1. Chapter 8 Skin Disorders and Diseases

2. “Attitude is more important than the past, than education, than money, than circumstances, than what people do or say. It is more important than appearance, giftedness, or skill.” – Charles Swindoll

3. Objectives Recognize common skin lesions.
Describe the disorders of the sebaceous glands.
Name and describe changes in skin pigmentation.
Identify the forms of skin cancer.

4. Objectives (continued)
Understand the two major causes of acne and how to treat them.
List the factors that contribute to the aging of the skin.
Explain the effects of overexposure to the sun on the skin.
Understand what contact dermatitis is and how it can be prevented.
LEARNING MOTIVATION (WHY?)
With the arrival of the twentieth century came the scientific study of proteins found in the hair, skin, and nails, made possible by the molecule-by-molecule breakdown of DNA by high-powered microscopes. While the level of knowledge needed by scientists is not necessary for cosmetologists, a thorough knowledge of the underlying structures of the hair, skin, and nails will help you achieve the best possible results when providing hair, skin, and nail-care services while at the same time providing the utmost protection for your client.
Your training will help you to become familiar with common disorders and diseases of the skin and allow you to recognize those conditions, which cannot be treated or serviced by a cosmetologist. Thoroughly analyzing the functions and components of the skin is the best way to understand how it works. With proper care, the skin can stay young and radiant- looking for many years.
The skin is the largest and one of the most important organs of the body. Healthy skin is slightly moist, soft, and flexible. It possesses a slightly acid reaction and is free from any disease or disorder. The ideal skin texture is smooth and fine grained. Hair, nails, sweat, and oil glands, which are all very important to the cosmetologist, are considered appendages of the skin. The skin on the eyelids is the thinnest of the entire body, while the skin on the palms and soles of the feet is the thickest. The skin on the scalp has larger and deeper follicles to accommodate the longer hair found on the head. Continued pressure on any part of the skin will result in calluses.
This lesson covers in detail diseases and treatment of the skin, presenting extensive new terminology and definitions that will help you provide the best service for your clients.

5. Skin Disorders
Dermatologist – a physician who specializes in diseases and disorders of the skin
Inflamed skin disorders, whether infectious or not, should not be served in the salon.

6. Lesions of the Skin
A lesion is a mark on the skin or structural change in tissues caused by injury or disease.

7. Primary Lesions Bulla – blister Cyst – sac containing fluid pus
Macule – small, discolored spot or patch
Nodule – solid bump larger than .4 inches
Papule – pimple
PRIMARY LESIONS
BULLA: Blister containing a watery fluid; similar to a vesicle, but larger. (See Figure 8–2.)
CYST: A closed, abnormally developed sac containing fluid or semifluid pus, or morbid matter; located above or below the skin.
MACULE: Small, discolored spot or patch on the surface of the skin, such as a freckles, that is neither raised or sunken.
NODULE: A solid bump larger than .4 inches that can be easily felt; requires medical referral.
PAPULE: A pimple; small, circumscribed elevation of the skin that contains no fluid but may develop pus.

8. Primary Lesions (continued)
Pustule – raised, inflamed pimple
Tubercle – abnormal rounded, solid lump
Tumor – abnormal cell mass
Vesicle – small blister with clear fluid
Wheal – itchy, swollen lesion (hives)
Pustule
PUSTULE: An inflamed pimple containing pus. (See Figure 8–3.)
TUBERCLE: An abnormal rounded, solid lump above, within, or under the skin; larger than a papule.
TUMOR: A swelling; an abnormal cell mass resulting from excessive multiplication of cells, varying in size, shape, and color. Nodules are also referred to as tumors, but are smaller.
VESICLE: Small blister with clear fluid, such as poison ivy; lies within or just beneath epidermis. (See Figure 8–4.)
WHEAL: Itchy, swollen lesion lasting only a few hours; caused by a blow, the bite of an insect, urticaria (skin allergy, such as hives), or the sting of a nettle.
Vesicle

9. Secondary Lesions Crust – dead cells formed over a wound or blemish
Excoriation – skin sore or abrasion
Fissure – crack in the skin
SECONDARY LESIONS
Secondary lesions develop in later stages of disease. (See Figure 8–5.)
CRUST: Dead cells that form over a wound or blemish while it is healing; an accumulation of sebum and pus mixed with epidermal material (scab).
EXCORIATION: A skin sore or abrasion produced by scratching or scraping.
FISSURE: Crack in the skin penetrating into the dermis (chapped lips).

