Disorders and Diseases of the Skin
Scope first
An esthetician recognizes and refers; only a physician diagnoses. Describe what you see ("raised, red, crusted area") rather than naming a disease, and document the referral.
Lesion vocabulary
Primary lesions arise first: macule, papule, pustule, vesicle, bulla, wheal, nodule, cyst, plaque, comedo. Secondary lesions evolve from primary ones or from scratching: crust, scale, fissure, ulcer, excoriation, scar, keloid, atrophy, lichenification.
Stop the service - contagious or contraindicated
Conjunctivitis, herpes simplex (cold sore), impetigo, verruca (warts), tinea (ringworm), scabies, pediculosis, molluscum contagiosum. Also defer on sunburn, open wounds, undiagnosed lesions, and severe inflamed acne.
Frequently tested conditions
- Acne vulgaris: open and closed comedones, papules, pustules; no steaming or heavy massage on inflamed cysts.
- Rosacea: flushing, telangiectasia, papules - no comedones; avoid heat, scrubs, and strong actives.
- Milia: keratin-filled cyst, not a comedo.
- Sebaceous hyperplasia: donut-shaped and benign; often confused with basal cell carcinoma.
- Pigment: melasma, post-inflammatory hyperpigmentation, solar lentigines; vitiligo is depigmentation.
Skin cancer cues
Basal cell carcinoma is most common (pearly, translucent, visible vessels); squamous cell carcinoma is firm, red, scaly; melanoma follows the ABCDE rule. Any new, changing, bleeding, or painful lesion is referred, never treated.
Rule of thumb: "If it's new, changing, bleeding, or painful - refer."