Skin Disorders & Diseases

Identify, Classify & Know When to Refer

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Foundations | State Board Exam Aligned

Shear Genius Society Curriculum

Know what you

CAN Treat vs. Must Refer

to a physician

Wrong call = liability • Right call = client safety • Board exams test this heavily

What You'll Learn

Identify and describe primary skin lesions
Identify and describe secondary skin lesions
Recognize common non-infectious skin disorders
Distinguish viral, bacterial, fungal & parasitic conditions

What You'll Learn

continued

Know which conditions allow service and which require referral
Apply contraindication awareness during client consultations
Understand the scope of practice for licensed professionals
Master skin disorder terminology for the State Board Exam

SECTION 01

Primary Skin Lesions

Lesions That Appear as the First Sign of a Condition

Primary Lesions — Flat & Small Raised

APPEAR DIRECTLY ON OTHERWISE HEALTHY SKIN

Macule

Flat, discolored spot — less than 1 cm

Examples: Freckle, age spot, flat birthmark

Papule

Small, raised bump — less than 1 cm, no fluid

Examples: Wart, small mole, insect bite

Wheal

Raised, itchy swelling — appears and fades quickly

Examples: Hive, mosquito bite, allergic reaction

Tubercle

Solid lump — larger than a papule, extends deeper

Examples: Cyst nodule, deep acne lesion

Primary Lesions — Large & Fluid-Filled

CONTAIN FLUID OR EXTEND DEEPER INTO TISSUE

Tumor

Large, solid mass — extends deep into the skin

Examples: Lipoma, larger skin growth (benign or malignant)

Vesicle

Small blister — less than 1 cm, filled with clear fluid

Examples: Poison ivy blister, cold sore in early stage

Bulla

Large blister — greater than 1 cm, fluid-filled

Examples: Severe burn blister, contact dermatitis blister

Pustule

Raised bump filled with pus — inflamed & infected

Examples: Acne pimple, infected hair follicle

Primary Lesion Quick Reference

SIZE & CHARACTERISTICS AT A GLANCE

FLAT

No elevation above skin surface

Macule

< 1 cm, discolored spot

RAISED / SOLID

Elevated above skin, no fluid

Papule

< 1 cm

Tubercle

Deeper, firm

Tumor

Large mass

Wheal

Temporary swelling

FLUID-FILLED

Contains clear fluid or pus

Vesicle

< 1 cm, clear

Bulla

> 1 cm, clear

Pustule

Contains pus

SECTION 02

Secondary Skin Lesions

Lesions That Develop from Injury, Trauma, or Changes to Primary Lesions

Secondary Lesions — Surface Changes

RESULT FROM TRAUMA, HEALING, OR IRRITATION

Crust

Dried serum, blood, or pus on the skin surface

Examples: Scab over a healing wound

Scale

Flaking, dry skin cells shedding from the surface

Examples: Psoriasis flakes, dandruff, dry skin patches

Excoriation

Skin that has been scratched or abraded away

Examples: Scratch mark, picked-at scab, self-inflicted abrasion

Fissure

Crack or split in the skin — often deep and painful

Examples: Cracked heels, chapped lips, dry hand cracks

Secondary Lesions — Deeper Changes

PERMANENT OR SEMI-PERMANENT SKIN ALTERATIONS

Ulcer

Open wound with loss of skin tissue — extends below surface

Examples: Pressure sore, chronic wound, severe infection site

Scar

Replacement tissue after wound healing — lighter/thinner skin

Examples: Healed cut, surgical scar, acne scar

Keloid

Thick, raised scar that extends BEYOND the original wound

Examples: Overgrown scar tissue — more common on chest, shoulders, ears

Stain

Discoloration remaining after a lesion has healed

Examples: Post-inflammatory hyperpigmentation, healed bruise discoloration

Primary vs. Secondary — Know the Difference

BOARD EXAM FAVORITE QUESTION

PRIMARY

First sign of a condition on otherwise healthy skin

Macule
Papule
Wheal
Tubercle
Tumor
Vesicle
Bulla
Pustule

SECONDARY

Develops from trauma, healing, or changes to primary

Crust
Scale
Excoriation
Fissure
Ulcer
Scar
Keloid
Stain

SECTION 03

Common Skin Disorders

Non-Infectious Conditions You Will See in the Salon

Acne Vulgaris & Comedones

THE MOST COMMON SKIN CONDITION IN SALONS

Acne Vulgaris

Chronic inflammatory disorder of the sebaceous glands

Caused by excess oil, dead skin cells, and bacteria clogging pores

Open Comedone

Blackhead — pore is open, sebum oxidizes and turns dark

NOT dirt — the dark color is from oxidation of melanin and oil

Closed Comedone

Whitehead — pore is closed, trapped sebum beneath surface

Small, flesh-colored bump — can become inflamed if irritated

Eczema & Psoriasis

INFLAMMATORY — NOT CONTAGIOUS

ECZEMA / DERMATITIS

Red, itchy, inflamed skin patches
Can be dry, cracked, or weeping
Triggered by allergens, stress, or irritants
Common on hands, inner elbows, behind knees
NOT contagious — may service with caution

