CHAPTER 1 The culture in the United States did not emphasize in their experience. Some, however, do train these TURN BACK THE Clock: the importance of the care of one’s skin and skills but may only train very basic information the need for regular professional cleansing as that is insufficient to support good decisions. A few Exfoliation, Resurfacing and the European culture did. Even now, with the schools do train the topic well, and hopefully you Peels awakening interest in skin care, few American attended one of them. Which category did your (4 CE Hours) women are committed to the professional school fit into? Were you one of the rare estheticians cleansing of their skin, and few schedule routine who received great information and were taught Learning objectives: facials. Until recent years, only a few Americans good skills to treat aging? ! ! Distinguish between esthetic and medical- even knew what the word “esthetics” meant or Estheticians hired without sufficient skills in level acid treatments. even how to spell it. Then, in the 1980s, affluent ! anti-aging treatments are apprehensive and poorly ! Define each: exfoliation, resurfacing and peels. women became interested in the relaxation ! prepared and sometimes make dangerous decisions ! Describe the actions of the skin after resurfacing. element of professional skin care, and a market ! concerning treatments for these conditions. As ! State the benefits of exfoliation, resurfacing was developed for that type of treatment. But it time passes, the situation may not change, sadly, and peels. was not a large market and financially supported ! as many of you will not be exposed to a structured ! Describe microdermabrasion. few beauty professionals. However, the market ! training program. So what are you to do as a new ! State the recommendations of the Cosmetic was maturing, and in the ’80s and ’90s, skin care esthetician if your spa does not have excellent Ingredient Review Board on alpha hydroxy acids. courses began being developed in many states for ! training in anti-aging? You must seek out your ! List the five most frequently used alpha a specialty license. Now, the only state without a own training to ensure the safety of your clients. hydroxy acids in esthetic skin care. specialty esthetics license is Connecticut. !! Discuss the advantageous of buffers in This course will address this topic for those Baby boomers, those persons born post-World resurfacer products. of you just out of a school who have not been War II between 1945 and 1964, are changing the !! Compare and contrast resurfacers with peels. provided the information and for those who landscape and cultures of the world. Included in !! List the categories of peels. have not found the information available to this change was the outlook of women in the U.S. !! Describe the effects of exfoliants, resurfacers them during their practice of esthetics. You who towards skin care. Slowly, it became a part of and peels on the layers of the skin. are already knowledgeable and experienced in American women’s preferred treatments. !! State why a series is important in the use of AHA these topics will find this course will refresh and treatments and microdermabrasion for anti-aging. Many North American boomers grew up in reinforce the proper techniques you presently !! The skin is exposed to different kinds of a time of relative affluence as the American perform and may contain some new information sunrays. List them. economy turned from war to growth; for the most to which you have not been exposed. The overall !! State the labeling requirements for SPF part, their prime working years were a time of function of this course is to 1) enhance your products concerning the measurement of each prosperity. These 76 million people who once confidence in these important topics, 2) elevate type of sunray. aspired to change the world are now reaching your knowledge, and 3) to ultimately ensure !! List and describe the purpose of two types of retirement age, and they are indeed changing the the safety of the clients who experience these SPF ingredients. look and lifestyle of retirement and advancing treatments under your recommendations. age. Many remain physically active, and they Introduction: Evolving American esthetics have adopted healthy lifestyles. They want to As in all personal care industries, skin care has think, act and look as young as they feel. States that support changed over time. Initially, it was a European By 2000, the media was whetting the appetites advanced training treatment performed by European-trained of American boomers for information on how to Two states, Utah and Virginia, have beauty therapists. It’s been said that European look their best and control fine lines and wrinkles. women consider the condition of their skin more bi-level training available for their Many began seeking out professional anti-aging important than women in America, and that estheticians. The first level trains basic treatments for what came to be called “results- they make appointments for their skin cleansing anatomy, physiology, chemistry and oriented” skin care, treatments that were designed more often than they do their haircut. As a esthetic and relaxation treatments, the to reduce the signs of aging. These people are result, the training in Europe for estheticians important basic knowledge estheticians insisting on remaining young and active; the old was and still is longer, lasting years instead of look and perception of aging is not an option they need to support taking the licensure months as in the U.S., and requires internships will accept without a fight. exam in their state. The