10. Secondary Lesions (continued)
Keloid – thick scar
Scale – thin plate of epidermal flakes
Scar or cicatrix – light-colored, slightly raised mark on skin
Ulcer – open lesion with pus
KELOID: Thick scar resulting from excessive growth of fibrous tissue. (See Figure 8–6.)
SCALE: Any thin plate of dry or oily epidermal flakes (excessive dandruff).
SCAR OR CICATRIX: Light-colored, slightly raised mark on the skin formed after an injury or lesion of the skin has healed.
ULCER: Open lesion on skin or mucous membrane of body, accompanied by pus and loss of skin depth.

11. Sebaceous Gland Disorders
Comedones – blackheads
Milia – benign, keratin-filled cysts
Acne – common pimples
SEBACEOUS GLAND DISORDERS
COMEDONES (BLACKHEADS): Hair follicles filled with keratin and sebum. (See Figure 8–7.)
MILIA (WHITEHEADS): Benign, keratin-filled cysts that appear just under the epidermis and have no visible opening. They resemble round sesame seeds. (See Figure 8–8.)
ACNE: Characterized by chronic inflammation of the sebaceous glands from retained secretions and propionibacterium. Occurs frequently on face, back, and chest; also known as common pimples, acne simplex, or acne vulgaris. (See Figure 8–9.)

12. Sebaceous Gland Disorders (continued)
Sebaceous cyst – large, protruding, pocketlike lesion filled with sebum
Seborrheic dermatitis – inflammation of the sebaceous glands
Rosacea – chronic inflammatory congestion of the cheeks and nose
SEBORRHEIC DERMATITIS: Skin condition caused by an inflammation of the sebaceous glands. Often characterized by inflammation, dry or oily scaling or crusting, and/or itchiness. Red, flaky skin often appears in the eyebrows, in the scalp and hairline, in the middle of forehead, and along sides of nose.
ASTEATOSIS: Condition of dry, scaly skin, characterized by absolute or partial deficiency of sebum, due to old age and exposure to cold.
ROSACEA: Chronic inflammatory congestion of cheeks and nose. Characterized by redness, telangiectasis (dilation of blood vessels), and formation of papules and pustules. Factors that aggravate rosacea are spicy foods; caffeine; alcohol; exposure to extreme heat, cold, or sunlight; and stress. (See Figure 8–10.)
STEATOMA: A sebaceous cyst or fatty tumor filled with sebum, ranging in size from a pea to an orange; sometimes called a wen. Usually appears on scalp, neck, and back.

13. Sudoriferous Gland Disorders
Anhidrosis – lack of perspiration
Bromidrosis or osmidrosis – foul-smelling perspiration
Hyperhidrosis – excessive perspiration
Miliaria rubra – prickly heat
SUDORIFEROUS GLAND DISORDERS
ANHIDROSIS: Lack of perspiration, often result of fever.
BROMIDROSIS (OSMIDROSIS): Foul-smelling perspiration.
HYPERHIDROSIS: Excessive perspiration caused by excessive heat or general body weakness.
MILIARIA RUBRA (PRICKLY HEAT): An acute inflammatory disorder characterized by an eruption of small red vesicles and accompanied by burning and itching; caused by exposure to excessive heat.

14. Skin Inflammations Conjunctivitis – pinkeye
Dermatitis – inflammatory skin condition
Eczema – acute, chronic lesions (dry or moist)
SKIN INFLAMMATIONS
CONJUNCTIVITIS ( PINKEYE): A common bacterial infection of the eyes; extremely contagious and should be referred to a physician. Discard products or implements that have touched an infected eye.
DERMATITIS: Inflammatory condition of skin with lesions.
ECZEMA: A skin inflammation of acute or chronic nature, presenting many forms of dry or moist lesions; accompanied by itching or burning sensation. (See Figure 8–11.)

