
Vascular conditions/disorders: important to understand for symptom management and treatment planning.
Rosacea: inflammatory vascular disorder with flushing, redness, visible vessels, and skin sensitivity; may involve eyes (redness, irritation).
Triggers include spicy foods, alcohol, caffeine, heat, sun, stress; progression can include pustular acne-like breakouts.
Management: collaboration with medical professionals; soothing care; antifungal prescriptions if needed; gentle facials and limited steam; possible advanced laser/radiofrequency treatments for some cases.
Telangiectasia: visible capillaries (0.5–1 mm) typically on face around nose, cheeks, chin; cosmetic irregularity, not a medical condition; treatment focuses on cosmetic improvement.
Varicose veins: dilated, twisted veins, often in legs; risk factors include pregnancy, prolonged standing/sitting, genetics.
Treatments: sclerotherapy; vein injections to collapse vessels; surgery for large vessels; medical referral advised.
Pigment disorders (dyschromia): abnormal pigmentation due to internal/external factors; hyperpigmentation vs hypopigmentation.
Hyperpigmentation forms:
Melasma: hormonal hyperpigmentation (pregnancy or birth control use); symmetrical pattern on forehead, cheeks, upper lip, chin; sun exposure worsens but can fade with lower UV exposure; management includes melanocyte-inhibiting skincare, chemical peels, lasers/IPLs, sunscreen; difficult to treat fully.
Lentigo: flat pigmented spots (age spots/solar lentigines) due to sun exposure.
Ephelides (freckles): small flat pigmented spots; also called macules.
Nevus (moles): pigmented nevus; some flat, some raised; monitor for color/shape changes using ABCDE rules.
Port-wine stain: vascular nevus; example of pigmented nevus with vascular involvement.
Hypopigmentation forms:
Leukoderma (hypopigmented patches): congenital or acquired; includes vitiligo and albinism.
Albinism: rare genetic lack of melanin; photophobia risk for skin cancer; very pale skin/hair/eyes; congenital hypopigmentation.
Vitiligo: autoimmune loss of melanocytes leading to white patches; may worsen with sun exposure; can occur at any age; conceptualized as autoimmune, with need for medical management.
Tinea versicolor (pityriasis versicolor): fungal (yeast) infection causing white, brown, or salmon patches; not contagious; triggered by humidity and heat; treated with antifungal creams, selenium sulfide shampoos; may be mistaken for vitiligo; referral recommended for differential diagnosis.
Post-inflammatory hyperpigmentation (PIH): darkening after skin injury or acne resolution; can be deep red, purple, or brown; management includes pigment-inhibiting skincare, chemical peels, laser/IPL, ongoing sunscreen and irritant avoidance.
Dermatitis and related inflammatory conditions
Dermatitis is a general term for inflammatory skin conditions; includes eczema, vesicles, papules; many forms with overlapping symptoms; referral to a medical professional is recommended for proper diagnosis.
Types of dermatitis:
Contact dermatitis (occupational): exposure to cosmetics, chemicals, allergens or irritants; symptoms include redness, itching; prevention includes protective gloves and barrier creams.
Allergic contact dermatitis: immune-mediated reaction to an allergen; sensitization may take months/years; hereditary predisposition and family history may exist; common salon allergens include cosmetics, skincare products, detergents, dyes, fragrances, nickel.
Irritant contact dermatitis: reaction to irritants such as caustic substances; immediate or delayed onset; acute symptoms include redness, swelling, scaling; chronic exposure may cause more damage; eyelids, hands, and scalp are common sites; prevention includes avoiding contact and wearing protection.
Atopic dermatitis (eczema): chronic, relapsing dermatitis with dry, cracked skin and itching; managed with humidification, emollients, topical corticosteroids; avoid irritants and triggers.
Perioral dermatitis: acne-like around mouth; clusters of papules; may be caused by toothpaste or facial products; not contagious; antibiotics may help.
Seborrheic dermatitis: inflammation with oily scales around eyebrows, scalp, hairline; behind the ears; red, flaky skin; may require medicated shampoos or corticosteroids.
Stasis dermatitis: occurs with poor circulation in lower legs; edema, scaly skin, itching, hyperpigmentation; may require cardiovascular referral; IPL can improve appearance after treating underlying issues.
Caution: when dermatitis is suspected, avoid aggressive facial treatments that may worsen symptoms; maintain gentle care and refer when needed.
Hypertrophies and common benign growths
Hypertrophy: abnormal tissue growth; most are benign but some may be premalignant or malignant.
Key hypertrophies include:
Hyperkeratosis: thickening of the epidermis due to keratin buildup.
Keratoma: thickened epidermal patch (callus is a form from pressure/friction).
Corn: inward growth of thickened skin.
Keratosis: excessive buildup of skin cells; includes keratosis pilaris (chicken skin): redness and bumps on cheeks, arms, or thighs; often genetic and fades after age 30.
Milia and moles are also discussed in this section as benign but important to differentiate from malignant lesions.
Psoriasis: itchy red patches with silvery scales; autoimmune-related; not contagious; managed with medications and light therapy.
Skin tags: small benign outgrowths; common under arms, neck, and near the breast; typically benign and not cancerous.
Contagious skin and nail diseases: identification and safety
Contagious diseases include: conjunctivitis (pink eye), herpes simplex virus (HSV-1/2), shingles (herpes zoster), impetigo, onychomycosis, tinea (capitis, corporis, pedis), verruca (wart).
Never treat a client with active contagious skin conditions; refer for medical care; proper hygiene and PPE (gloves) are essential to prevent spread.
