Medical Esthetics, Contraindications, and Pharmacology Considerations
Where the line sits
Medical esthetics is practiced in a medical setting under physician oversight, but oversight does not expand your license. Master estheticians perform advanced services within their scope; diagnosing, prescribing, and injecting remain medical acts. Your job is to recognize, document, and refer. Working alongside a physician means knowing which findings go straight to them - suspicious lesions, uncontrolled rosacea, severe cystic acne, or suspected infection.
Drugs that change your plan
Isotretinoin thins and photosensitizes skin; resurfacing is generally deferred until a physician clears the client, commonly six to twelve months after the last dose. Topical tretinoin is usually stopped about five to seven days before a peel or resurfacing. Tetracyclines and doxycycline cause photosensitivity. Anticoagulants and NSAIDs increase bruising and bleeding with microneedling. Hydroquinone carries ochronosis risk with long use and demands sun protection. Hormonal changes drive melasma. Other photosensitizers include sulfa drugs, thiazide diuretics, some antifungals, and St. John's wort. Immunosuppressants and biologics raise infection and delayed-healing risk.
Pregnancy and allergy
Avoid retinoids, high-percentage salicylic acid, hydroquinone, and most energy devices in pregnancy unless a physician directs otherwise. Patch test new products 24 to 48 hours before full application and distinguish irritation from true allergy. Redness and stinging that fade are irritation; hives, swelling, or wheezing are allergy and an emergency-level referral.
If a reaction happens
Stop, remove product, cool the skin, do not apply more actives, document objectively, give aftercare, follow up, and refer if it does not resolve.
Traps: implying you can diagnose or prescribe; treating a client on isotretinoin because the peel is mild; assuming natural products cannot cause allergy. Rule of thumb: when a medication, condition, or pregnancy is in question, get written clearance or decline the service.