All your life, your skin has been making a first impression for you. It can reveal whether you are hot or cold, tired or rested, sick or healthy. Your skin provides protection from potentially lethal bacteria and viruses, and shields you from the sun’s ultraviolet rays. To some extent, your genes determine how well your skin stands the test of time. As the population ages, more and more people approaching middle-age will be diagnosed with skin disorders, some that will be life-threatening.
Because there will be a constant increase in skin disorders, especially as clients age, it is a primary goal of aesthetic education to familiarize students of aesthetics with a variety of common skin disorders. Having insights into the scientific principles of diagnosis will help clinicians make judgments for proper treatment either in clinic or by referring to the appropriate medical specialist.
Cutaneous diseases affect the integumentary system; the organ system made up of skin, hair and nails that protect the body from the external environment. There are literally hundreds of cutaneous disorders and interpretation can be difficult for the non-dermatologist. Of the total yearly outpatient visits in the U.S., seven percent are for dermatological complaints. Diagnosis of skin disease must be approached in an orderly and logical manner and the temptation to make rapid judgments after hasty observation must be controlled.
There are certain methodologies involved in diagnosing a client with a skin disorder. Knowing and using this methodical approach builds the client’s trust in their skin care professional. The loss of a client relationship due to inability to prescribe correct treatments and products for their skin condition is a struggle aestheticians and skin care establishments face every day, but by following this diagnostic approach, this can and will be remedied.
Methodology
The recommended methodical approach to the patient with skin disorder is as follows:
History
Obtain a brief history, noting duration, rate of onset, location, symptoms, family history, allergies, occupation, and previous treatment. The initial client consultation is one of the most important phases of the clinical treatment process. The clinical intake creates a connection between your treatment recommendations and the client’s concerns and the answers to the intake questions offer insights for how to develop the treatment plan and manage the client’s skin health care. It also plays a vital role in avoiding treatment complications. After receiving your client’s completed paperwork, review the medical history and discuss the client’s concerns.
Skin Analysis
The skin should be examined methodically. It is most productive to mentally divide the skin surface into several sections and carefully study each section. For example, when studying the face, examine the area around each eye, the nose, the mouth, the cheeks, and the temples. Many dermatologists will advocate for a complete skin examination for all their patients. Decisions about medications and quantities to dispense require visualization of the big picture.
Before you start, ask what improvements they want to see from their treatment and refer back to their skin concerns mentioned during the medical and skin history paperwork procedure. Asking this question will open the lines of communication and get your client to open up so that you can target their concerns in your treatment plan discussion. Follow these steps when examining the client’s skin:
Cover eyes with pads.
Give a compliment on their skin or face.
Determine skin type then discuss the skin’s condition.
List skin conditions with which they are concerned.
List any other conditions that you may see.
Show the client their skin under the Magnifying Loop.
The diagnosis of any particular skin condition can only be made by gathering pertinent and valuable information about the skin lesion, including the location, symptoms, duration of symptoms, arrangement (solitary, generalized, annular, linear), morphology (the form or shape of the symptoms), and color (black, red, yellow, et cetera).
Primary Lesions
Most skin diseases begin with a basic lesion that is referred to as a primary lesion. Identification of the primary lesion is the first step and the key to accurate interpretation and description of a cutaneous disease. Viewing a disease process provides valuable information about the disease. Close examination with a magnifying device provides much more information about its distribution. Primary lesions include the macule, papule, patch, plaque, vesicle, bulla, nodule, tumor, wheal, and pustule. Secondary lesions are a modification of primary lesions.
Accurately discovering and identifying primary lesions allows the aesthetician to approach the skin’s problems methodically with little to no guesswork in their recommendations for future treatment.
Secondary Lesions
Secondary lesions are the result of a primary lesion that can develop during the evolutionary process of the skin disease or are created by scratching or infection. Examples of secondary lesions include scale, crust, lichenification (visible skin thickening), atrophy, or umbilication (a depression at the top of a papule or pustule). Sometimes the secondary lesion may be the only type of lesion present; therefore the primary disease process must be understood.
Special Lesions
A unique number of structures and changes can occur including: burrow, folliculitis, furuncle (boil), wen (epidermal cyst), sebaceous cyst, comedone, telangiectasia (cluster of dilated blood vessels), and milium.
