How do I obtain credit for this course and receive my certificate of completion?

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1 A bout your CE Why am I receiving this course? Carefully read the instructions below. Illinois allows you to complete half of your continuing education through home-study. Records indicate that your license will need to be renewed by September 30, Completing your continuing education is required before license renewal. How do I complete this course? After reviewing the material, you must complete the final exam on page 24, marking your answers on the answer sheet on page 25. Fill out all information on the answer sheet (be sure to fill in your license number) and include payment of $24.95 made payable to. As long as you receive a 75 percent or better on your exam, you will be issued a certificate of completion. How do I obtain credit for this course and receive my certificate of completion? MAIL: You can complete the final exam and mail it to us in the envelope provided. If you have misplaced your envelope, you can mail it to us at: PO Box 37 Ormond Beach, FL FAX: For faster service, you can fill in your credit card number and expiration date and fax your test to us at ONLINE: For an even more convenient way of completing your CEUs, you can take the test online at Upon passing, you will then be asked to fill in your information and will be able to print out a certificate of completion for your records. Our website is secured by Thawte. We are rated A+ by the National Better Business Bureau. Do I need to send my certificate with my renewal? No, the Illinois State Board of Cosmetology conducts audits. Be sure to keep your certificate in a safe place so you can prove you completed your hours. When do I get my renewal notice from the state? The state mails out renewal notices days before your license expires. What if I still have questions? No problem, we are here to help you. Call us toll-free at , Monday-Friday, 8:00 a.m.- 8:00 p.m. and Saturday 9:00 a.m.-1:00 p.m. EST or us at office@elitecme.com. Page I

2 Table of Contents Chapter 1 Chapter 2 Anatomy and Conditions of the Skin, Hair and Nails (4 CE Hours)...Page 1 Make-up Classics (3 CE Hours)...Page 12 Final Examination Questions...Page 24 Final Examination Answer Sheet...Page 25 Course Evaluation...Page 26 All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Professional Education LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. If necessary, it is recommended that you consult a medical, legal or professional services expert licensed in your state. Professional Education LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing. Page II

3 CHAPTER 1 Anatomy and Conditions of the Skin, Hair and Nails (4 CE Hours) Learning objectives Describe the basic anatomical structures of the skin, hair and nails. List common symptoms with conditions of the skin, hair, scalp and nails. Explain the role of the acid mantle and ph in skin and hair health. List common disorders and conditions of the nail that can and cannot be treated in a salon. List the risk factors for exfoliation and microdermabrasian services. Describe methods to reduce the risk of overexposure to toxic chemicals in salons. Introduction When providing services to your clients, remember that the human body is not just a collection of different anatomical bits and pieces, but an integrated system in which everything is interconnected. The better you know the natural processes that create and sustain a healthy body, the better you are able to choose products and services that bring your clients the greatest benefits and help them protect and care for their skin, hair and nails. The first part of this chapter discusses the basic anatomy of the skin, common skin (and scalp) conditions, and risk factors for specific services. Later sections discuss the structure and growth of the hair and nails, including changes experienced throughout one s life, common reasons for and patterns of hair loss, and common nail disorders. The final sections discuss safety concerns, issues of toxicity and how to avoid injury and reduce risk when working with potentially dangerous chemicals. The skin The skin is a vital organ that covers the entire outside of the body, forming a protective barrier against pathogens from the environment. The skin is the body s largest organ; covering the entire outside of the body, it is about 2 mm thick and weighs approximately six pounds. It shields the body against heat, light, injury and infection. The skin also helps regulate body temperature, gathers sensory information from the environment, stores water, fat and vitamin D, and plays a role in the immune system, protecting us from disease. The color, thickness and texture of skin vary over the body. There are two general types of skin: thin and hairy, and thick and hairless. The latter is typically found on parts of the body that are used heavily and endure a large amount of friction, like the palms of the hands or the soles of the feet. The skin is made up of two layers that cover a third fatty layer. Each layer differs in function, thickness and strength. The outer layer is called the epidermis; it is a tough protective layer that contains the melanin-producing melanocytes. The second layer (located under the epidermis) is called the dermis; it contains nerve endings, sweat glands, oil glands and hair follicles. Under these two skin layers is a fatty layer of subcutaneous tissue, known as the subcutis or hypodermis. The skin contains many specialized cells and structures: Basket cells: These surround the base of hair follicles and can sense pressure. Blood vessels: These carry nutrients and oxygen-rich blood to the cells that make up the layers of skin and carry away waste products. Hair erector muscles (arrector pili muscles): These are tiny muscles connected to each hair follicle and the skin. When it contracts, it causes the hair to stand erect, and a goosebump forms on the skin. Hair follicles: These tube-shaped sheaths surround the part of the hair that is under the skin and nourish the hair. Located in the epidermis and the dermis. Hair shaft: This is the part of the hair that is above the skin. Langerhans cells: These attach themselves to antigens that invade damaged skin and alert the immune system to their presence. Melanocytes: These are cells that produce melanin, and are located in the basal layer of the epidermis. Merkel cells: These are tactile cells located in the basal layer of the epidermis. Pacinian corpuscles: These are nerve receptors located in the subcutaneous fatty tissue that respond to pressure and vibration. Sebaceous glands: These small, sack-shaped glands release an oily substance onto hair follicles (forming the acid mantle) that coats and protects the hair shaft from becoming brittle. They can be found everywhere on the body except for the palms of the hands