second level and other specialized training. In addition, it is course trains the more advanced skills, Now skin care has become ingrained in the completely separate from hair design. Skin care those that actually can change the skin, is considered a more personal service, closer to culture of the United States, with sales of skin being a medical treatment than hair design, and care products over $10 billion in 2009. The such as exfoliation, resurfacing, peels is taught in a semi-medical-clinical environment. children of boomers are already seeking anti- and microdermabrasion. Estheticians The U.S. esthetic industry began much later aging treatments, some as young as their 20s, in these states are not allowed to than the European industry, and most of the first and they are looking for the best professional perform these skills without this estheticians in the U.S. were European-trained they can find. For that reason, you must be fully advanced training. professionals that brought their skills and services knowledgeable in the products and treatments to the American public. available and how they can be optimally used to achieve the results these clients want and expect. Few professionals in the U.S. beauty industry Chemical peels specialized in skin care before the 1980s, and if Information on the treatment of aging is rarely When considering anti-aging treatments, as they did, for lack of an appropriate professional taught in cosmetology schools in the U.S., though an esthetician you think of peels as the pivotal license, the states required them to have a license it is the most sought after treatment in the skin care treatment for anti-aging. Peels are not a new in cosmetology. Sadly, the skin care training in industry. Many schools are allotted too few hours in treatment concept; they go back to Ancient Rome cosmetology courses was and still is very short, their skin care program by the legislatures to train and the Middle East since before the time of a mere week or two and at most three, and the the assigned information, so it is difficult for them to Cleopatra. This infamous queen of Egypt used training is usually in how to perform a basic (or get even the basic program into the required hours. lactic acid (found in sour milk) and tartaric acid cleansing) facial; no program includes sufficient Other schools believe information on anti-aging (found in wine) to give herself mild chemical training in skin analysis and in how to design a is considered advanced topics and skills, beyond peels, and noble women followed her example. treatment plan. what their students should be learning this early The practice was passed down through the www.elitecme.com Page 1 Middle Ages as the women of those times indeed where peeling is legal for estheticians to perform. People with the following conditions also wanted beautiful skin. They are very effective without the pain of the should not undergo peels or resurfacing: In the late 1800s, these treatments were performed deeper peels. ▪▪ Pregnant/lactating. with “secret beauty formulas” by mystical beauty Medium depth chemical peels create an injury ▪▪ Herpes simplex. therapists, though the formulas were probably that extends through the epidermis into the ▪▪ Current or very recent sunburn. still similar to those of Cleopatra. These skin superficial portion of the dermis (upper reticular ▪▪ Autoimmune disease. improvements were popular among the affluent, dermis). In proper hands, these peels are very ▪▪ Recent chemotherapy. and the formulas for the products remained the effective for the conditions that affect these areas ▪▪ Recent radiation therapy. ® secret of the beauty therapists to the wealthy. of the skin. Due to their immediate improvement, ▪▪ Use of Accutane or similar medication Modern scientists now know that the sour milk the therapeutic effects of medium-depth chemical within one year. (lactic acid) and wine (tartaric acid) that Cleopatra peels go far beyond what can be achieved with ▪▪ Use of retinoid products or similar and her descendants passed down through the superficial peels and as such are selected by medications within one year. ages contain alpha hydroxy acids, ingredients that patients who are willing to go though more pain ▪▪ A tendency for keloids. have been studied by hundreds of laboratories and for faster results. These peels can be repeated ▪▪ A recent laser procedure. universities and have become stable and respected about four months apart until the desired goal is ▪▪ Immunosuppression. ingredients. These acids are used today in effective achieved to the maximum of three treatments. ▪▪ Organ transplants. esthetic-level chemical peels. With medium-depth chemical peels, there is Application of peels Physicians developed aggressive chemical peels partial or complete removal of the epidermis The use of Retin A™ and like products in and performed them for decades in the 1900s. through desquamation. This leads to skin healing pretreatment protocols deepens any peel and can Some had serious side effects that could require mechanisms that are partly responsible for cause higher irritation responses. While physical- medical care if the client reaction was extreme. achieving the final result of new, smoother and level protocols performed under the supervision No longer were these peels safe to be performed more beautiful skin. These impressive results do of a physician many times include it in their by non-medical persons. Thankfully, more recent not come without risks. Skin irritation, infection, pretreatment protocol, estheticians should not in medical-only peels are safer and effective but still scarring, milia formation, herpes, worsening