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Thursday, 24 August 2006 00:30

Recognizing Skin Disorders

Written by   Patricia Heitz

As most aestheticians will confirm, typically, people with skin disorders don’t always seek the help of an aesthetician. However, because of the explosion in professional skin care technology, this trend is shifting. More and more people are beginning to understand the helpful role the aesthetician plays in the treatment and management of skin disorders, including physicians. As most disorders are treated by a physician, adding the services of the aesthetician is the best case scenario for the patient and/or client.

Whether working with a physician onsite, as a referral, or in conjunction with your client’s skin care, the aesthetician’s knowledge of skin disorders is crucial. With the help of the aesthetician, the client or patient can work with the physician educating about proper home care as well as offering topical treatments that work with the physician in the management and improvement of the disorder or condition.

Medical Terminology

Knowing your medical terminology will better enable you to communicate with a physician that may be treating your client. Let’s discuss some terminology and some of the most common types of skin disorders, and a few that may not be so common:

PATHOLOGY - the study of a disease

TRICHOLOGY - the study of the hair and its diseases

ETIOLOGY - the study of the cause of disease.

DIAGNOSIS - the recognition of a disease from its symptoms

PROGNOSIS - the foretelling of the probable course of a disease.

SYMPTOMS - a sign of a disease. Symptoms are divided into two groups:

a. subjective - symptoms felt such as itching, burning, or pain

b. objective - symptoms seen such as pimples, pustules, or inflammation.



Keratosis refers to a condition of the skin involving keratin.

· -Hyperkeratosis refers to an abnormal increase of the horny layer (stratum corneum) of the skin. Retention Hyperkeratosis in Acne is an example.

· -Parakeratosis: abnormal formation of horny cells in epidermis. Caused by abnormal nuclei and incomplete formation of keratin, is observed as scaling as in psoriasis.

· -Dyskeratosis: premature keratinization of individual epidermal cells

· -Acanthosis: thickening of the prickle cell layer (stratum granulosum) as in eczema and psorasis.

· -Spongiosis: condition producing sponge like appearance of the skin due to increase of fluid in cell layers.

· -Pruritus: medical term for skin inflammation that causes itching.

· -Erythema: medical term for redness of skin

· -Edema: medical term for swelling

· -Acute: severe


A lesion is a structural change in the tissues caused by injury or disease. There are three types of lesions:

Primary Lesions: lesions that are in the early stages of development

Some common examples:

· Papule - small elevated pimple containing no fluid, is inflamed with bacteria, and may develop pus

· wheal - itchy swollen lesion that is temporary i.e.: mosquito bite

· vesicle - blister with clear fluid i.e.; poison ivy

· pustule - an elevation of the skin with inflammation and pus

Secondary Lesions: Lesions that are a consequence of illness and/or what primary lesions could become

Some Common Examples:

· crust - accumulation of sebum and pus mixed with epidermal material

§ i.e.: scab

· excoriation - skin sore or abrasion produced by scratching or scraping

· fissure - crack in skin penetrating into dermis (chapped hands)

· ulcer - open lesion on skin or mucous membrane with pus and loss of skin depth

Tertiary Lesions: Lesions that belong to the third level of development

This term is used to describe other lesions, not necessarily associated with disorders of the skin. Example: Tertiary syphilis, and specialized intensive care units

The Aesthetician is only concerned with the primary and secondary lesions.



1. Milia

· Accumulation of dead keratinized cells and other matter, trapped below skins surface. Appearing as small grains of sand under skin, because of the hard texture of keratinized cells. They can be a result of severe trauma to the skin. As skin heals, it over produces keratinized cells in epilthelization. Milia can also be caused by overuse of collagen based and/or wax based products.

2. Comedones

· Open comedones: blackheads - mass or plug of keratinized cells and hardened sebum appearing within the follicle opening. The sticky sebum in the follicle attracts dirt from the air giving it a blackened look. This plug allows oil to drain from around it, therefore, it is not an infection. However, it can become infected if the keratinized cells and sebum build to the point of closing off oil drainage and oxygen.

· Closed comedones - whiteheads - follicle opening does not stretch enough to allow for flow of sebaceous material. This material containing bacteria, starts to grow causing an infection and pus.


3. Acne

· Chronic inflammatory disorder of sebaceous gland and probably the most common of skin disorders seen by an aesthetician. It is caused by overactive sebaceous glands, triggered by hormonal changes either during teen years, and/or for women during menopause or during or after pregnancy. Common acne is known as acne simplex or acne vulgaris. Acne is graded by dermatologists on a 4 point scale:

a. Grade 1 acne - mostly open and closed comedones with an occasional pimple.

