NH Esthetician cheat sheet

New Hampshire defines disinfection as the destruction of pathogenic microorganisms on hard, nonporous surfaces; it does not reliably kill bacterial spores, so items contacting broken skin require sterilization or single use.

EPA-registered hospital-grade disinfectants must be used at the label's dilution and contact time; a 10-minute contact time at 1:10 bleach dilution is typical for blood or body-fluid spills on nonporous surfaces.

Classify implements: porous or skin-penetrating items (nippers that cut cuticle, lancets, comedone extractors that break skin) are single-use or sterilizable; nonporous items contacting intact skin (spatulas, brushes, bowls) require cleaning plus disinfection.

Standard universal precautions treat all blood, lymph, and body fluids as infectious; gloves are worn for extractions, waxing, and any service where contact with body fluids is likely.

Handwashing with soap and running water for at least 20 seconds precedes gloving and follows glove removal; alcohol-based sanitizer is not a substitute when hands are visibly soiled.

Contaminated waste goes in a lined, covered container; sharps such as used lancets and single-use razors go in a rigid sharps container, never in general trash.

A wet sanitizer is a container of disinfectant solution for immersing cleaned implements; a dry sanitizer is a clean, closed, disinfected cabinet or drawer that keeps implements sterile between uses.

Bloodborne pathogen exposure: wash the exposed area with soap and water, flush mucous membranes, report to the employer, and seek medical evaluation; New Hampshire requires employers with employees at risk to maintain an exposure control plan.

Epidermis layers, deep to superficial: stratum basale (germinativum), stratum spinosum, stratum granulosum, stratum lucidum (palms and soles only), stratum corneum.

Keratinocytes are formed in the stratum basale, migrate upward, and convert to keratin in the granulosum layer; the full turnover takes roughly 28 days in young skin and lengthens with age.

Melanocytes in the basale produce melanin and transfer it via melanosomes to surrounding keratinocytes; melanin absorbs UV and determines baseline skin and hair color.

Langerhans cells (immune surveillance) reside mainly in the spinosum; Merkel cells at the basale-epidermis junction function in light touch sensation.

Dermis has two layers: papillary (thin, loose areolar tissue with capillary loops) and reticular (thick, dense irregular collagen and elastin bundles).

Fibroblasts in the dermis synthesize collagen (strength) and elastin (recoil); hyaluronic acid in the ground substance binds water and gives skin turgor.

Appendages arise from the epidermis and dip into the dermis: hair follicles with sebaceous glands, eccrine sweat glands (most numerous on palms and soles), and apocrine glands (axillae, groin).

Subcutaneous layer (hypodermis) is adipose and fascia; it insulates, cushions, and stores energy. Skin functions include protection, sensation, thermoregulation, excretion, secretion, and vitamin D synthesis.

Skin types: normal, dry (alipidic, tight, flaky), oily (lipid-rich, enlarged pores, shine), combination (oily T-zone with normal-to-dry cheeks), and sensitive (reacts with redness, stinging, or itching).

Lesion vocabulary: primary lesions form first (macule, papule, pustule, vesicle, bulla, nodule, wheal, cyst); secondary lesions result from change or trauma (scale, crust, excoriation, fissure, scar, keloid, ulcer, atrophy).

Contagious conditions that contraindicate service: impetigo, ringworm (tinea), scabies, lice, herpes simplex with active vesicles, and conjunctivitis; refer to a physician.

Inflammatory acne is characterized by papules and pustules with possible nodules; noninflammatory acne is open and closed comedones. Do not extract inflamed, deep, or cystic lesions.

Skin cancer warning signs (ABCDE): Asymmetry, Border irregularity, Color variation, Diameter over 6 mm, Evolving size, shape, or symptoms. Any suspicious lesion is referred out, not treated.

Vascular conditions: telangiectasia (dilated capillaries), couperose (diffuse redness), and rosacea (flushing, papules, trigger sensitivity). Avoid heat, friction, and strong stimulation on rosacea-prone skin.