their treatments and should require the client to have potentially serious side effects that cause of the treated problem as well as pigmentary have been off the products for a year. their use to remain medical-only level care. abnormalities (hyper- and hypo-pigmentation) are the most common problems that are a result of a Application of peels should be trained hands-on Categories of peels medium-depth chemical peel gone wrong. by a highly experienced trainer who knows all the The words “chemical peels” became an inaccurate variables and how to deal with them. Therefore, Deep chemical peels create an injury that industry and consumer label of a loosely defined the how-to will not be discussed in this course. extends though the epidermis to the mid portion class of beauty treatments that includes alpha of the dermis (mid-reticular dermis or upper hydroxy acids (30 percent) that do not peel. Scope of practice papillary dermis). This category of peels includes Chemical peeling is a procedure in which an acid The regulatory agencies in each state define the phenol as well as Baker-Gordon formula. They mixture is applied to the skin and is allowed to treatments that can be performed by their licensed produce dramatic results. Few physicians are soak in until the skin is burned to some degree. professionals within the legal boundaries of trained to perform deep peels now because of The acid is then removed, and the injured regulations passed by their state legislature. This the introduction of lasers that compete with skin begins to peel off, whether in sheets or in agency can withdraw or suspend a professional’s deep chemical peels in their results with a much epidermal rolling, revealing newer, smoother license or assign penalties and fees if treatments higher safety margin and improved control of skin. Chemical peels are categorized according are performed outside these boundaries of care. the depth. The most important disadvantage of to their effects on the epidermis and dermis. Though a few states do not regulate peels, they deep chemical peels is that they have a narrow Realize, however, that some acid treatments do are generally thought to be outside the scope safety margin, and the risk of complications is not injure or coagulate cells to produce roll-off or of practice of estheticians because of their substantial. There is no longer a reason for their peeling; these are not peels, they are resurfacers or potential for damage, infection and scarring use even in the physician’s office. However, you exfoliants and will be discussed later. when performed incorrectly. Most skin care need to know about these products so you can professionals who perform peels that are beyond Very superficial peels create an injury only to explain them if clients ask questions. the scope of practice for them are usually not the epidermis, and they are recommended for adequately trained. You need to know also that if a the treatment of skin conditions that primarily Considerations with all peels client is damaged when a professional is working affect the upper epidermis. They rejuvenate the ▪▪ Patients must stay out of the sun for at least a illegally, a protective policy can be deemed void epidermis by rolling off the outer stratum corneum week after the peel. If they must go out, they by the insurance company who holds the policy. and occasionally more layers, but never to the must wear a wide-brimmed hat to shade their level of the basal layer. They peel off this outer face and to protect any other treated areas. Phenol – a deep peel layer to reveal newer, more youthful looking skin, ▪▪ The patient must always wear a broad- Phenol is the strongest of the peel solutions skin that has a higher glow and smoothness. Low spectrum sunscreen after the first weeks of currently used, though rarely, and produces a percentages of the usual higher-level peels or low recovery. The skin will still be healing for deep peel. It is used mainly to treat patients with concentrations of them combined with AHAs can several weeks, and during that time, it will be the most deep and obvious facial wrinkles, areas produce this rolling effect. vulnerable to hyperpigmentation. of hyperpigmentation, damaged skin caused by ▪▪ Patient must use moisturizers sparingly Superficial chemical peels create an injury to sun exposure and pre-cancerous growths. immediately after the peel because they only the epidermis and they are recommended can diminish the effectiveness of the peel. Phenol provides a relatively deep though for the treatment of skin conditions that Moisturizers can and should be applied somewhat predictable injury to the dermis, and primarily affect the epidermis. Conditions such when the skin becomes cracked and peeling, then the patient goes through the peel process. as acne, actinic keratosis, epidermal melasma however, to prevent scarring. The phenol considered “pure” is 88 percent (discoloration of the skin), superficial wrinkling ▪▪ When peel solution is on the skin, it stings phenol. This is a serious peel. The few physicians (fine lines) as well as mild photo-damage can and burns. A small, hand-held mechanical fan who still perform phenol peels provide minor benefit from properly selected and applied held by the patient is recommended to reduce sedation before application. The patient’s vital superficial chemical peels. This level of peels is the discomfort. signs must be monitored while the solution is on usually performed in esthetic skin care rooms

