Skin Disorders and Conditions for the Esthetics Exam

Why Estheticians Study Skin Disorders

An esthetician works on healthy or mildly disordered skin. Recognizing what is in front of you decides three things: whether you can treat the client today, what services are safe, and when to send the client to a dermatologist. State board exams test this judgment with photo identification and case scenarios. The treatment room demands the same skill every shift.

You are not allowed to diagnose. You are expected to notice, document, and refer. Saying "I would like you to see a dermatologist about this area before we treat it" is the right phrasing in almost every situation where you see something you do not recognize.

Acne and Follicular Conditions

Acne Vulgaris

Acne vulgaris is the most common skin disorder you will treat. Four factors drive it:

• Excess sebum production
• Cutibacterium acnes (formerly P. acnes) bacteria in the follicle
• Hyperkeratinization (dead skin cells blocking the follicle opening)
• Hormones, especially androgens

Acne is graded I through IV based on severity:

Lesions in the Acne Family

• Comedo: a clogged follicle. Closed comedones are whiteheads. Open comedones are blackheads (the dark color is oxidized sebum, not dirt).
• Papule: a small raised bump without pus.
• Pustule: a raised bump with visible pus.
• Cyst: a deep, tender, fluid-filled sac. Never extract a cyst.
• Milia: small, hard white cysts trapped under the epidermis, often around the eyes. Some states allow lancing with proper training. Other states do not.
• Folliculitis: bacterial infection of the follicle, often after shaving or waxing. Active folliculitis is a contraindication for service in that area.

Rosacea

Rosacea is chronic redness with visible capillaries (telangiectasia), often with papules and pustules on the central face. It is not acne, even when it has bumps. Common triggers:

• Heat, sun, and steam
• Spicy food and alcohol
• Stress
• Strong topicals like glycolic acid in high concentrations

Rosacea clients need calm, non-stimulating treatments. Skip steamers, hot towels, microdermabrasion, and aggressive peels. Use cool compresses, gentle cleansers, and ingredients like niacinamide, azelaic acid, and green tea. A dermatologist manages the medical side with topical metronidazole, ivermectin, or oral medication.

Pigmentation Disorders

Hyperpigmentation

Hyperpigmentation is darker patches of skin caused by excess melanin. Three patterns matter for the exam:

• Solar lentigines: sun spots from cumulative UV exposure. Most common on the face, chest, and hands.
• Post-inflammatory hyperpigmentation (PIH): dark marks left after acne, burns, or trauma. PIH is more common and more stubborn in Fitzpatrick types IV through VI.
• Melasma: hormonally driven brown patches, often symmetrical on the cheeks, forehead, and upper lip. Triggered by pregnancy, oral contraceptives, and hormone replacement. Heat and sun make it worse.

Estheticians work pigmentation slowly with broad-spectrum SPF, tyrosinase inhibitors (vitamin C, kojic acid, arbutin, tranexamic acid), and gentle peels. Hydroquinone is prescription only in many states. Aggressive treatments often rebound and darken pigmentation, especially in deeper skin tones.

Hypopigmentation

• Vitiligo: autoimmune destruction of melanocytes, producing patches with no pigment. Refer for medical management.
• Albinism: congenital absence of melanin. Clients need strong sun protection.
• Leukoderma: loss of pigment after burns, scars, or chemical injury.

Inflammatory Dermatologic Conditions

Eczema (Atopic Dermatitis)

Eczema is dry, itchy, red skin that flares in cycles. It often appears in the bends of the elbows and knees, on the face, and on the hands. Triggers include fragrance, harsh detergents, wool, stress, dry air, and food allergies. Active flares are a contraindication for facial services. Even when calm, eczema-prone skin needs fragrance-free products, ceramide-rich moisturizers, and lukewarm water.

Psoriasis

Psoriasis is an autoimmune condition that produces thick silvery scales over red plaques, often on the elbows, knees, scalp, and lower back. The skin cell turnover rate is much faster than normal. Active psoriatic plaques are a contraindication for service in that area. The condition is not contagious, but treatments that work for eczema usually do not help psoriasis. Refer for dermatologic care.

Contact Dermatitis

Contact dermatitis is a reaction to a substance touching the skin. Two forms:

• Irritant contact dermatitis: caused by direct chemical injury. Anyone exposed long enough will react.
• Allergic contact dermatitis: an immune reaction to a specific allergen. Common culprits include fragrance, nickel, formaldehyde-releasing preservatives, and some essential oils.

Always patch test new products on a small area before a full service. A patch test on the inner forearm or behind the ear, checked at 24 and 48 hours, prevents most reactions in the treatment room.

Vascular Conditions

• Couperose skin: diffuse redness from fragile, dilated capillaries. Often paired with sensitivity.
• Telangiectasia: individual visible capillaries, often on the cheeks and nose.
• Spider angioma: a small red lesion with a central point and radiating vessels. Common during pregnancy and with liver conditions.
• Erythema: redness from inflammation, friction, heat, or irritation.

Vascular skin needs cool, gentle handling. Skip hot steam, prolonged massage with friction, and stripping cleansers. Vascular lasers and IPL clear visible vessels but require advanced training and, in many states, medical supervision.

Primary and Secondary Lesions

The state board exam asks you to label lesions from photos and case descriptions. Memorize the vocabulary.

Primary Lesions (the original change)

Secondary Lesions (changes after the primary lesion)

Skin Cancer Awareness

You are not allowed to diagnose skin cancer. You are expected to notice it and refer. The ABCDE rule for melanoma is required exam knowledge:

• Asymmetry: one half does not match the other
• Border: irregular, ragged, or blurred edges
• Color: more than one shade, or unusual colors
• Diameter: larger than 6 mm (about the size of a pencil eraser)
• Evolving: changing in size, shape, color, or texture

Other common skin cancers to recognize on sight:

• Basal cell carcinoma: the most common skin cancer. Often a pearly, waxy bump, sometimes with a central depression or visible vessels. Slow growing, rarely spreads, but needs treatment.
• Squamous cell carcinoma: a scaly, red, sometimes crusted patch or sore that does not heal. Can spread if ignored.
• Actinic keratosis: rough, sandpaper-textured patches from chronic sun damage. Considered precancerous.

If you see anything that fits the ABCDE rule, a sore that has not healed in weeks, or a mole the client says is changing, document the finding and refer. Do not name the condition. Use neutral language: "I noticed a spot here that I would like a dermatologist to look at before we book another service."

Esthetician Scope of Practice

Active infections, undiagnosed lesions, recent surgical sites, severe acne, and uncontrolled skin disease all warrant referral. The boards will give you a case where the answer is "refer to a dermatologist," and the wrong answers will offer a peel, a wax, or microdermabrasion. When in doubt, refer.

Practical rules to follow in the treatment room:

1. Inspect the skin under good lighting before every service.
2. Document any noted lesion in the client record with location and appearance.
3. Avoid working over a lesion you cannot identify with confidence.
4. Use specific, neutral language when recommending a referral.
5. Reschedule the service rather than push through an active flare or infection.

Knowing what is in front of you protects the client, protects your license, and earns trust that builds a long career.