Typical of a teenager just beginning puberty.

b. Grade 2 acne - large number of closed comedones with occasional pustules or papules.

c. Grade 3 acne- “typical teenage acne.” involves large numbers of open and closed comedones and many papules and pustules. It is very inflamed and red.

d. Grade 4 acne-commonly referred to as cystic acne with many deep cysts and scar formation.

The Acne Cascade:

First: Androgens are produced from testosterone. This hormone, primarily present in males is also found in females. Upon onset of puberty, androgen production goes into high gear, causing the sebaceous gland to enlarge, and speed up production of oil. Because this is primarily a male hormone, male teens will have more of a problem with acne than females. Females produce androgen as well, but estrogen production helps to balance. During the time of the menstrual cycle, when estrogen levels drop, androgens affect the sebaceous gland, stimulating oil production. This will peak during adolescence and menopause; two periods in life where there is an extreme hormonal imbalance. In early stages of puberty when these oil glands are first stimulated, the skin tries to accommodate for extra oil production, by stretching the follicle opening to allow for drainage. Therefore, larger follicle openings are found in areas with increased oil production.

Second: Because of hormone stimulation a “hypershedding” occurs of the epidermis cells. In normal skin the epidermis replaces itself every 28-32 days. However, with hormone stimulation, the shedding of these epidermal cells are speeded up or “hyper” and are “retained”, stick to, and line the inside walls of follicle. This cell build-up is called retention hyperkeratosis, causing blockage.

When the follicle is blocked the following occurs:

Third: Cornybacterium acnes, and Propionibacterium acnes or P acnes are found within the follicles in small number. As additional oil is manufactured by the sebaceous gland, these bacterium feed on the oil and reproduce very rapidly. This causes white blood cells to rush in to kill the bacteria and an infection starts.

Fourth: The skin will now become inflamed. If this infection is deep enough into the dermis layer, the skin, in trying to repair itself, will manufacture more collagen to repair itself, thus forming scar tissue. In skin types that are very thick and have a denser epidermis, the amount of collagen produced will produce a raised scar or “keloid”. Additionally, in trying to protect itself, darker skin types will produce additional melanin causing hyperpigmentation as a result at the infection site, known as post traumatic hyperpigmentation.

A “pit” scar is different than a keloid. This is a depression of the skin caused when the infection destroyed the skin tissue at that point and the skin was not able to repair itself.

Five: The worst case of acne will occur when the infection is at its deepest level in the follicle, well into the reticular layer of the dermis. If this infection breaks through the walls of the follicle at this deep level, a pit scar will be formed. This large, deep infection is called a “cyst”. If the acne is treated with oral antibiotics and/or topically applied antibiotics, the infection may be cleared up before it “bursts” into the dermis; thus preventing scarring. This is why it is so important to refer a client who has this grade of acne to a dermatologist.

Remember, we as aestheticians are limited, when it comes to dealing with a severe skin disorder. We need to know when to refer and when we can treat.

Aesthetic Treatments for Acne would include:

-no massage in any way to stimulate the oil activity or spread infection

-antibacterial based products

-exfoliation - steam – extraction

-galvanic machine- a valuable tool to help liquefy impacted follicles for extraction

-high frequency machine-a valuable tool to disinfect extraction site-(violet mushroom electrode)

Home care should include daily cleansing with acid based/antibacterial products or AHA products, and daytime protection. Evening treatments should disinfect, relax, and slow the sebaceous gland.

3. Rosacea

· Chronic inflammatory congestion of cheeks and nose, and sometimes forehead, characterized by redness, dilation of blood capillaries, and in later stages, formation of papules and pustules.

Stages of Rosacea:

a. redness or flushing in the nose and cheek area (butterfly effect)

b. telangiectasia ( distended capillaries)

c. papules and pustules

d. Rhinophyma - an enlargening of the nose

The exact cause of rosacea is unknown; however, recent research indicates a bacterium called Demodex folliculorum which is present in all skin types. It is theorized, as we age, our immune system weakens allowing the bacterium to grow. As this bacterium feeds on sebum, the resulting inflammation occurs in areas of the skin with numerous sebaceous openings. In some medical circles, it is thought to be contagious; aestheticians should wear gloves when treating a client with this skin disease.

Heat can cause flare-ups, including spicy foods, alcohol, and especially sun exposure. Temperature changes can also aggravate the condition.

Aesthetic Treatment for Rosacea:

-elimination of steam, and stimulating massage

-calming/soothing treatment creams/masks


Home care for Rosacea includes: washing face with tepid water, keeping shower temperature at cooler temperature (not steaming), no rubbing or stimulation of skin in that area.

