Skin Conditions on the State Board Exam
Skin conditions and disorders are heavily tested on every esthetics state board exam. You need to be able to identify common conditions, understand their causes, and know whether they are contraindications for facial services. This knowledge is not just for passing the exam — it is essential for safely serving clients in the salon.
Acne Vulgaris
Acne vulgaris is the most common skin condition seen in esthetics practice. It is caused by a combination of factors: excess sebum production, abnormal shedding of skin cells inside the follicle, colonization of the follicle by Cutibacterium acnes (formerly Propionibacterium acnes), and inflammation.
Non-inflammatory acne lesions:
- Comedone — a clogged follicle. An open comedone (blackhead) is dark because the melanin in the sebum oxidizes when exposed to air. A closed comedone (whitehead) is covered by a thin layer of skin.
Inflammatory acne lesions:
- Papule — a small, raised, red bump. It is an inflamed comedone without visible pus.
- Pustule — a papule with visible pus at the surface. This is what most people think of as a "pimple."
- Nodule — a large, deep, painful lesion that extends into the dermis.
- Cyst — a large, fluid-filled lesion that can cause scarring.
For the state board exam: Active, inflamed acne (papules, pustules, nodules, cysts) is a contraindication for many facial services, including aggressive exfoliation and extractions. Non-inflammatory acne (comedones) can often be treated with appropriate facials.
Rosacea
Rosacea is a chronic inflammatory skin condition characterized by facial redness, visible blood vessels (telangiectasia), and sometimes acne-like bumps (papulopustular rosacea). It primarily affects the central face (nose, cheeks, forehead, chin) and is most common in fair-skinned individuals.
Rosacea is triggered by heat, spicy foods, alcohol, sun exposure, stress, and certain skin care products. It is a contraindication for treatments that involve heat, aggressive exfoliation, or strong chemical peels.
Hyperpigmentation
Hyperpigmentation refers to areas of the skin that are darker than the surrounding skin, caused by excess melanin production. Common types include:
Melasma — brown or gray-brown patches, typically on the face. Often triggered by hormonal changes (pregnancy, birth control pills) and sun exposure.
Post-inflammatory hyperpigmentation (PIH) — dark spots that develop after skin inflammation or injury (acne, eczema, cuts). More common in darker skin tones.
Solar lentigines (age spots) — flat, brown spots caused by cumulative sun exposure. Most common on the hands, face, and other sun-exposed areas.
Ephelides (freckles) — small, flat, brown spots that are genetically determined and darken with sun exposure.
Eczema and Psoriasis
Eczema (atopic dermatitis) — a chronic inflammatory skin condition characterized by dry, itchy, red skin. It is often associated with allergies and asthma. Active eczema is a contraindication for most facial services.
Psoriasis — a chronic autoimmune condition characterized by thick, scaly, red plaques. It is caused by an accelerated skin cell turnover cycle. Active psoriasis is a contraindication for most facial services.
Primary and Secondary Skin Lesions
State board exams test your ability to identify and classify skin lesions using the correct terminology.
Primary lesions develop on previously normal skin:
- Macule — flat, discolored spot (freckle)
- Papule — raised, solid bump
- Vesicle — small, fluid-filled blister
- Pustule — pus-filled lesion
- Nodule — large, deep, solid lesion
- Wheal — raised, itchy area (hive)
Secondary lesions develop from primary lesions:
- Scale — flaking skin
- Crust — dried serum or blood
- Excoriation — scratch mark
- Fissure — crack in the skin
- Scar — fibrous tissue replacing damaged skin
- Keloid — raised, overgrown scar