PSORIASIS

Thick, silvery-white scales on red patches
Autoimmune condition — overactive skin cells
Commonly on scalp, elbows, knees, lower back
Can affect nails — pitting, ridging, discoloration
NOT contagious — may service with caution

Rosacea & Pigmentation Disorders

COMMON CLIENT CONCERNS

ROSACEA

Chronic redness of the face — flushing, visible blood vessels, sometimes bumps or pustules

Triggers: sun, heat, spicy food, alcohol, stress

HYPERPIGMENTATION

Darkened patches — excess melanin production

Causes: sun, hormones, inflammation, injury. Types: melasma, sun spots, post-inflammatory

HYPOPIGMENTATION

Lightened patches — reduced melanin production

Can result from burns, scars, or autoimmune. Vitiligo is the most well-known example

SEBORRHEA

Overproduction of sebum — excessively oily skin

Often affects scalp (dandruff), nose, forehead. Related: seborrheic dermatitis

More Common Disorders

RECOGNIZING EVERYDAY SKIN CONDITIONS

Milia

Tiny, white, pearl-like bumps — trapped keratin beneath skin surface

Common around eyes and cheeks — NOT acne; no pore opening

Contact Dermatitis

Inflammatory reaction caused by direct contact with an irritant or allergen

Two types: irritant (chemicals, detergents) and allergic (latex, fragrance, nickel)

Asteatosis

Extremely dry, cracked skin caused by loss of natural oil and moisture

Common in cold weather, elderly clients, over-washed hands — can lead to fissures

BOARD TIP: Milia is often confused with acne — but has NO pore opening and cannot be "popped."

SECTION 04

Infectious Skin Conditions

Viral • Bacterial • Fungal • Parasitic — ALWAYS Refer to Physician

Viral Infections

CAUSED BY VIRUSES — CONTAGIOUS — MUST REFER

DO NOT SERVICE — Refer client to a physician immediately

Herpes Simplex

Cold sores / fever blisters — recurring viral infection

Highly contagious during outbreak — spread by direct contact

Warts (Verruca)

Raised, rough skin growths caused by human papillomavirus (HPV)

Contagious — can spread by touch; common on hands and feet

Conjunctivitis

"Pink eye" — inflammation of the eye membrane, viral or bacterial

Extremely contagious — red, watery, crusty eyes; do NOT perform facial services

Bacterial Infections

CAUSED BY BACTERIA — CONTAGIOUS — MUST REFER

DO NOT SERVICE — Refer client to a physician immediately

Impetigo

Highly contagious bacterial skin infection — honey-colored crusts

Common in children — spreads rapidly by direct contact or shared items

Folliculitis

Infection of the hair follicles — red, inflamed, pus-filled bumps

Caused by bacteria entering damaged follicles — looks like acne around hair

Fungal Infections

CAUSED BY FUNGI — CONTAGIOUS — MUST REFER

DO NOT SERVICE — Refer client to a physician immediately

Tinea (Ringworm)

Fungal infection that forms ring-shaped, red, scaly patches on the skin

Despite the name, it is NOT caused by a worm — it is caused by a fungus (dermatophyte).

Tinea Corporis

Body — ring-shaped patches on trunk/limbs

Tinea Capitis

Scalp — scaly patches, possible hair loss

Tinea Pedis

Feet — "athlete's foot" — itching, cracking between toes

Tinea Unguium

Nails — thickened, discolored, crumbly nails

Parasitic Infections

CAUSED BY PARASITES — CONTAGIOUS — MUST REFER

DO NOT SERVICE — Refer client to a physician immediately

Scabies

Caused by the itch mite — burrows under the skin surface

Intense itching, especially at night; small, red, bumpy rash; highly contagious by contact

Pediculosis

Infestation of lice — head lice, body lice, or pubic lice

Spread by close contact or shared items (combs, hats, headrests); causes intense itching

BOARD TIP: ANY infectious condition = DO NOT SERVICE. Always refer to a physician first!