Any stimulation to skin increases blood flow, where capillaries dilate to allow for this increase. If capillary walls have been weakened by bacterium, increased blood flow will cause a leak in the capillary wall enhancing telangiectasia (medical term for distended capillaries).

Extraction Procedures

As most all aestheticians are familiar with extractions, the following are reminders:

(Many states do not allow use of a Lancet if not in a medical facility. Check with your state board regulations)

Lancet: Should be individually wrapped for sterilization. Place parallel to surface of the skin and gently prick dead cell layer making opening for drainage. (Do not pick!) Follow with extraction of impacted material.

Remember, when any oozing is present, the aesthetician must disinfect the follicle opening and keep gloves on from that point on in the treatment to protect from blood borne pathogens.

n Metal comedone extractor – commonly used in a hard to reach area like the nose.

n Pros : The extractor creates pressure around the follicle opening helping release deposits. If the follicle opening fits inside the opening of the extractor, the even amount of pressure applied creates an efficient extraction.

n Cons: If follicle opening is larger than the size of the extractor opening, the pressure can cause follicle walls to rupture spilling sebum and bacteria into dermis. Use with discretion. Additionally, because of exposure to blood bourne pathogens, ANY EXPOSURE TO BLOOD, INFECTIOUS MATERIAL OR BODILY FLUIDS NECESSITATES THIS EXTRACTOR BE STERILIZED IN AN AUTOCLAVE AFTER USE.

Most state boards recommend use of disposable products such as thin strips of cotton wrapped around the fingers or cotton swabs.


Some common inflammations the aesthetician will be exposed to are:

· Dermatitis - used to describe a general inflammatory condition of the skin. The lesions come in various forms such as vesicles or papules. Can be caused by trauma or allergies

· Eczema - an inflammation of the skin acute or chronic in nature, presenting many forms of dry or moist lesions, frequently accompanied by itching, burning, and various other sensations. All cases of eczema should be referred to a physician for treatment. When inflamed, is usually a red, blistered, oozing area that itches painfully. It is not recommended to receive aesthetic treatment when this condition is inflamed.

· Psoriasis - a common, chronic, inflammatory skin disease whose cause is unknown. Usually found on the scalp, elbows, knees, chest, and lower back, but rarely on the face. Lesions are round, dry patches covered with coarse silvery scales. If irritated, bleeding points occur. While not contagious, it can be spread by irritating it.

· Herpes simplex - a viral infection of unknown origin, commonly called fever blisters. It is characterized by the eruption of a single group of vesicles on a red, swollen base. Blisters usually appear on lips, nostrils or other parts of the face, and rarely last more than a week.


Allergic reactions are caused when skin senses a foreign object, or is traumatized by a wound. The skin manufactures histamines that rush to the site, causing swelling to close the wound. Blood is also rushed to the area causing inflammation. Treatment of anti-histamines either topically or orally, which contradict, the histamine reaction is most effective.

Some common allergies seen in the Skin:

1. Urticaria - medical name for hives.

2. Insect stings - can cause a severe reaction in some people.


Whenever there is any concern regarding any of these conditions, the client must be referred to a physician:

Basal Cell Carcinoma - type of cancer characterized by light or pearly nodules and visible blood vessels.

Squamous Cell Carcinoma - scaly, red papules. Blood vessels are not visible. This is more serious than Basal Cell Carcinoma.

Malignant Melanoma - characterized by dark brown, black or discolored patches on the skin. THIS IS THE MOST SERIOUS OF SKIN CANCERS.

The American Cancer Society recommends the following guidelines when evaluating any changes in the skin:

A - Asymmetry - or shape

B - Border - whether the border changes in any way

C - Color

D - Diameter - the size of the mole

As I am sure you have already noticed skin care for the future, whether within a salon, spa or physicians office is moving speedily in a medical direction. By beginning to expand your relaxation facial services into specialized areas such as treating skin disorders, you are taking those future steps. The aesthetician of the future is here!

Patricia Heitz, CIDESCO DIPLOMATE, has been in the beauty industry since 1975, as a Cosmetologist and Esthetician. She has worked as a manufacturers representative and trainer for Skin and Hair product manufacturers, and more recently as an Esthetics School Director and Instructor. Having earned the prestigious title of CIDESCO Diplomate, is also an educator and contributing author for Milady/ Thomson Learning with both the Standard Text and Comprehensive Text for Estheticians. Currently, she owns Patricia Heitz Consulting, -Dermatech Academy offering online and onsite Skin Technology Training and Consulting for Schools, Spas, and Distributors, and is an exclusive Industry consultant to Gerson/Lehrman Financial Analysts Council of Advisors in New York. She can be reached at (518) 261-1236 or This email address is being protected from spambots. You need JavaScript enabled to view it.

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