HSV-1 (cold sores) can appear around the lips and nostrils; avoid procedures that stress or irritate the skin during an outbreak; lesions may appear in other locations.
HSV-2 (genital herpes) requires caution; avoid treating affected areas; risk of spreading during procedures that involve skin contact.
Impetigo is highly contagious and requires antibiotics; lesions must be managed under medical care.
Onychomycosis and tinea infections require antifungal treatment; avoid bodywork on affected nails; cosmetic services may continue on unaffected areas after infection management.
Warts (verruca) caused by viruses; management may involve cryotherapy or other medical treatments; ensure gloves and hygiene; avoid spreading infection via tools or direct contact.
Safety note: page-specific images referenced (Figures 4-27 to 4-33) illustrate examples of herpes, impetigo, onychomycosis, tinea, and verruca.
Mental health considerations and ethical practice
Dermatillomania: obsessive-compulsive spectrum where individuals pick at their skin; stress relief yet causes injury and scarring; treatment includes CBT, hypnosis, and medications; can be misinterpreted as drug use.
Body dysmorphic disorder (BDD): preoccupation with appearance and fixation on minor flaws; clients may require medical and psychological care; beyond the aesthetician’s ability to satisfy, may need CBT and medications.
Recognize these conditions and respond with empathy, refer to professionals when appropriate, and avoid pursuing impossible cosmetic improvements.
Ethical practice: focus on evidence-based information; verify reliability of sources; avoid relying on outdated or unverified claims (ABCDE of melanoma and other guidelines are recommended resources).
Common skin conditions: overview table and key signs
Table 4-6 lists common skin conditions and notes that many conditions share similar symptoms; a differential diagnosis approach is necessary when signs overlap.
Important signs and conditions to recognize include:
Furuncle (boil): localized collection of pus due to infection of a hair follicle or gland.
Edema: swelling from fluid balance issues or injury/inflammation.
Erythema: redness due to inflammation.
Folliculitis: hair follicle infection that may appear as bumps; barber’s itch (pseudofolliculitis) describes razor-induced folliculitis.
Pruritus: itching.
Stotoma: sebaceous cyst or subcutaneous tumor filled with sebum; size ranges from pea to orange; commonly appears on scalp, neck, back; also called a wen.
Pseudoriferous gland (sweat gland) disorders
Anhydrosis: deficiency in perspiration due to sweat gland failure; often requires medical treatment.
Bromhidrosis: foul-smelling perspiration due to bacteria/yeast breakdown.
Hyperhidrosis: chronic excessive perspiration; possible treatments include microwave therapy to destroy underarm sweat glands; neuromodulators (e.g., Botox) to reduce sweat production.
Diaphoresis: excessive sweating due to underlying medical conditions (e.g., menopause).
Miliaria (prickly heat): inflammatory disorder of sweat glands causing red vesicles and itching with excessive heat exposure.
Practical implications for estheticians
Always assess for contraindications before treatments; if a patient has a diagnosed skin disease, tailor treatment accordingly and consult with the client’s medical team when needed.
Use evidence-based resources; be cautious about taking medical advice from non-professionals or social media; direct clients to licensed medical professionals for diagnosis.
Keep clients informed about safety, expectations, and potential risks; emphasize the importance of sunscreen and sun protection for pigment disorders and cancer prevention.
Be mindful of emotional well-being; acknowledge that skin conditions can impact self-esteem and body image; offer supportive communication.
Review intake forms for any active contagious conditions or outbreaks before scheduling services.
Maintain a strong collaboration with dermatology and oncology teams when needed; this includes understanding cancer therapies and their impact on the skin and treatment compatibility.
Additional resources and references
Oncology aesthetics resources: Chapter 13 references; oncology-focused skincare considerations.
ABCDE melanoma checklist: widely used in clinical dermatology to screen for suspicious moles.
Impact Melanoma Organization: educational program for beauty professionals; Skinny on Skin program is available for free (www.impactmelanoma.org).
American Cancer Society and cancer.org resources for patients and professionals.
Table 4-3: descriptions of skin cancer types (basal cell carcinoma, squamous cell carcinoma, malignant melanoma).
Table 4-4: acne grades with representative images (grades 1–4).
Table 4-5: common medications used to treat acne (e.g., adapalene, azelaic acid, clindamycin, isotretinoin, spironolactone, tazarotene, tretinoin).
Table 4-6: common skin conditions and signs to differentiate between conditions.
Page 155: web resources list for further study.
Summary takeaways for exam preparation
Know the scope of practice: estheticians cannot diagnose but should recognize symptoms, assess contraindications, and refer appropriately.
Memorize major lesion types (primary, secondary, tertiary) and their clinical descriptions, along with typical examples and required referrals.
Be able to identify and differentiate common skin cancers and understand the ABCDE criteria for melanoma detection.
Understand acne pathophysiology, triggers, grading, and a wide range of treatment options (topical, systemic, hormonal, and lifestyle factors).
Recognize common dermatoses (dermatitis types, rosacea, psoriasis, seborrheic dermatitis, stasis dermatitis) and know when to refer.
Be familiar with pigment disorders (hyperpigmentation, hypopigmentation) and the role of sun exposure and hormones; understand PIH management.
Acknowledge contagious diseases and safety protocols in the clinical setting.
Recognize mental health conditions that can present with skin signs and know when to refer for psychological/medical help.
Emphasize evidence-based practice and use credible sources when researching skin disorders and treatments.
Remember practical skincare considerations for various conditions (non-comedogenic products, sun protection, gentle treatments, protective measures).
Title for the notes
Notes: Comprehensive Overview of Skin Disorders and Diseases for Estheticians