What Is a Contraindication?
A contraindication is a condition or factor that makes a particular treatment inadvisable or unsafe. In esthetics, recognizing contraindications protects both the client and the practitioner. State board exams test this knowledge through scenario questions that ask whether a service should proceed, be modified, or be refused.
There are three categories of contraindications:
- Absolute contraindications: The treatment must not be performed under any circumstances.
- Contraindications requiring physician clearance: Treatment may proceed only after written approval from the client's doctor.
- Relative contraindications: Treatment can proceed with modifications to protocol, products, or intensity.
Absolute Contraindications
These conditions require immediate refusal of service and referral to a physician or healthcare provider:
- Open wounds, sores, or abrasions: Any break in the skin is a pathway for infection. No treatment over or around open wounds.
- Active herpes simplex outbreak: Cold sores or fever blisters (HSV-1) are contagious. Service spreads the virus and can trigger a severe outbreak from chemical or mechanical stimulation.
- Impetigo: A highly contagious bacterial skin infection. Presents as honey-colored crusted sores. Do not service.
- Active fungal infections (tinea faciei, tinea corporis): Contagious; do not service the affected area.
- Severe, inflamed cystic acne: Active, infected cysts should not be treated with manual techniques, peels, or extractions. Refer to a dermatologist.
- Contagious rashes or skin diseases (scabies, contact dermatitis with oozing): Refuse service and refer.
If a condition is contagious, has open lesions, or involves active infection, refuse service and refer the client to a physician. This protects the client, other clients, and the practitioner from cross-contamination and liability.
Contraindications Requiring Physician Clearance
| Condition | Reason for Clearance | Affected Treatments |
|---|---|---|
| Cancer (active treatment) | Chemotherapy/radiation compromises skin integrity and immune response | All facial treatments; massage; peels |
| Autoimmune conditions (lupus, psoriasis) | Skin may be reactive; treatments can trigger flares | Chemical exfoliation; electrical modalities |
| Pacemaker | Electrical currents (galvanic, microcurrent, high-frequency) may interfere with device | All electrical modality treatments |
| Epilepsy | Flashing lights and electrical equipment may trigger seizures | High-frequency; certain light therapies |
| Metal implants or plates in the face/neck | Electrical treatments conduct through metal | Galvanic; microcurrent; radiofrequency |
Relative Contraindications: Modify, Don't Refuse
These conditions require adjustments to the treatment but do not require full refusal:
- Pregnancy: Avoid certain essential oils (clary sage, rosemary, juniper), strong chemical exfoliants, and electrical currents. Positioning must accommodate comfort and circulation. Gentle facials are generally safe; deep peels and aggressive treatments are not.
- Retin-A / tretinoin users: No chemical or mechanical exfoliation. The skin barrier is sensitized and thinned by the retinoid. A waiting period (typically 5 to 7 days minimum after last application) is required before exfoliating services.
- Blood thinners (anticoagulants): Avoid aggressive massage and any technique that could cause bruising or broken capillaries. Light effleurage only.
- Rosacea: Avoid heat, steam, high-frequency devices, and AHA peels at higher concentrations. Use cool steam only, enzyme peels, and calming products.
- Recent cosmetic procedures (Botox, fillers, laser): A minimum waiting period (typically 2 weeks) is required before facial treatments in the treated area.
The exam will distinguish between conditions that require refusal versus modification. Active herpes simplex = refuse. Pregnancy = modify. Rosacea = modify. Pacemaker = require physician clearance before electrical treatments. Memorize which category each condition falls into.
The Client Intake Form
The intake form (health history or consultation form) is completed before every new client's first service and updated periodically. It must ask about:
- Medications (topical and oral, especially retinoids, blood thinners, and antibiotics)
- Medical conditions (autoimmune, diabetes, cancer, heart conditions)
- Allergies (especially to nuts, aspirin, latex, or fragrances)
- Recent cosmetic procedures
- Pregnancy status
- History of cold sores or skin infections
Clients do not always volunteer medical information voluntarily. Ask direct, specific questions on the intake form and verbally confirm key items before applying any products. A signed intake form also provides documentation that the esthetician performed due diligence, which is important for liability purposes.