First wax on isotretinoin and sunburned legs
Anjali, 19, arrives for her first leg, underarm and upper-lip wax. She started isotretinoin 20 mg daily six days ago for acne, and has been applying adapalene 0.1% gel every night. Three days ago she spent the afternoon at the beach; her shins are pink and warm and there are three small shaving scabs on her knees. She mentions that she shaved her legs two days ago and that her skin stings when she applies moisturiser. She is otherwise healthy, not pregnant, and has no known allergies. She has a friend's wedding in four days and wants 'everything smooth'. The salon uses a roll-on warm wax pot set at 42°C and strip wax, with hard wax available for the lip. The therapist has a queue of four clients and the room has one wax pot.
1. Which services, if any, can you perform today? Explain each contraindication.
Read the worked answer
No waxing on any area today.
- Isotretinoin 20 mg daily: this systemic retinoid thins the epidermis and impairs the skin barrier. Waxing can strip skin, cause erosions, bleeding, infection, scarring and pigmentation. Standard advice is to avoid waxing during treatment and for at least six months after the last dose; confirm the timeline with her prescriber.
- Adapalene 0.1% nightly: a topical retinoid. It should be stopped for at least 5–7 days before waxing, and the skin must be calm; she used it last night.
- Sunburn on the shins: the skin is inflamed, warm and fragile, and retinoids increase photosensitivity. Waxing over sunburn can tear the skin.
- Shaving scabs and stinging: broken skin and a compromised barrier mean a high risk of infection and poor healing.
- Upper lip: even a small area carries the same systemic risk, and the skin is delicate; hard wax does not remove the contraindication.
Explain that the wedding is four days away, which is not enough time for damaged skin to recover. Suggest trimming or covering the area rather than any hair removal on inflamed skin, and rebook after medical clearance.
2. When she is cleared to return, describe the hygiene and technique you would use.
Read the worked answer
- Patch test: 24–48 hours before, apply a small amount of the exact wax to the inner forearm and check for a reaction.
- Recheck contraindications at every visit: retinoids, recent sun exposure, acids, broken skin, active infection, pregnancy-related sensitivity and any new medication.
- Set-up: cleanse the area, apply a thin pre-wax oil, blot, and powder to protect the skin. Wear gloves and use disposable strips.
- Temperature: do not trust the dial alone. Check the wax with a thermometer (warm wax is applied at roughly 40–45°C) and test a small drop on your inner wrist; if it feels hot, it is too hot.
- No double-dipping: one spatula, one dip, then discard. This prevents cross-contamination between clients.
- Removal: hold the skin taut, remove the strip against the direction of hair growth, and apply pressure immediately afterwards.
- Lip: use hard wax in a thin layer and support the skin.
- Aftercare: soothe with a post-wax product and advise no heat, sun, swimming, sauna or tight clothing for 24–48 hours, and no retinoids on the area for 5–7 days.
3. How would you communicate the refusal and document it?
Read the worked answer
Explain the reason in terms she can act on: 'The acne medicine and the sunburn make your skin fragile. Waxing now could tear the skin, leave scars or cause an infection, so I cannot do it today.' Avoid judging her for sunbathing or for starting treatment; keep the focus on safety and on the wedding.
Offer alternatives for the wedding that do not involve waxing: trim the hair, choose clothing that covers the legs, or use a gradual tanner only after the sunburn has settled and on intact skin. Book her for a patch test and wax once her prescriber confirms it is safe.
In her record, note the date, the services requested, the products she is using, the reasons for refusal, the advice given, the alternatives offered, the rebooking plan and her signature. Warn her that other salons also need to know about the isotretinoin, and that she should not book a wax elsewhere without disclosing it. This protects her and documents that you met your duty of care.