15. Skin Inflammations (continued)
Herpes simplex – fever blisters
Impetigo – weeping lesions
Psoriasis – common, chronic, inflammatory skin disease
Herpes Simplex
HERPES SIMPLEX: Recurring contagious virus infection; commonly called fever blisters. Characterized by eruption of single vesicle or group of vesicles on a red, swollen base. (See Figure 8–13.)
IMPETIGO: A contagious bacterial skin infection characterized by weeping lesions. Normally occurs on face and most frequently seen in children. Refer to a physician.
PSORIASIS: Common, chronic, inflammatory skin disease; cause unknown; found on scalp, elbows, knees, chest, and lower back, rarely on face. (See Figure 8–14.)
Psoriasis

16. Pigment Disorders of the Skin
Pigment can be affected by internal factors such as heredity or hormonal fluctuations, or outside factors such as prolonged sun exposure.
Abnormal coloration (dyschromia) accompanies every skin disorder and many systemic disorders.
PIGMENT DISORDERS OF THE SKIN: Pigment can be affected by internal factors such as heredity or hormonal fluctuations, or outside factors such as prolonged exposure to sun. Abnormal coloration accompanies every skin disorder and many systemic disorders.

17. Changes in Skin Pigmentation
Hyperpigmention – darker than normal pigmentation, appearing as dark splotches
Hypopigmentation – absence of pigment, resulting in light or white splotches

18. Changes in Skin Pigmentation (continued)
Albinism – absence of melanin pigment
Chloasma – increased pigment in spots
Lentigines – freckles
Leucoderma – light, abnormal patches
ALBINISM: Congenital leucoderma or absence of melanin pigment of the body, skin, hair, and eyes. Hair is white; skin is pinkish white and will not tan; eyes are pink; skin is sensitive to light and ages early. (See Figure 8–14.)
CHLOASMA: Characterized by increased deposits of pigment in the skin; found mainly on forehead, nose, and cheeks; also called moth patches or liver spots. Generally caused by cumulative sun exposure.
LENTIGINES: Freckles; small yellow-to-brown spots on parts exposed to sunlight and air.
LEUCODERMA: Light, abnormal patches the skin caused by a burn or congenital disease that destroys the pigment-producing cells. Vitiligo and albinism are examples.

19. Changes in Skin Pigmentation (continued)
Nevus – birthmark
Stains – abnormal brown skin patches
Tan – caused by exposure to UV rays
Vitiligo – hereditary, hypopigmented spots
NEVUS: Birthmark; small or large malformation of the skin due to abnormal pigmentation or dilated capillaries.
STAINS: Abnormal brown skin patches having a circular or irregular shape. Occur during aging, after certain diseases, and after disappearance of moles, freckles, and liver spots. (See Figure 8–15.)
TAN: Change in pigmentation of skin caused by exposure to the sun or ultraviolet rays.
VITILIGO: Hereditary condition that causes hypopigmented spots and splotches on the skin; may be related to thyroid conditions. (See Figure 8–16.)
Vitiligo
Port wine stain

20. Hypertrophies of the Skin
Keratoma – callus
Mole – small brownish spot or blemish
Skin tag – small brown or flesh-colored outgrowth of the skin
Verruca – wart
HYPERTROPHIES OF THE SKIN: Abnormal growths; many are benign or harmless.
KERATOMA (CALLUS): An acquired, superficial, round, thickened patch of epidermis caused by pressure or friction on hands and feet. If it grows inward, it is called a corn.
MOLE: Small brownish spot or blemish on the skin; believed to be inherited; ranges in color from pale tan to brown to bluish black. Some are small and flat; others are raised and darker. CAUTION: Do NOT remove hair from moles.
SKIN TAG: Small brown or flesh-colored outgrowth of the skin; occurs most frequently on neck of an older person. (See Figure 8–17.)
VERRUCA (WART): Caused by a virus; can spread from one location to another, particularly along a scratch in the skin.
Skin tags