Examples of Common Skin Disorders
Dermatitis (allergic contact and irritant contact), acne, rosacea, psoriasis (genetic disease characterized by red, scaling papules), folliculitis (inflamed hair follicle caused by infection), eczema (most common inflammatory skin disease), keratosis pilaris (follicular pustules), melasma, adult lentigo (liver spots), and epidermal cysts are some of the more common skin disorders. While these are not life threatening, they can still affect a person’s daily life, their health, and their confidence. One of the most important skin disorders to familiarize yourself with are the symptoms and signs of skin cancer. Basil cell carcinoma is the most common malignant cutaneous neoplasm found in humans, with 85 percent of occurrences appearing on the head and neck region and 25 to 30 percent occurring on the nose alone. Squamous cell carcinoma is common in middle aged and the elderly and separated into two groups based on their malignant potential. Lastly, malignant melanoma – which derives from an existing lesion (a mole) – is increasing in occurrence and may be reaching epidemic proportions. These skin cancers need to be treated by a physician, but as a skin care professional it is extremely important to know and recognize the signs and symptoms to potentially save or prolong the life of your client.
All aesthetic professionals should have a working knowledge of the majority of cutaneous disorders, their symptoms, how they present themselves in the skin, and how to correctly recommend the next step in the treatment process for their clients. Be certain you provide the highest level of service when consulting with a client on a skin disorder, that way the resulting credibility greatly reduces the risk of doing business with you. It is extremely important to be a proactive aesthetician and repeat a needs assessment with clients every time they visit. By doing this, you can stay up to date on the symptoms and issues of clients who have an already diagnosed skin condition, and can potentially discover a newly developed condition in a client’s skin.
Focus on Making a Difference
Using your knowledge on skin conditions and leading your client down the correct treatment path gives you extra value. It is something that you can do for the customer that is outside the expected products and services and builds their trust in you. It shows you are knowledgeable, are paying attention, and that you care, which will only work to build your client/professional relationship.
Clients care about the difference you can make for them! That is what will separate you from the ranks of every skin care technician they have visited in the past. Keep in mind that making a difference starts with the needs assessment principle mentioned earlier.
Becoming a Consultant to Your Client
During the needs assessment phase, where a client’s needs and wants are examined, the aesthetician should pay close attention to the best solutions for the client, ideally making sure the prospect receives more value from the product or service than they are paying for.
Correct recommendations by the aesthetician on the client’s skin and its condition is more likely to result in the client purchasing a full series of treatments, taking the home care products, and staying loyal to a particular aesthetician.
Consultative aesthetics is the process of learning your client’s needs, then meeting those needs with solutions combining products and/or services. A consultative aesthetician typically provides detailed instruction or advice on which solution best meets these needs.
Executing the Consultative Process
Setting up a separate room for consultations is preferable, however if this is not possible then set up an area that affords privacy as well as a professional ambiance. Keeping the consultation area separate from the treatment area underscores the importance of the skin analysis procedure and establishes the professionalism of the aesthetician.
Arrange a table, two chairs, and your skin analysis equipment in your consultation room/area.
Keep the room/area stocked with service menus, point of sale posters, home care guides, and
product information.
At the time the client calls to make a skin care appointment, make sure additional time is allowed for the consultative process and skin analysis. Inform the client about this aspect of your service and what to expect.
Assure your client that the information they reveal will be treated in complete confidence.
A medical condition (past or present) must be documented, along with any medication being taken for the condition.
Allergies, allergy treatments, vitamin supplements, daily aspirin, et cetera must also be listed along
with dosage.
History should include the client’s past and current lifestyle habits. For example: sun exposure, alcohol use, smoking, et cetera
Review the client’s present skin care and cosmetic use as well as their past usage. Ask leading questions such as what they liked about a product or treatment, what they did not like, why they stopped using a particular product line or receiving professional treatments.
Once you have completed your intake notes, conducted the skin analysis and documented your observations, discuss your findings honestly with the client and make your treatment and product recommendations for optimal skin rejuvenation and results.
While you may receive objections to your recommendations at first, remember you are setting the tone for the future relationship in a professional way by taking charge of their skin health and giving your client every opportunity to make an informed decision. Correct recommendations by the aesthetician on the client’s skin and its condition – even if that recommendation is to advise them to see a physician – is more likely to result in long-term loyalty as well as ongoing future purchase recommendations.
Lyn Ross, President of the Institut’ DERMed Spa Enterprise is licensed by the Georgia Board of Cosmetology as a Master Aesthetician and Esthetic Instructor with over 25 years of experience in the field of professional skin care. Lyn’s passion for skin care grew from her personal need to heal the physical and physiological afflictions of teenage acne. Lyn is a true pioneer of the MediClinical Spa Industry owning and operating Atlanta’s most prestigious MedSpa for 22 years. Determined to promise results and make a difference for her beloved clients in 1994 Lyn created the Institut ‘DERMed Cosmeceutical product line and founded the Institut’ DERMed College of Advanced Aesthetics. Today Lyn’s focus is educating both Clients and Professional Skin Care Specialists on the results oriented treatment techniques she developed to correct problematic skin conditions. Additionally Lyn writes articles on skin health and contributes regularly to trade publications as well as text books.