Pigmentation: hyperpigmentation from sun or inflammation (post-inflammatory hyperpigmentation), melasma (hormonal and UV-driven), vitiligo (loss of melanocytes), and albinism. Fitzpatrick I-II burns easily; V-VI rarely burns.

Aging: intrinsic aging thins the epidermis and dermis and slows turnover; extrinsic aging from UV (photoaging) produces coarse wrinkles, laxity, and mottled pigment. Smoking and free radicals accelerate collagen breakdown.

A consultation intake record documents name, contact, medications, allergies, medical conditions, prior treatments, skin type and condition, and the service plan; it is retained and updated at each visit.

Absolute contraindications for most facial and waxing services include active infection, open or broken skin at the site, recent chemical peel or laser within the healing window, and known allergy to a product ingredient.

Pregnancy and breastfeeding call for caution: avoid retinoids, high-percentage salicylic acid, and strong essential oils; many estheticians defer electrical and heat-based devices.

Isotretinoin (Accutane) use, recent dermabrasion, and recent cosmetic surgery require physician clearance and a waiting period before waxing or exfoliation because skin is fragile and may lift.

Informed consent is obtained in writing before service, covering benefits, risks, alternatives, and aftercare; the client signs and dates, and the esthetician signs and dates the treatment record.

Treatment records note products used, lot numbers when relevant, equipment settings, skin response, and aftercare given; corrections are dated and initialed, never erased.

Scope of practice: an esthetician may cleanse, exfoliate, extract, wax, apply makeup, and perform lash and brow services; diagnosing disease, prescribing, or treating with medical intent is outside scope and requires referral.

Confidentiality: client records and health information are not shared without written authorization except as required by law or to prevent serious harm.

Standard facial sequence: consultation and skin analysis, cleansing, exfoliation (mechanical or chemical), steam or warm towel, extractions if indicated, massage, mask, toner, moisturizer, and sun protection.

Cleansers: foaming gels suit oily and combination skin; cream and oil cleansers suit dry and mature skin; milks and micellar waters suit sensitive or reactive skin.

Mechanical exfoliation uses granular scrubs, brushes, or gommages; chemical exfoliation uses alpha hydroxy acids (glycolic, lactic) or beta hydroxy acid (salicylic) to loosen corneocyte bonds.

Salicylic acid is lipid-soluble and penetrates pores, suiting oily and acne-prone skin; glycolic acid has the smallest AHA molecule and penetrates fastest; lactic acid is gentler and more hydrating.

Extraction: after softening with warm steam, wrap fingers in tissue or use gloved fingers, apply even pressure around the lesion with two cotton swabs or extractor; stop if the lesion does not release or if blood appears.

Do not extract in the triangle of death (around nose and mouth) with ungloved hands, over inflamed acne, telangiectasia, or moles; never squeeze with fingernails.

Mask selection: clay and sulfur masks absorb oil; hydrating gel or sheet masks add water; enzyme and peel-off masks exfoliate; cooling masks reduce redness after extractions.

Massage movements follow muscle direction and lymph flow toward the nodes; contraindicated over active acne, infection, recent surgery, or thrombosis risk.

Hair growth cycle: anagen (active growth, deepest follicle, best waxing target), catagen (transition), and telogen (resting, hair sheds). Waxing is scheduled every 3-6 weeks to catch anagen hairs.

Hard wax is applied warm, sets without strips, and grips shorter and coarser hair; soft wax is applied thin and removed with fabric strips, suited to large areas and finer hair.

Sugaring uses a sugar, water, and lemon paste applied against hair growth and removed in the direction of growth; it is water-soluble, applied at body temperature, and less likely to adhere to live skin.

Wax temperature should be tested on the inner wrist and remain warm, not hot; burns occur above roughly 130 degrees Fahrenheit for soft wax and higher for hard wax.

Waxing contraindications: isotretinoin use, recent chemical peel or laser, sunburn, active infection, open lesions, varicose veins, moles, and diabetes-related neuropathy or poor healing.