21. Skin Cancer Basal cell carcinoma Squamous cell carcinoma
Malignant melanoma
SKIN CANCER
If caused by overexposure to the sun, skin cancer comes in three distinct forms, varying in severity.
BASAL CELL CARCINOMA: The most common type and the least severe. Often characterized by light or pearly nodules. (See Figure 8–18.)
SQUAMOUS CELL CARCINOMA: More serious than basal cell carcinoma and often characterized by scaly red papules or nodules. (See Figure 8–19.)
MALIGNANT MELANOMA: Most serious form of skin cancer; often characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised. (See Figure 8–20.) Often called the “city person’s cancer” because it may be located on areas of the body that aren’t exposed to the sun or on individuals who do not receive regular sun exposure.

22. Skin Cancer Checklist A – Asymmetry B – Border C – Color D – Diameter
E – Evolving
SKIN CANCER CHECKLIST
When checking existing moles, look for these types of changes:
A – Asymmetry
B – Border
C – Color
D – Diameter
E – Evolving
If any such changes are noted, consult a physician. For more information, contact the American Cancer Society at

23. Acne and Problem Skin
Retention hyperkeratosis – hereditary tendency for acne- prone skin to retain dead cells in the follicle
Propionibacterium acnes – anaerobic (cannot survive in the presence of oxygen)
Main food source – fatty acids

24. Acne Treatment Cleansers and toners for oily skin Follicle exfoliants
Avoidance of fatty skin-care products
Avoidance of harsh products
ACNE TREATMENT
Cleansers formulated for oily and acne-prone skin are usually foamy, rinse-off products that remove excess oil. Toners designed for oily skin help to further remove excess sebum.
Follicle exfoliants are leave-on products that help remove cell buildup from the follicles, allowing oxygen to penetrate the follicles and kill bacteria. Commonly used ingredients in these products are alpha hydroxy acid, salicylic acid, and benzoyl peroxide. Benzoyl peroxide can be especially effective since it not only helps shed cellular debris, but also kills the acne bacteria.
Avoidance of fatty skin-care and cosmetic products is important because products that contain large amounts of fatty materials and oils can cause follicles to clog from the outside. Make sure all makeup and skin-care products used on acne-prone skin are non- comedogenic, which means the product has been designed and proven not to clog the follicles.
Do not use harsh products or overclean acne-prone skin; this can cause inflammation that can worsen the condition.

25. Intrinsic Skin Aging Factors
Genetic aging
Gravity
Facial expressions
INTRINSIC SKIN AGING FACTORS
GENETIC AGING: How our parents’ skin aged; their coloring and resistance to sun damage.
GRAVITY: Constant pulling downward on our skin and bodies.
FACIAL EXPRESSIONS: Repeated movements of the face result in the formation of expression lines, such as crow’s-feet (lines around the eyes), nasolabial folds from the corners of the nose to the corners of the mouth, and scowl lines between the eyes.