and the soles of the feet. Their secreted oil also helps keep the skin smooth and supple, waterproof and protects against an overgrowth of bacteria and fungi on the skin. They are located in the dermis. Sensory nerves: Contained within the epidermis, these nerves sense and transmit heat, pain, and other noxious sensations. When they are not functioning properly, sensations such as numbness, pins-andneedles, pain, tingling or burning may be felt. Stratum corneum: The outermost layer of the epidermis, it is comprised of dead skin cells. It protects the living cells beneath it by providing a tough barrier between the environment and the lower layers of the skin. Sweat gland (sudoriferous gland): Located in the epidermis, these produce moisture (sweat) that is secreted through tiny ducts onto the surface of the skin (stratum corneum). When sweat evaporates, skin temperature is lowered. The average person has about 3 million sweat glands. Sweat glands are classified into two types: Apocrine glands are specialized sweat glands that can be found only in the armpits and pubic region. These glands secrete a milky sweat that encourages the growth of the bacteria responsible for body odor. Eccrine glands are found over the entire body; they regulate body temperature by bringing water via the pores to the surface of the skin, where it evaporates and reduces skin temperature. These glands can produce up to two liters of sweat an hour, but they secrete mostly water, which doesn t encourage the growth of odor-producing bacteria. The epidermis The epidermis is the outermost layer of the skin, which protects the body from the environment. The thickness of the epidermis varies in different types of skin; it is only 0.05 mm thick on the eyelids, and is 1.5 mm thick on the palms and the soles of the feet. The epidermis contains the melanocytes (the cells in which melanoma develops), the Langerhans cells (involved in the immune system in the skin), Merkel cells and sensory nerves. The epidermis layer itself is made up of five sublayers that work together to continually rebuild the surface of the skin: The basal cell layer. The basal layer is the innermost layer of the epidermis, and contains small round cells called basal cells. The basal cells continually divide, and new cells constantly push older ones up toward the surface of the skin, where they are eventually shed. The basal cell layer is also known as the stratum germinativum because it is constantly germinating (producing) new cells. The basal cell layer contains cells called melanocytes. Melanocytes produce the skin coloring or pigment known as melanin, which gives skin a particular color and helps protect the deeper layers of the skin from the harmful effects of the sun. Sun exposure causes melanocytes to increase production of melanin to protect the skin from damaging ultraviolet rays, producing a suntan. Patches of melanin in the skin cause birthmarks, freckles and age spots. Melanoma develops when melanocytes undergo malignant transformation. Merkel cells are also located in the basal layer of the epidermis. The squamous cell layer. The squamous cell layer is located above the basal layer, and is also known as the stratum spinosum or spiny layer because the cells are held together with spiny projections. Within this layer are the basal cells that have been pushed upward. The maturing basal cells become squamous cells, or keratinocytes, which produce keratin, a tough, protective protein that makes up the majority of the structure of the skin, hair and nails. Page 1

4 The squamous cell layer is the thickest layer of the epidermis, and is involved in the transfer of substances in and out of the body. The squamous cell layer also contains cells called Langerhans cells. These cells attach themselves to antigens that invade damaged skin and alert the immune system to their presence. The stratum granulosum and the stratum lucidum. The keratinocytes from the squamous layer are then pushed up through two thin epidermal layers called the stratum granulosum and the stratum lucidum. As these cells move further towards the surface of the skin, they get bigger and flatter and adhere together, and then eventually become dehydrated and die. This process results in the cells fusing together into layers of tough, durable material, which continue to migrate up to the surface of the skin. The stratum corneum. The stratum corneum is the outermost layer of the epidermis, and is made up of 10 to 30 thin layers of continually shedding, dead keratinocytes. The stratum corneum is also known as the horny layer, because its cells are toughened like an animal s horn. As the outermost cells age and wear down, new layers of strong, longwearing cells replace them. The stratum corneum is sloughed off continually as new cells take its place, but this shedding process slows down with age. Complete cell turnover occurs every 28 to 30 days in young adults, while the same process takes 45 to 50 days in elderly adults. The dermis The dermis is located beneath the epidermis and is the thickest of the three layers of the skin (1.5 to 4 mm thick), making up approximately 90 percent of the thickness of the skin. The main functions of the dermis are to regulate temperature and to supply the epidermis with nutrient-saturated blood. Much of the body s water supply is stored within the dermis. This layer contains most of the skins specialized cells and structures, including blood vessels, hair follicles, sweat glands and sebaceous glands. Lymph vessels: These bathe the tissues of the skin with lymph, a milky substance that contains the infection-fighting cells of the immune system. These cells work to destroy any infection or invading organisms as the lymph circulates to the lymph nodes. Nerve endings: The dermis layer also contains pain and touch receptors that transmit sensations of pain, itch, pressure and information on temperature to the brain for interpretation. If necessary, shivering (involuntary contraction and relaxation of muscles) is triggered, generating body heat. Collagen and elastin: The dermis is held together by a protein called collagen, made by fibroblasts. Fibroblasts are skin cells that give the skin its strength and resilience. Collagen is a tough, insoluble protein found throughout the body in the connective tissues that hold muscles and organs in place. In the skin, collagen supports the epidermis, lending it its durability. Elastin, a similar protein, is the substance that allows the skin to spring back into place when stretched and what keeps the skin flexible. Page 2 The dermis layer is made up of two sublayers: The papillary layer. The upper, papillary layer, contains a thin arrangement of collagen fibers. The papillary layer supplies nutrients to select layers of the epidermis and regulates temperature. Both of these functions are accomplished with a thin, extensive vascular system