Hair and Skin Conditions, Disorders, and Contraindications
Recognition drives safety
Your role is to recognize, document, and refer - not to diagnose. Learn to distinguish normal variation (fine vellus hair, freckles, moles that are symmetric and uniform) from findings that warrant referral. The ABCDE framework for pigmented lesions (Asymmetry, Border irregularity, Color variation, Diameter, Evolving) is a recognition aid, not a diagnosis.
Common conditions you must recognize: hirsutism (coarse terminal hair in androgen-dependent female patterns, often endocrine-linked), hypertrichosis (excess hair not androgen-patterned, generalized or localized), folliculitis (infected/inflamed follicles - do not treat over active infection), pseudofolliculitis (ingrown hair inflammation, common after shaving), and acne (active pustules/cysts are a relative contraindication to treatment over the area).
Absolute contraindications typically include active infection, open lesions, and certain implanted electronic devices depending on modality. Relative contraindications include recent sun exposure/tanning, photosensitizing medications, pregnancy (jurisdiction- and modality-dependent), and skin that is irritated or recently waxed/plucked.
Traps to watch
- Treating over active infection or inflammation "because it's just a little redness."
- Confusing hirsutism (androgen-patterned, often medical) with hypertrichosis (non-androgen excess).
- Missing a medication history (isotretinoin, anticoagulants, photosensitizers) that changes risk.
- Assuming a lesion is benign because the client says "it's been there forever."
Rule of thumb
New, changing, bleeding, itching, or asymmetric → refer before treating. Document what you see in objective terms and note the referral.