26. Extrinsic Aging Factors
Sun exposure
Smoking
Excessive alcohol and smoking
Illegal drugs
Cumulative stress
Poor nutrition
Exposure to pollution
EXTRINSIC AGING FACTORS
Extrinsic factors are primarily environmental factors that contribute to aging and the appearance of aging. Many scientists and dermatologists believe that these extrinsic factors are responsible for up to 85 percent of skin aging. Extrinsic factors include:
SUN EXPOSURE: Tanning and sunbathing are no-nos, but the cumulative sun that we get in small doses every day is the real damage-causer for most people. Sun is by far the number one cause of the appearance of premature aging. The key to preventing this prominent skin-aging factor is to use a broad-spectrum sunscreen every single day; and the easiest way to do this is to use a daily moisturizer with built-in sunscreen. As a cosmetologist, you can help your clients find the best sunscreen/moisturizer.
SMOKING: Smoking produces tremendous numbers of free radicals, unstable molecules that cause biochemical aging, especially wrinkling and sagging of the skin. These molecules, over time, can have a devastating effect on the body and skin. Smoking causes oxygen deprivation of the body and skin, and it affects blood flow so the skin does not get adequate blood nutrients. Lack of blood flow also causes the accumulation of cellular waste, often called toxins.
EXCESSIVE ALCOHOL AND SMOKING: Alcohol abuse causes the body to repair itself poorly and interferes with proper nutrition distribution for the skin and the body’s tissues, as well. Alcohol can dehydrate the skin by drawing essential water out of the tissues, which causes the skin to appear dull and dry. Both smoking and drinking contribute to the aging process on their own, but the combination of the two can be devastating to the tissues. The constant dilation and contraction of the tiny capillaries and blood vessels, as well as the constant deprivation of oxygen and water to the tissues, quickly make the skin appear lifeless and dull.
ILLEGAL DRUGS: Illegal drugs affect the skin as much as smoking does. Some drugs interfere with the body’s intake of oxygen, thus affecting healthy cell growth. Some can even aggravate serious skin conditions, such as acne. Others can cause dryness and allergic reactions on the skin’s surface.
CUMULATIVE STRESS: Scientists are now learning that stress causes biochemical changes that can lead to the tissue damage that we call aging. Exercise, relaxation techniques, and a healthy state of mind can reduce stress levels, as can relaxing treatments like facials, aromatherapy, and massage.
POOR NUTRITION: Poor nutrition deprives the skin of the proteins, fats, carbohydrates, vitamins, and minerals that are required to maintain, protect, and repair the skin, keeping it looking young and beautiful.
EXPOSURE TO POLLUTION: Exposure to pollution produces free radicals and interferes with proper oxygen consumption, which affects the lungs and other internal organs, as well as the skin. The best defense against pollutants is the simplest one: Follow a good daily skin- care routine. Routine washing and mild exfoliating (removing dead surface skin cells) helps to remove the buildup of pollutants that have settled on the skin’s surface throughout the day. The application of daily moisturizers, protective lotions, and even foundation products all help to protect the skin from airborne pollutants.

27. The Sun and Its Effects
80 to 85 percent of aging is caused by sun’s rays.
UVA rays – weaken the collagen and elastin fibers
UVB rays – burning rays that cause sunburn and tanning by affecting the melanocytes
THE SUN AND ITS EFFECTS
The sun and its UV rays have the greatest impact of all extrinsic factors on how skin ages. Aging occurs at a much faster rate when the skin is frequently exposed to UV rays without protection.

28. Sun Exposure Precautions
Avoid prolonged exposure.
Apply sunscreen liberally 30 minutes prior to exposure and after swimming.
Use full or broad-spectrum sunscreen.
Avoid exposing children under six months old.
Wear hat and protective clothing outdoors.

29. Dermatitis Medical term for abnormal skin inflammation
Can result from contact with chemicals or tints
Allergies from product ingredients

30. Contact Dermatitis
Most common work-related skin disorder for cosmetology professionals
Caused by certain substances touching skin

31. Allergic Contact Dermatitis
Caused when skin is allergic to an ingredient or product
Sensitization – an allergic reaction created by repeated exposure to a chemical or substance

32. Irritant Contact Dermatitis
Caused when irritating substances temporarily damage the epidermis
Examples: corrosive substances or exfoliating agents
Avoided by wearing gloves when working with irritating chemicals

33. Self-Protection
Keep tools and surroundings clean (proper disinfection of brush handles, containers, surfaces, etc.).
Wear protective gloves.
Keep hands clean and moisturized.