that operates similarly to other vascular systems in the body. Constriction and expansion control the amount of blood that flows through the skin and dictate whether body heat is dispelled when the skin is hot or conserved when it is cold. The reticular layer. The lower, reticular layer, is thicker and made of stout collagen fibers that are arranged parallel to the surface of the skin. The reticular layer is denser than the papillary dermis, and it strengthens the skin, providing structure and elasticity. It also supports other components of the skin, such as hair follicles, sweat glands and sebaceous glands. The subcutis The subcutis is the innermost layer of the skin and consists of a network of fat and collagen cells. The subcutis is also known as the hypodermis or subcutaneous layer, and functions as both an insulator, conserving the body s heat, and as a shock absorber, protecting the inner organs. It also stores fat as an energy reserve for the body. The blood vessels, nerves, lymph vessels and hair follicles also cross through this layer. The thickness of the subcutis layer varies throughout the body and from person to person. As skin ages The epidermis is the outermost layer of our skin, which consists of five different layers. The dermis is the supporting layer of skin, containing the collagen fibers that provide skin with its internal support. Collagen acts very much like metal rods that are laid down in concrete to support buildings and bridges. Pigment cells or melenocytes are positioned in between these two layers of skin. The epidermis typically begins to thin as collagen in the dermis begins to break down, with fine wrinkles beginning to form in the skin. While age naturally thins the epidermis, repeated exposure to ultraviolet radiation from the sun s rays causes skin to thicken (the body s way of protecting the skin from the effects of harmful radiation). The process is akin to abrasion, with the development of rough spots or calluses on the skin. In the dermis, this results in an accelerated breakdown of collagen and further wrinkles. Also as a result of sun exposure, the pigment cells begin to cluster, resulting in brown spots on the skin. What is ph? Acidic and basic are two extremes that describe chemicals, just like hot and cold are two extremes that describe temperature. Mixing acids and bases can cancel out their extreme effects, much like mixing hot and cold water can even out the water temperature. A substance that is neither acidic nor basic is neutral. The ph scale measures how acidic or basic a substance is. It ranges from 0 to 14. A ph of 7 is neutral. A ph less than 7 is acidic, and a ph greater than 7 is basic. Each whole ph value below 7 is 10 times more acidic than the next higher value. For example, a ph of 4 is 10 times more acidic than a ph of 5 and 100 times (10 times 10) more acidic than a ph of 6. The same holds true for ph values above 7, each of which is 10 times more alkaline (another way to say basic) than the next lower whole value. For example, a ph of 10 is 10 times more alkaline than a ph of 9. Pure water is neutral, with a ph of 7.0. When chemicals are mixed with water, the mixture can become either acidic or basic. Vinegar and lemon juice are acidic substances, while laundry detergents and ammonia are basic. Chemicals that are very basic or very acidic are called reactive. These chemicals can cause severe burns. Automobile battery acid is an acidic chemical that is reactive and a stronger form of some of the same acid that is in acid rain. Household drain cleaners often contain lye, a very alkaline chemical that is reactive. PH of the skin and scalp How does the ph scale pertain to skin and nails and your salon environment? On the ph scale hair and skin falls on average between 4.5 and 6. What this measures is not the ph of the actual skin and scalp, but the protective film of oily acidic secretions that coats and lubricates the surface of the skin. This combination of oils and watersoluble materials is referred to as our acid mantle. The acid mantle is produced by the skin system. The average ph on the surface of the scalp is 4.8; as we measure the ph on the hair at further distances from the scalp, the ph value increases. This shows that less of the acid mantle reaches the ends of longer hair. The scalp s oils keep the hair lubricated and shiny, while its acidity keeps the fiber compact and strong. Products with a ph of 4.5 to 5.5 are compatible with the natural biology of the skin and scalp. These products maintain a mildly acidic environment that closely resembles the environment of our acid mantle. We call these products acid balanced. One of the skincare industry s primary challenges is creating products that can actually penetrate the skin. Our epidermis, the skin s outer layer, is specifically designed to keep things out. Even the best ingredients do no good if they are unable to penetrate. Chemists have found that most ingredients work best at a specific ph balance. Some chemical services require a high ph to work properly. If you encounter a product that does not have the ph number listed on the label, you can use ph test paper or nitrazine paper to determine the correct ph. Just dip the paper into the solution. A product with 4.5 ph or below will not change the paper from its original yellow shade. A higher ph will change the color to dark blue (4.6 to 7.4), and any product with a ph over 7.5 will turn the paper purple. The significance of ph The skin is the first line of defense against all microorganisms and pollutants. Specifically, it is the acid mantle the slightly acidic coating on the surface of the skin that protects us from the elements. It is necessary to protect the stratum corneum, making it less permeable to

5 water or other compounds. The acid mantle also contributes to the low ph of the skin surface. Normal skin surface ph in healthy people is between 4 and 6.5, though it varies in different areas of the skin. Newborn infants do have a higher skin surface ph compared to adults, but this normalizes within three days. It s important to maintain proper ph to keep the stratum corneum healthy. The acid mantle contains lactic acid and various amino acids from sweat, free fatty acids from sebum, and amino acids. If the acid mantle becomes disrupted or damaged or loses its acidity, the skin becomes more prone to damage and infection. The surface ph of damaged skin has been shown to increase, creating susceptibility to bacterial skin infections, fungal infections or further skin damage and disease. Washing skin with soaps or detergents can cause the loss of acid mantle. Repetitive washing alters the stratum corneum and barrier functions, including skin ph. Once damaged, it can take up to 14 hours to restore, by which time it s most likely under assault again from another washing. A single washing can shift ph to the alkaline region, which