A Changing Mole, a Cold Sore, and a Request for Hotter Wax
Elena, 47, requests lip, chin, and brow waxing before a family reunion. She has a 4-mm dark, irregular mole on the upper lip that she says has changed in two months; she asks you to just wax around it. At the corner of her mouth she has tingling and a small cluster of blisters that appeared yesterday. She had a light chemical peel seven days ago and her skin still feels tight. She takes lisinopril for well-controlled hypertension and aspirin daily. She reports a history of ingrown hairs on the chin and uses a coarse scrub there. She wants hard wax at 60°C because she believes hotter wax gives a cleaner pull. She has no allergies and no known communicable disease. She is Fitzpatrick III and tans easily.
1. Decide which areas you would treat or refuse, and justify each decision.
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I would not wax the upper lip over the changing mole. A new or changing irregular pigmented lesion needs dermatologic evaluation; waxing could traumatize it and delay diagnosis. I would also refuse the lip and chin area while she has tingling and blisters, because active herpes simplex is contagious and waxing can spread it and cause a severe reaction. The recent chemical peel seven days ago means the skin is still repairing; waxing now could strip the barrier. The brow area is farther from the cold sore, but I would still check for irritation and use a patch test; if the skin is tight or erythematous, postpone all waxing. Aspirin and hypertension increase bruising risk, so gentle technique is important. I would document the lesion, the cold sore, and the referral, and offer to reschedule after the dermatologist clears the mole and the cold sore is fully healed.
2. If Elena is cleared later and returns, explain safe waxing parameters, sanitation, and aftercare.
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If I treat the brow, I would use hard wax at the manufacturer's recommended temperature, not 60°C just because she wants a hotter pull. Test on a small area first; hot wax can burn Fitzpatrick III skin and cause post-inflammatory hyperpigmentation. Cleanse the area, use gloves, apply wax in the direction of hair growth, remove against it while holding skin taut, and apply pressure. Use a fresh spatula for each dip; never double-dip. For the chin, even away from the cold sore, I would not wax over ingrown hairs or use a coarse scrub beforehand. Aftercare: avoid heat, sun, and exfoliation for 24-48 hours, and use SPF. If I refuse, I would still charge only for services performed and document the refusal.