Infectious Conditions — Quick Reference

KNOW THE CATEGORY FOR YOUR BOARD EXAM

VIRAL

Herpes Simplex
Warts (Verruca)
Conjunctivitis

DO NOT SERVICE

BACTERIAL

Impetigo
Folliculitis

DO NOT SERVICE

FUNGAL

Tinea (Ringworm)
Tinea Pedis
Tinea Unguium

DO NOT SERVICE

PARASITIC

Scabies
Pediculosis (Lice)

DO NOT SERVICE

SECTION 05

Service Decision Guide

Can You Service? • Must You Refer? • Contraindications

Can Service vs. Must Refer

YOUR SCOPE OF PRACTICE

CAN SERVICE

(with caution & client awareness)

Acne (mild, non-inflamed)
Eczema (mild, non-weeping)
Psoriasis (mild, non-open)
Rosacea (mild, avoiding triggers)
Hyperpigmentation / Hypopigmentation
Dry skin / Asteatosis
Milia (avoid area)
Healed scars / Keloids (gentle)

MUST REFER

(do NOT service — physician referral required)

Herpes Simplex (active outbreak)
Warts / Verruca
Impetigo
Tinea / Ringworm (any type)
Scabies
Pediculosis / Lice
Conjunctivitis / Pink eye
Severe / cystic acne

Contraindications for Service

CONDITIONS THAT PREVENT YOU FROM PERFORMING A SERVICE

Open wound / broken skin

Risk of infection transmission in both directions

Active infection

Contagious — could spread to you or other clients

Severe inflammation

May indicate underlying condition requiring medical attention

Undiagnosed growths

Lumps, moles that have changed — could indicate serious condition

Certain medications

Blood thinners, Accutane — skin may be fragile or hypersensitive

When to Refuse Service

PROTECTING THE CLIENT AND YOURSELF

You have the right — and the responsibility — to refuse service.

If you observe signs of a contagious infection — do NOT touch the area
If the client insists on service despite a visible condition — politely decline
If you are unsure what a condition is — err on the side of caution
Document what you observed — recommend a physician visit
Never diagnose — say "I recommend seeing a doctor" not "You have ringworm"

BOARD TIP: You are NOT allowed to diagnose. Your role is to identify, refer, and protect.

Consultation Red Flags

WHAT TO WATCH FOR DURING INTAKE

Unusual rashes or spots

New, unexplained, or rapidly changing skin markings

Open sores / weeping areas

Active wounds, oozing, crusting lesions

Intense itching or burning

Persistent discomfort — could be parasitic or fungal

Swollen, red, or hot areas

Signs of active infection or severe inflammation

Changes in moles / growths

Asymmetry, irregular borders, multiple colors, growing — refer immediately

Key Terms Review

PART 1

Macule

Flat, discolored spot smaller than 1 cm — freckle, age spot

Papule

Small raised bump, no fluid — wart, mole, insect bite

Pustule

Raised, pus-filled bump — acne pimple, infected follicle

Keloid

Thick, raised scar extending beyond the original wound

Comedone

Clogged pore — open (blackhead) or closed (whitehead)

Key Terms Review

PART 2

Tinea

Fungal infection (ringworm) — ring-shaped, scaly patches

Pediculosis

Infestation of lice — head, body, or pubic

Contraindication

Condition that prevents performing a service

Dermatitis

Inflammation of the skin — redness, itching, swelling

Excoriation

Skin that has been scratched or scraped away

Board Exam Tips

SKIN DISORDERS EDITION

Know primary vs. secondary lesions — the board loves this distinction
Infectious = NEVER service — always refer to a physician first
You can NOT diagnose — only identify, refer, and document
Memorize the 4 infection categories: viral, bacterial, fungal, parasitic
Contraindication questions appear on EVERY version of the exam

Q1

A flat, discolored spot on the skin smaller than 1 cm is called a:

A) Papule
B) Macule
C) Vesicle
D) Pustule

Click to reveal answer

Q2

Which type of skin lesion is filled with pus?

A) Bulla
B) Vesicle
C) Pustule
D) Tubercle

Click to reveal answer

Q3

A thick, raised scar that grows beyond the boundary of the original wound is a:

A) Fissure
B) Excoriation
C) Stain
D) Keloid

Click to reveal answer

Q4

Tinea is caused by which type of organism?

A) Virus
B) Bacteria
C) Fungus
D) Parasite

Click to reveal answer

Q5

Which condition should a cosmetologist NEVER service?

A) Mild eczema
B) Hyperpigmentation
C) Healed scar
D) Impetigo

Click to reveal answer

Q6

An open comedone is commonly known as a:

A) Whitehead
B) Blackhead
C) Milia
D) Pustule

Click to reveal answer

Q7

Pediculosis refers to an infestation of:

A) Mites
B) Ringworm
C) Bacteria
D) Lice

Click to reveal answer

Q8

When you observe signs of a contagious skin condition on a client, you should:

A) Diagnose the condition and treat it
B) Proceed with service using extra gloves
C) Recommend the client see a physician and decline service
D) Apply antiseptic and continue

Click to reveal answer

Skin Disorders & Diseases

Chapter Complete

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