typically reverts back to normal within a few hours. Skin conditions that can cause an increase in skin ph include eczema, contact dermatitis, atopic dermatitis and dry skin. Individuals with skin problems typically have skin ph values beyond 6. The presence of acne is very dependent on the skin s ph value, because it is a common bacteria found in all people. More alkaline environments tend to support acne, and most commercially available soaps are very alkaline, with ph values ranging from 9-11, which alter the skin s ph to a more alkaline value. Acute eczema with erosion can cause skin surface ph to shift from normal to 7.3 to 7.4. (This is a 1,000-fold increase in the ph shift; remember, ph is measured in logarithmic function.) The entire skin surface ph is increased on skin of people with atopic dermatitis. An increased skin ph contributes to Staphylococcus aureus colonization, which can play a role in the formation of atopic dermatitis, discoid eczema, and infective dermatitis. Diseases that can cause an increase in skin surface ph include diabetes, chronic renal failure and cerebrovascular disease. An increase in skin surface ph encourages bacterial growth, so individuals with diabetes are more prone to certain skin infections. Studies show individuals with diabetes have a decreased level of skin lactic acid. The use of skin occlusive products, such as dressings and diapers, are known to raise skin ph but may be associated with skin infections. Maintaining healthy ph levels There are three main types of cleaning agents: soaps, synthetic detergents and lipid-free cleansing agents. Soaps typically make the skin more alkaline than synthetic detergents. Acidic cleansers are less irritating than neutral or alkaline ones, and people prone to dry skin are typically advised to use acidic cleansers. Agents with slightly acidic or neutral ph (nonionic) may be preferable for individuals who are at increased risk for irritating skin reactions. You may recommend to individuals with skin conditions that they choose a mild cleaning agent with a low ph. Even minor differences in the ph of skin cleansing preparations can cause irritation to the skin s surface. The United States carries very low-ph soaps and cleansers. Others have a ph of 9.5 to 10.5, which is inherent to a sodium soap composed of fatty acids. The formulas that have a neutral ph are called syndet. Chemically, they are not soaps, but a synthetic detergent in a bar form. Common skin disorders You will want to develop workplace guidelines for recognizing potential health risks and determining when and how to proceed with services or whether you should proceed at all. If you have any questions or concerns about the conditions or diseases described below, consult a health care provider. Common skin conditions include contagious skin disorders, such as herpes or athlete s foot; noncontagious inflammatory skin disorders, such as acne or eczema; neoplastic skin disorders, such as melanoma or psoriasis; and may include skin injuries, such as burns or scars. Use appropriate caution with any unknown condition. Dermatitis refers to several different itching, inflamed conditions of the skin that are characterized by scaling, swelling, redness and the formation of papules. Dermatitis can refer to conditions with unknown as well as known origins, including those that are a reaction to environmental agents. Dermatitis can be endogenous, caused by a malfunction in the skin, or exogenous, caused by external factors. Atopic dermatitis, also known as eczema, is a hereditary, non-contagious condition that may first appear in infancy and can continue into adulthood. The condition is characterized by extreme dryness as well as itchy, thick and cracked skin occurring in the folds of the body. Lesions resulting from the itchy condition tend to appear on the neck, face and bend of the knee. In adults, redness and scaling on the hands are common. Exposure to stress, certain medications and temperature extremes can trigger symptoms, especially in individuals with sensitivities to these exogenous factors. Eczema may also be associated with increased incidence of asthma. Hydrocortisone lotions can treat mild cases, while intermediate or high-potency corticosteroids may be required in more severe cases. Antihistamines are also useful to combat the itching associated with eczema, but may have a sedating effect. Irritant or allergic contact dermatitis is another type of dermatitis that occurs when the skin is exposed to an irritant, such as a powerful household cleaner, or an allergen, like poison ivy. Some common allergens are nickel, used in earrings and jewelry, and many substances used in cosmetics and perfumes. Redness, swelling and itching at the contact site are common symptoms of both irritant and allergic contact dermatitis. Blistering, as well as cracking, dry skin may occur in more severe cases. Children with eczema may have a greater tendency to develop irritant or allergen contact dermatitis as adults. Treatment for contact dermatitis involves identifying the irritant or allergen, and minimizing or eliminating exposure. Topical treatments as well as antihistamines can be used to reduce itching. Seborrheic dermatitis, more commonly known as dandruff, usually appears as an inflammation of the scalp, but may also cause red, scaly patches around the nose, eyebrows, behind the ears, and on the chest, armpits or groin. Dandruff shampoo is usually effective in treating mild cases, but more severe cases may require a dermatologist s attention. Stasis dermatitis is a kind of dermatitis that occurs primarily in older women who have varicose veins. The constant inflammation of the varicose vein may cause the skin to become thick, scarred and discolored. Wearing support stockings and elevating the legs can help prevent or alleviate symptoms. Rosacea is characterized by red areas of the face that may take the form of small, red bumps or pustules on the nose, cheeks, forehead and chin; a red, bulbous nose (rhinophyma); and visible small blood vessels on the nose and cheeks. In some cases, individuals also feel a burning or gritty sensation in the eyes. Researchers have a number of theories as to what causes rosacea, but most believe it is likely due to some combination of hereditary and environmental factors. Rosacea usually proceeds in phases, progressing to a persistent redness resulting from the dilation of blood vessels close to the skin s surface. In severe and rare cases, the oil glands (sebaceous glands) in the nose and sometimes the cheeks become enlarged, resulting in a buildup of tissue on and around the nose (rhinophyma). Some kinds of rosacea also cause the inner skin of the eyelids to become inflamed or appear scaly, a condition known as conjunctivitis. Proceed slowly and carefully. Many skin services aggravate rosacea, causing increased redness and irritation. Hives (urticaria) appear as a single red welt or as inflammation all over the body, and may take a matter of hours to days or even weeks to resolve. Single hives are usually a reaction to an insect bite or other irritant. More widespread outbreaks can be caused by medications like penicillin, or foods like chocolate and shellfish. Stress is also thought to play a part, in some instances, in the development of hives. Keeping a diary of one s diet and medications and noting the timing of reactions can be helpful in identifying the cause of hives. Treatments include antihistamines, lotions, and adrenaline injections. Psoriasis is a skin disorder that affects more than 3 million Americans, and, like eczema, tends to occur within families. Men and women are equally affected, with Caucasians more likely to have psoriasis than either African or Asian Americans. The condition occurs when the skin cells multiply more rapidly than normal, and move quickly through the dermis, toward the epidermis, where they are shed in scales. There are several theories on the cause of psoriasis, which may be due to a genetic component, immune system abnormalities, or cellular, biochemical or metabolic defects. Page 3

6 Psoriasis initially resembles red patches on the skin, but develops into sharply demarcated, crusty patches with silvery scales. Knees, palms, scalp, elbows, trunk, soles of the feet and genitalia are common sites for psoriasis. Additionally, the condition can appear on the finger and toenails, causing thickened, discolored nails, or nails that separate from the nailbed. There is no known cure for psoriasis, but existing treatments offer months or years of relief from symptoms. Topical medications such as corticosteroids or crude coal tar ointments can be very effective in mild cases, while drugs like methotrexate, etretinate and cyclosporine can be useful in more severe cases. Non-pharmaceutical methods like UV light therapy may also be effective treatment options. Growths and tumors Benign tumors and growths become more prevalent as we age. Unless they become irritated, most growths and tumors need not be removed, but many individuals choose to do so for cosmetic reasons. Cherry angiomas are small red bumps on the skin that are usually harmless, but should be removed if they begin to bleed. Liver spots are flat, light brown or black spots common in fair-skinned individuals over the age of 50 that typically occur on the face and backs of the hands. They are usually harmless, associated with sun exposure, and can be removed by cryosurgery, acid peeling or electrosurgery. Moles are fleshy brown or black growths that result from melanocyte overgrowth. Most moles are harmless, but each should be checked, and possibly removed, if changes are observed. Seborrheic keratoses are flat or slightly elevated rough, brown spots on the back, chest, face and arms that can be removed by cryosurgery. Solar keratoses are flat or slightly raised, red, scaly spots caused by exposure to the sun. These should be removed because they become cancerous more than 20 percent of the time. Warts are caused by viral infection. While they can occur anywhere on the body, they appear most commonly on the hands and feet. While they usually disappear on their own, over-the-counter medications, cryotherapy and other medical interventions can also be effective in their removal. Skin infections Many bacterial and viral skin infections initially appear relatively minor and easy to treat, but can develop into serious and even life-threatening conditions if improperly treated. Bacterial infections Boils are caused when staphylococcus bacteria infect hair follicles and cause inflammation to the skin. They can be accompanied by fever or fatigue, and present as painful, red and swollen nodules on the skin. They can appear anywhere but are most common on the upper back and nape of the neck. Hot compresses can help bring them to a head, releasing the pus and allowing the infection to heal. For recurrent boils, medical attention is needed. Page 4 Cellulitis or erysipelas is also caused by streptococcus bacteria that enter the skin, causing an infection of the skin and subcutaneous tissue. Fever, headache and chills followed by a rash with patches of red, swollen, hot skin are characteristic of the infection. Immediate medical treatment is necessary because the condition can be fatal if left untreated. Antibiotics are the most common and effective treatment. Impetigo is a bacterial skin infection common in babies and young children. Streptococcus bacteria enter through a small cut or bite, causing the infected area to become covered with blisters that form a honey-colored or gray crusty rash on the face, near the mouth and nose. Topical treatments or oral antibiotics may be prescribed, depending on the severity of the infection. Fungal infections Athlete s foot is caused by a fungus related to ringworm and jock itch. The fungus is especially prevalent among adolescents, although people of any age can get it. Over-the-counter and prescription medications are both used to treat fungal infections, depending on the severity of infection. In acute conditions, itchy blisters may appear, either singly or in groups, on one or both feet. These blisters, or vesicles, may spread over the sole and in between the toes, becoming red and oozy upon rupture. While the lesions dry as they heal, this type of fungal infection can become chronic. Keep the skin as cool, clean and dry as possible. Yeast infections, or candidal dermatitis, are common among infants who wear diapers as well as among adolescent girls and women. Viral infections Chickenpox are caused by herpes zoster, the virus responsible for shingles in adults. The disease is most common in children, with symptoms including red, itchy blisters and fever. In severe cases, permanent scarring can result from scratching chicken pox. Tingling or pain in the affected area is typically the first sign of shingles. After that, red skin and blistering on one side of the body or face may appear, along a spinal nerve path. Pain can last from two to three weeks or longer in some cases. Acyclovir or oral corticosteroids are effective treatments. Cold sores or fever blisters are caused by the herpes simplex I virus, and are contagious. Sun exposure, stress and even menstruation can trigger an outbreak. Over-the-counter treatments as well as prescription acyclovir can help treat cold sores. Genital herpes is caused by the herpes simplex virus 2, a variation of the herpes virus that is usually spread by sexual contact, and is characterized by itching, sores and rashes, primarily of the genital area. Measles is comparatively rare because of the existence of a vaccine; symptoms include fever, coughing and a skin rash. Changes in the skin during pregnancy Women may experience changes in their skin during pregnancy. In most cases, these changes