Full-Leg Wax Before a Beach Holiday
A 22-year-old client books a full-leg and underarm wax for Thursday; she leaves for a beach holiday on Saturday. During consultation she mentions that she began oral isotretinoin 20 mg daily five months ago and expects to continue for another two months. She also uses adapalene 0.1% gel on her cheeks three nights a week. Her legs are dry with faint erythema over the shins; she says she has waxed every month for two years without problems. She insists she needs smooth skin for photographs and asks you to 'just do a quick strip test and then proceed' because the salon's cancellation policy charges 50% within 24 hours. The salon uses hot film wax at 42°C and has no cooling gel in stock. She also requests upper-lip threading in the same appointment.
1. What should you do about the leg wax, the upper-lip threading, and the cancellation fee? Explain the clinical reasoning and give the words you would use with the client.
Read the worked answer
Decline both the leg wax and the upper-lip threading today. Isotretinoin is a systemic retinoid; at 20 mg daily for five months, the skin is likely fragile and slower to re-epithelialise even where it looks normal. Adapalene adds a local retinoid effect on the cheeks. A 'strip test' on a small area cannot predict how a full-leg wax will strip skin or cause post-inflammatory hyperpigmentation, and having no cooling gel makes aftercare weaker. Threading the upper lip is also trauma; the lip is not where adapalene is applied, but systemic isotretinoin still affects healing, and the client's expectation is already high. The 50% late-cancellation fee is a business policy, not a clinical reason to perform a contraindicated service. I would waive or suspend the fee, document the refusal and the reason, offer a patch test only when her dermatologist confirms it is safe, and rebook no earlier than the agreed post-isotretinoin waiting period. Script: 'I can't safely wax or thread today because your medication makes skin more likely to tear and mark. I'd rather lose the booking than give you a burn before your holiday. I'll note it on your record and waive the late fee; we can plan a patch test after your dermatologist clears you.'
2. Write the consultation record entries and a 48-hour follow-up plan, including what you will tell her about alternatives for the holiday.
Read the worked answer
Record the date and time, service requested, medications (isotretinoin 20 mg daily since the stated start date; adapalene 0.1% on cheeks three nights weekly), findings (dry legs, faint shin erythema), the service declined and why, fee waived, no wax or threading performed, advice given, and client signature. Follow-up: call the next day to confirm there has been no reaction, since no service was performed, and send written aftercare: no scrubs, no hot baths, fragrance-free moisturiser, and SPF 30+ on exposed legs. For the holiday, do not suggest a new chemical hair remover on erythematous shins; gentle trimming is safer than another wax or depilatory. For the upper lip, trimming is safer than threading until clearance. Explain that smoothness is not worth a burn or pigment mark. Rebook after dermatologist clearance and follow the salon's written protocol for clients on retinoids. Document the follow-up call and any advice repeated.