34. Summary and Review What is a skin lesion?
Name and describe at least five disorders of the sebaceous glands.
SUMMARY AND REVIEW
The skin is the largest organ of the body and protects us from the environment, regulates body temperature, and provides sensation. The skin can be affected quite easily by most salon services. Therefore, it is important that cosmetologists know what products can penetrate the skin and what effects they will have on clients. By learning to identify the various diseases and disorders of the skin, you will be able to provide more effective and safe services for your clients.
1. What is a skin lesion?
Answer: A lesion is a mark on the skin. It can be as simple as a freckle or as dangerous as a skin cancer. Lesions can indicate skin disease or disorders, and sometimes may indicate other internal diseases.
2. Name and describe at least five disorders of the sebaceous glands.
Answer:
A comedone, or blackhead, is a wormlike mass of hardened sebum in the hair follicle.
Milia are small deposits of sebum between the hair follicle and the corneum that resemble small grains of sand under the skin surface.
Acne is characterized by chronic inflammation of the sebaceous glands from retained secretions.
Seborrheic dermatitis is a skin condition caused by an inflammation of the sebaceous glands, often characterized by redness, dry or oily scaling or crusting, and/or itchiness.
Rosacea, formerly called acne rosacea, is a chronic condition appearing primarily on the cheeks and nose, characterized by flushing (redness), telangiectasis (distended or dilated surface blood vessels), and, in some cases, the formation of papules (small, solid bumps) and pustules (raised lesions containing pus).
A sebaceous cyst is a large protruding pocketlike lesion filled with sebum. Sebaceous cysts are frequently seen on the scalp and the back. They should be removed surgically by a dermatologist.

35. Summary and Review (continued)
Name and describe at least five changes in skin pigmentation.
Name and describe the three forms of skin cancer.
What are the two major causes of acne and how should they be effectively treated?
3. Name and describe at least five changes in skin pigmentation.
Answer:
Albinism is absence of melanin pigment of the body.
Chloasma is characterized by increased pigmentation on the skin, in spots that are not elevated.
Lentigines is the technical term for freckles, small yellow-to-brown-colored spots on skin exposed to sunlight and air.
Leucodermas are light abnormal patches, caused by a burn or congenital disease that destroys the pigment-producing cells.
Nevi (singular, nevus), commonly known as birthmarks, are small or large malformations of the skin due to abnormal pigmentation or dilated capillaries.
Stains are abnormal brown or wine-colored skin discolorations with a circular and irregular shape.
Tan is the change in pigmentation of skin caused by exposure to the sun or ultraviolet (UV) rays.
Vitiligo is a milky-white spot on the skin.
4. Name and describe the three forms of skin cancer.
(1) Basal cell carcinoma, the most common type and least severe, is characterized by light or pearly nodules.
(2) Squamous cell carcinoma is more serious than basal cell carcinoma and is characterized by scaly red papules or nodules.
(3) Malignant melanoma, the most serious form, is characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised.
5. What are the two major causes of acne and how should they be effectively treated?
Answer: The two major causes of acne are: (1) heredity and (2) hormones. Minor forms of acne can be treated effectively by: (1) the use of oily skin wash-type cleansers that remove excess oil from the oily and acne-prone skin and toners designed for oily skin to help further remove excess sebum; (2) the use of follicle exfoliants that help to remove cell buildup from the follicles, allowing oxygen to penetrate the follicles and kill bacteria; (3) avoidance of fatty skin-care and cosmetic products that can cause follicles to clog from the outside and by using non-comedogenic products, which do not clog the follicles; (4) eliminating the use of harsh products or overcleaning acne-prone skin, which can cause inflammation that can worsen the condition; and (5) regularly seeing a trained salon or spa professional who has received specialized education in acne treatment.

36. Summary and Review (continued)
List the factors that contribute to the aging of the skin.
Explain the effect of overexposure to the sun on the skin.
What is contact dermatitis and explain how can it be prevented?
6. List the factors that contribute to the aging of the skin.
Answer: Sun, environment, health habits, general lifestyle, genetics, and gravity.
7. Explain the effect of overexposure to the sun on the skin.
Answer: The sun’s ultraviolet (UV) rays weaken the collagen and elastin fibers, causing wrinkling and sagging in the tissue.
8. What is contact dermatitis and how can it be prevented?
Answer: Contact dermatitis is an inflammation of the skin caused by having contact with certain chemicals or substances used in cosmetology. Contact dermatitis can be prevented by:
Keeping brush handles, containers, and tabletops clean and free from products, dusts, and residues.
Wearing protective gloves whenever using products known to cause irritation or allergic contact dermatitis with repeated contact.
Keeping hands clean and moisturized.

37. You have completed one unit of study toward course completion.
Congratulations!
You have completed one unit of study toward course completion.