are temporary and will return to their original condition after the birth. Existing skin conditions may either be exacerbated or improved with pregnancy; eczema, for example, generally becomes more severe during pregnancy, while psoriasis typically appears less severe. Herpes gestationis is characterized by blisters on the abdomen that usually appear during the second trimester of pregnancy, then disappear, and reappear at delivery. Topical and oral corticosteroids can provide relief. Hyperpigmentation, characterized by the appearance of dark spots on the skin, affects more than 90 percent of pregnant women. This condition is caused by an overproduction of melanin, which may turn the breasts, nipples, genitals, freckles and scars a shade or two darker than is usual; they will return to normal a few months after pregnancy. Melasma, or the mask of pregnancy affects about 70 percent of pregnant women. It is caused by an increase of pigmentation in areas that have previously been exposed to the sun. Three common patterns of melasma are the centrofacial pattern, with pigmentation occurring on the cheeks, forehead, upper lip, nose and chin; the malar pattern, showing pigmentation on the cheeks and nose; and the mandibular pattern, appearing on the cheeks and jawline. Proper use of sunscreen may be helpful. This condition returns to normal after pregnancy. Pruritic urticarial papules and plaques of pregnancy (PUPPP) typically appear in the third trimester, and is the most common skin condition associated with pregnancy. Small red bumps or hives form a rash on the abdomen that may spread to the thighs, buttocks, breasts and arms. Topical anti-itch medications generally provide relief, and the condition disappears after delivery. Stretch marks are a common condition especially prevalent in Caucasians, but may exist among other populations in women who lose or gain a great deal of weight. The condition is characterized by pink or purple bands that appear on the abdomen, breasts or thighs. Exercise and some topical preparations may reduce or lessen their appearance. Skincare and treatments Exfoliation and microdermabrasian Facial technicians may use chemicals, products and devices designed for surface skin treatments, but are not intended to remove viable (living) skin below the stratum corneum. Chemical concentrations of chemicals prohibited for use include: Unbuffered alpha hydroxyl acids at concentrations greater than 15 percent. Buffered concentrations of alpha hydroxyl acids of percent where ph is less than 3. Any concentration or formulation of alpha hydroxyl acids greater than 30 percent. Any concentration or formulation of trichloracetic acid (TCA) containing phenol or resorcinol, or salicylic acid, which acts on living tissue. Facial technicians must receive appropriate training in the safe and effective use of each system of skin care used to perform services. All exfoliating products or formulations and manual

7 or mechanical devices shall be used in accordance with manufacturers recommendations. Exfoliation Exfoliation may be achieved through a variety of techniques used in the skin-care industry, including medical peels, lasers, microdermabrasian, light machines and preparations applied to the skin. Care must be used because aggressive exfoliation over extended periods of time can irritate and thin the skin, making it more sensitive and easily damaged by the sun. This sensitivity is exacerbated by the use of medications like Accutane and Retin-A. Doctors typically recommend that individuals using these products do not undergo exfoliation services because of the risk of adverse reactions. Adverse reactions may also be seen in individuals not taking medications who have conditions including sunburn, rosacia, severe acne, eczema and psoriasis, and even recent waxing. Individuals being treated with radiation or chemotherapy should not undergo exfoliation. Exfoliating products are numerous and include alpha hydroxy acids such as glycolic, malic and tartaric acid; beta hydroxy acids including salicylic and citric; benzoyl peroxide; sulfur; resorcinol; and various enzymes. These should be used in relatively small quantities to exfoliate the skin, treat acne and clogged pores, and refine the skin surface. The delivery vehicle of the product should be appropriate for the skin type, with creams typically more appropriate for dry skin and gels for oilier skin. Daily use of a broad-spectrum SPF 15 (or higher) sunscreen is necessary with the use of exfoliants like AHAs. One of the risks of exfoliant use is related to the ph of the product. PH values lower than 3.5 tend to strip the barrier function of the skin, removing protective lipids between the cells and leaving the skin dehydrated, red and inflamed. The concentration of ingredients for the particular skin can also be too high, or the client may have not had an appropriate history taken. In general, do not use products with a ph of less than 3.5. Learn to analyze the skin properly and make sure the product is in the right base vehicle for the client s skin. Do not use more than one exfoliant product at a time on a client, and make sure the plan of treatment proceeds at a steady, but slow pace. Microdermabrasian Microdermabrasion is a general term for the application of tiny rough grains to buff away the surface layer of skin. Many different products and treatments use this method, including medical procedures, salon treatments and creams and scrubs that clients apply themselves at home. It s usually done to the face, chest, neck, arms or hands. To understand how microdermabrasion does what it does, it s important to review how skin works. The epidermis is the outermost skin layer. It is a set of dead skin cells on top of another layer of cells that are in the process of maturing. The topmost layer, the stratum corneum, acts as a barrier between the outside world and the lower skin layers. It keeps all but the smallest molecules from getting through. When people put lotions or creams on their skin, some of the moisture passes through the stratum corneum, but not all of it. This layer is home to many minor skin imperfections, such as fine wrinkle lines and blemishes. All of the action in microdermabrasion takes place at the level of the stratum corneum. Because it only really targets the epidermis (and not the dermis), it is more accurate to call it micro-epidermabrasion. Affecting deeper layers of skin is painful and harmful, and risks permanently embedding the tiny grains into the skin. Whether done with a product at home or in a professional setting with a specialized tool, the principal of microdermabrasion is the same. If you remove or break up the stratum corneum, the body interprets it as a mild injury and rushes to replace the lost skin cells with new and healthy ones. In the first hour after treatment, this causes mild edema (swelling) and erythema (redness). Depending on the individual, these side effects can last anywhere from an hour to two days. This process has a few beneficial effects. With the stratum corneum gone, the skin s surface is improved. The healing process brings with it newer skin cells that look and feel smoother. Some of the skin s visible imperfections, like sun damage, blemishes and fine lines, are removed. Also, without the stratum corneum acting as a barrier, medicinal creams and lotions are more effective because more of their active ingredients and moisture can find their way down to the lower layers of skin. Because microdermabrasion temporarily removes some moisture from the skin, it is always followed by the application of moisturizing creams. Microdermabrasion is a useful alternative for patients whose skin is too sensitive to use antiacne drugs like Retin-A. It is not recommended for those who have active oral herpes. Individuals with the following conditions should not undergo microdermabrasion: Rosacea. Fragile capillaries. Herpes (herpetic lesions). Open sores or skin lesions. Use of anti-coagulants. Eczema. Dermatitis. Psoriasis. Lupus. Erythematosus. Diabetes mellitus. Vascular lesions. Warts. Widespread acne. Free radicals and antioxidants Free radicals are produced by the environment, in sunlight, heat and radiation. They damage the skin by attacking cellular membranes. It is these highly reactive or unstable molecules and atoms that cause aging and degenerative diseases. Some molecules in the human body are more susceptible to free-radical attacks than others. Fats, DNA, RNA, cellular membranes, proteins, vitamins and carbohydrates are particularly prone to free radicals, which are atoms or molecules with an unpaired electron that are highly reactive. Normally, the body can handle free radicals with the use of antioxidants. These include vitamins (e.g., ascorbic acid, alpha-tocopherol), minerals, enzymes (e.g., superoxide dismutase, catalase, peroxidase) and even proteins that can be found naturally in the body or ingested in the diet. If, however, the antioxidants are in short supply or if the free-radical damage is excessive, damage to the cells and tissue can occur. In the skin, this presents itself in the form of superficial lines, wrinkles, hyperpigmentation, rashes and inflammation. On a deeper level, this may cause cross-linking of collagen and elastin, damage to the DNA, and tissue degradation, just to name a few symptoms. Unfortunately, as we age, freeradical damage accumulates. Cosmetic formulators compare the composition of younger and older skin and try to discover new formulas with active ingredients that mimic younger skin. Many anti-aging formulas contain sunscreens, for example, to minimize the damaging effect of ultraviolet light on skin. Formulas may also contain retinol and other active ingredients to reduce the appearance of lines, along with anti-irritants such as the vitamin panthenol. Nutritional supplements and even foods are considered potential new skin care ingredients. Some are believed to have greater efficacy when applied to the skin than when they are eaten and digested. A difficulty for formulators of cosmetics that boast wrinkle-easing properties or antioxidant effects is designing effective delivery systems for the most beneficial ingredients. Ingredients have to remain stable in the bottle and then must penetrate the skin under a variety of conditions. Putting a delivery system together must get the ingredients into the stratum corneum at the right time and deliver the ingredient at the optimum rate. More important is choosing an emollient system appropriate for the ingredient to make sure the ingredient can penetrate the skin. Some ingredients are difficult to preserve long enough to be useful when a consumer opens and uses a formula that may have been sitting on a shelf for a year. Sunscreen active ingredients like avobenzone and octyl methoxycinnamate, vitamins like retinol and vitamin E, and ß-carotene are not very stable in a bottle. If the skin is not protected by sunscreens, reactive oxygen is generated by exposure to ultraviolet radiation, which causes oxidative damage to DNA, collagen, elastin and lipids within the skin, leading to wrinkles. The use of antioxidants prevents this from happening. If a formulation is designed correctly, it can actually slow skin aging. Because there are many skin types, a formula may work well with one skin type but not another. Only testing with consumers will tell whether a product really provides benefits. The hair Like other mammals, humans are covered by hair. Human body hair, however, is much finer than that of our nonhuman relatives, and is concentrated Page 5

8 primarily on our heads, underarms and genital regions. Most men, and some women, also have hair on their faces. Each hair grows from an individual follicle that is adjacent to a sebaceous gland. Sebaceous glands produce sebum, which moisturizes skin and hair and is a barrier to toxins. Sebum also manufactures the body s vitamin D, triggered by exposure to the sun. Hair is an outgrowth of skin but provides no sense of feeling because it lacks nerve endings. It is made up of the protein keratin (also found in skin and nails), which is formed by the joining of amino acids. Because acids join at some places along the protein chain, keratin is relatively resistant to change. The chemical make-up of hair also contains carbon, hydrogen, nitrogen, sulfur and oxygen. A nerve ending surrounds the bulb of each hair follicle. Glands secrete an oily substance directly onto the hair follicle, lubricating the hair shaft. Hair is composed of cells arranged in three layers: the cuticle, the cortex and the medulla. The cuticle is the outside layer, composed of transparent, scale-like cells. Certain chemicals cause these scales to swell and open so solutions such as chemical relaxers, hair color or permanent wave solutions can enter. The cortex is the inner layer of cells that give hair its strength. It is composed of numerous parallel fibers of hard keratin. These fibers are twisted around one another like a rope. This layer gives hair its color. Within each cortical cell are the many fibrils, running parallel to the fiber axis, and between the fibrils is a softer material called the matrix. It grows from a hair follicle. The medulla is the innermost layer and is composed of round cells. Medulla cells may be absent in people with very fine hair. The cuticle is responsible for much of the strength of the hair fiber. Human hair typically has 6-8 scale-shaped layers of cuticle. Wool has only one, and other animal hair may have many more layers. Hair responds to its environment and to its mechanical and chemical history. For example, hair that is wetted, styled and then dried acquires a temporary set that holds a style. This style is lost when the hair gets wet again. For more permanent