Direction rules: apply wax in the direction of hair growth, remove against the growth for soft wax strips, and hold skin taut; apply pressure after removal and apply a soothing post-care product.

Hair length of about one-quarter inch (roughly 6 mm) is needed for effective waxing; trim longer hair before application to reduce pulling.

Aftercare: avoid heat, sun, friction, and chlorinated pools for 24 hours; exfoliate gently after 48 hours to reduce ingrown hairs; no shaving between appointments.

Foundation undertones: cool (pink, blue, red), warm (yellow, golden, peach), and neutral; match foundation at the jawline in natural light and test on the face, not the hand.

Face shapes guide contour and highlight: oval is balanced; round is softened with vertical shading; square is softened at the jaw corners; heart is balanced by shading the forehead and highlighting the chin.

Eye shadow placement: base over the lid, contour in the crease, highlight on the brow bone; blending follows the bone structure, and brushes are cleaned and disinfected between clients.

Lash and brow tinting requires a patch test 24 to 48 hours before service; tint left on too long or applied to broken skin can cause irritation or staining.

Eyelash extensions require isolated natural lashes, a curl and length matched to the eye shape, and adhesive cured in low humidity; a lifting or curling service is not performed on lashes with extensions.

Brow shaping by waxing, tweezing, or threading follows the natural arch: the brow starts above the inner corner of the eye, arches over the outer iris, and ends at the outer corner.

Sanitation for makeup: never double-dip mascara or lip products, sharpen pencils before use, and use disposable applicators or spatulas to remove product from containers.

Lash and brow contraindications include active eye infection, recent eye surgery, allergies to adhesive or dye, and skin irritation around the eye area.

pH scale: 0-14; skin surface averages about 4.5-5.5. Lower pH suits the acid mantle; alkaline products swell the stratum corneum and increase penetration and irritation.

Emulsions: oil-in-water (lighter, water-continuous, good for oily skin) and water-in-oil (richer, water-resistant, good for dry skin); an emulsifier keeps the two phases from separating.

Humectants bind water (glycerin, hyaluronic acid, sorbitol); emollients soften and smooth (esters, oils, fatty alcohols); occlusives block water loss (petrolatum, dimethicone, beeswax).

Surfactants have a hydrophilic head and lipophilic tail; they lift oil and debris, and their strength determines how stripping a cleanser is. Mild syndets are less alkaline than true soaps.

Antioxidants such as vitamin C, vitamin E, and ferulic acid neutralize free radicals; vitamin C also inhibits tyrosinase and brightens, and is stabilized by low pH and opaque packaging.

Retinoids increase cell turnover and collagen synthesis but cause irritation and photosensitivity; they are contraindicated in pregnancy and require daily sunscreen.

Preservatives (parabens, phenoxyethanol, sodium benzoate) prevent microbial growth in water-containing products; anhydrous products need fewer or none.

Ingredient label order lists components by decreasing concentration; the first five ingredients typically make up most of the formula.

New Hampshire regulates estheticians through the Board of Barbering, Cosmetology, and Esthetics under the Office of Professional Licensure and Certification; licensure requires completion of an approved program and passage of the state exam.

License renewal follows the state cycle set by the Board; licensees must display their license and practice only in a licensed establishment that has passed inspection.

Continuing education requirements are set by Board rule and must be completed from approved providers; keep certificates for audit.

Sanitation rules require a clean, disinfected workstation for each client, properly labeled and stored chemicals, and adherence to manufacturer contact times for disinfectants.

Estheticians must not diagnose skin disease, prescribe medication, or perform services outside the licensed scope; suspicious lesions and infections are referred to a physician.

Ethical practice includes honest advertising, no guarantee of results, informed consent before service, and full disclosure of product ingredients and potential risks.

Client records are confidential; release requires written client authorization unless compelled by law, and records are retained per Board rule.

Fee splitting with unlicensed persons and allowing unlicensed practice are prohibited; only licensed individuals may perform services for compensation.