styling, chemical treatments (perms) break and re-form the disulphide links within the hair structure. In people of European descent, blond hair and black hair are at the finer end of the scale, while red hair is the coarsest. The hair of people of Asian descent is typically coarser than the hair of other groups. Hair with a round cross-section will fall straight as opposed to curly hair, which has a flat cross-section. The cross-sectional shape of human hair is typically round in people of Asian descent, round to oval in European descent, and nearly flat in African peoples; it is that flatness which creates frizz. In contrast, hair that has a round cross section will be straight. Cells at the base of the hair follicle divide and grow extremely rapidly. A single strand of human hair can hold approximately 100 g (3.5 oz) of weight, although this will vary greatly with thickness. Wet hair, however, is very fragile. Page 6 The following section discusses common conditions of the hair and scalp, part of the integumentary system. Use it to develop workplace guidelines for recognizing potential health risks, and determining when and how to proceed with service or whether you should proceed at all. This information is not meant to be used for selfdiagnosis or as a substitute for consultation with a health care provider. If you have any questions or concerns about the conditions or diseases described below, consult a health care provider. Disorders of the hair and scalp The condition and appearance of the hair and scalp are influenced by many factors, including physical health, nutrition, blood circulation, emotional state, function of the endocrine glands, and medications consumed. Common disorders of the hair and scalp include vegetable and animal parasitic infections, staphylococci infections, which cause furuncles (boils), and the following conditions, which may affect the hair follicle and sebaceous glands. Alopecia is the formal term for any abnormal hair loss. It should not be confused with natural hair loss, which occurs when the hair has grown to its full length, falls out and is replaced by a new hair. Alopecia senilis is hair loss associated with old age, alopecia prematura may occur any time before middle age, and is characterized by slow thinning over time. Alopecia areata is relatively sudden, patchy hair loss, including the spotty baldness that is associated with anemia and typhoid fever, among other conditions. Tension alopecia is caused by tight braiding or hairstyles that pull the hair s roots. Canities is the formal term for gray hair, which is caused by the loss of pigment. Acquired canites is usually associated with aging, while congenital canites, a condition existing at birth, includes albinism. Dandruff (or pityriasis) is a condition in which small white flakes or scales appear on the scalp and hair. Excessive dandruff can lead to baldness if the condition is severe and neglected. Dandruff may be caused by microbial infection, poor circulation, nerve stimulation or diet, and may be associated with specific shampoos or insufficient rinsing of shampoos. Pityriasis capitis simplex, or drytype dandruff, is characterized by an itchy scalp and white scales scattered throughout the hair. Pityriasis steatoides, a greasy or waxy type of dandruff, is characterized by a scaly skin surface mixed with sebum, and may include bleeding or oozing of the sebum when scales tear off. Refer the client to a physician for medical attention. Dandruff is considered contagious and may spread through the common use of brushes, hair clips or styling implements. Tinea capitis (ringworm) is a fungal infection that forms a scaly, ring-like lesion on the scalp. It is highly contagious. Hair loss occurs naturally as part of hair growth and regeneration. In women, childbirth, crash dieting, emotional stress and shock can cause greater than normal hair loss, though it is usually temporary. Some older women experience female-pattern hair loss with thinning of the crown and hairline. Drugs used in cancer chemotherapy frequently cause a temporary loss of hair, noticeable on the head and eyebrows, because they kill all rapidly dividing cells, not just the cancerous ones. Other diseases and traumas can cause temporary or permanent loss of hair, generally or in patches. Hirsutism (or hypertrichosis) is excess hair on the body. Genetic background and age can impact how much hair a woman has on the cheeks, upper lip, arms and legs. There are a variety of methods to cope with unwanted hair, such as tweezing, waxing, shaving, bleaching, depilatories and electrolysis. Electrolysis is the only permanent hair-removal method, and is typically among the most expensive and timeconsuming means of removal. Trichorrhexis nodosa, or knotted hair, is characterized by dry, brittle hair with nodular swellings along the length of the hair shaft. Hair breaks easily, but the condition may be remedied somewhat by conditioners. Fragilitas crinium is the formal term for brittle hair, which may include split ends. Conditioners may improve hair flexibility. Trichoptilosis is the formal term for split ends. Monilethrix is the formal term for beaded hair, which breaks between the nodes or beads. Hair and scalp treatments may prove helpful. Changes in the hair Women may experience changes in their hair during pregnancy. In most cases, these changes are temporary and the hair will return to its original condition after the birth. Hirsutism, or excessive hair growth, can appear on the face and chest because of hormonal changes experienced during pregnancy. Within six months after giving birth, this condition generally dissipates. Telogen effluvium refers to excessive hair loss that occurs within five months after pregnancy. This condition does not cause permanent hair loss or baldness, typically returning to normal after six to 12 weeks. Hair color change is probably one of the most obvious signs of aging. Hair color is caused by a pigment (melanin) produced by hair follicles. With aging, the follicle produces less melanin. Graying often begins in the 30s, although this varies widely. Graying usually begins at the temples and extends to the top of the scalp. Hair becomes progressively lighter, eventually turning white. Many people have some gray scalp hair by the time they are in their 40s. Body and facial hair also turn gray, but usually later than scalp hair. The hair in the armpit, chest and pubic area may gray less or not at all. Graying is genetically determined. Gray hair tends to occur earlier in Caucasians and later in Asian races. Nutritional supplements, vitamins and other products will not stop or decrease the rate of graying. Both blond hair and darker hair may turn green after prolonged exposure to chlorine in swimming pools or hot tubs. Usually, the problem is associated with concentrations of copper dissolved in the pool water, which can chemically