Page 2 www.elitecme.com the skin. The physician may prescribe post-peel TCA. Generally, this peel is performed in a 1-2 Preconditioning for TCA peel pain medication for relief of the initial pain. layer process. Retin A™ and similar prescription-only Phenol peels have notable risks, so its use is The results of a TCA peel are less dramatic than medication derived from Vitamin A may be used definitely restricted to medical-level only. Use the phenol peel and are not permanent like those to pretreat some skin types in medical level peels; of this product is beyond the scope of practice of a phenol peel. The results, however, are very other products are in the regimen, though the of an esthetician. pleasing for most patients willing to go through a specific products vary among physicians who desquamation process. perform peels. The patient uses the products as Considerations with phenol: home care as prescribed for a set amount of time Below 17 percent and at one layer it is ▪▪ It can be only used on the face; use on the before scheduling the peel. considered a resurfacer and should not produce neck and body can produce scaring. desquamation, merely flaking. The 12 percent The amount of pretreatment time is defined ▪▪ Only Fitzpatrick Scale patients from I-III TCA is now a popular resurfacer, and in some according to the Fitzpatrick Scale of the skin. are recommended for its application; it states is legal for estheticians to perform. (See Fitzpatrick Phototyping Classification is not suggested for use on dark-skinned When used above the percentage of 17 percent, Scale later in this course.) The patient may have individuals. (See Glogau and Fitzpatrick it is considered a medical-only level peel at to spend four to six weeks in the pretreatment scales later in this course.) medium-depth and produces the same peeling phase before the doctor will schedule the actual ▪▪ The skin is red and flushing immediately response as phenol but takes far less time to heal. peel, and resurfacing treatments also may be following the peel. Experts vary on the percentage above which it performed during that time to further prepare ▪▪ It sometimes permanently lightens the treated is considered a peel, but realistically it is at the the skin. Preconditioning before medical-level areas, and that is a consideration in its choice. percentage at which it stimulates the peeling peels improves the overall health of the skin and ▪▪ The procedure may pose a risk for patients response. Of course, two layers will be a deeper thins out the stratum corneum allowing the TCA with heart problems; deaths have been peel than a one-layer peel. solution to penetrate more deeply and evenly into reported during a phenol peel. the lower layers of the epidermis and into the ▪▪ Recovery may be slow, and complete healing Contraindications dermis to the desired level. may take as long as six months. ▪▪ Herpes simplex or active infection. If the patient’s skin will not tolerate Retin-A™ ▪▪ This peel may permanently remove facial ▪▪ Pregnancy. or similar products and it responds quickly freckles and discolorations due to damage ▪▪ Breast-feeding. with erythema, the physician may change and desquamation of the melanocytes. ▪▪ Obsessive pickers. the preconditioning product to an AHA, an ▪▪ The new skin frequently loses its ability to alternative ingredient. The erythema response by make pigment (such as a tan). Clients with a history of herpes simplex must the skin requires lengthening of the pretreatment ▪▪ It removes pre-cancerous lesions (keratosis); call their physicians for a prescription for time to allow the skin to become stronger and it does not treat cancerous growths. prophylactic medication to start before having healthier because it indicates there may be a more ▪▪ High SPF products must always be used by the peel. Allowing the development of herpes can intense post-peel irritation. the client when the treated area is exposed to produce severe scaring and a spread of the area infected by the virus. the sun or hyperpigmentation develops. Peeling process ▪▪ Permanent lines of demarcation may develop, The occurrence of frosting during the peel many times at the junction of the facial and Considerations with TCA: treatment process indicates at that point the neck skin below the mandible and at the ▪▪ It can be used on neck or other body areas reaction to the peel is complete. Careful feathering hairline if not properly applied. with few problems. of the solution into the hairline and around the ▪▪ The patient cannot drive immediately following ▪▪ A preconditioning regimen will usually be set rim of the jaw and brow by an experienced the peel. Monitoring by a companion is by physicians. professional can eliminate the line demarcation suggested for 1-2 days following the peel. ▪▪ The one-layer TCA treatment takes only 10- 15 minutes for application. between peeled and non-peeled areas. The perioral Trichloroacetic acid (TCA) ▪▪ It is preferred for darker-skinned patients area requires an even application of solution over the skin, but not over the vermilion border. Trichloroacetic acid (TCA) can be used in many (Fitz IV) over phenol. concentrations, and is usually used in 12-35 ▪▪ The peel depth can be adjusted by using lower The affected areas of a peel do not release from percent concentrations. TCA patients can develop percentages of the chemical in the solution. the skin all at the same time, with the movement complications, especially scarring, in strengths ▪▪ Sunscreen must be used after this peel to areas first, such as around the mouth and eyes, of 50 percent or higher, so the percentage used prevent discoloration or hyperpigmentation. and usually the neck and forehead last. By the is usually 25-35 percent for medium-depth ▪▪ Healing is much quicker than with a phenol 1960s and 1970s, dermatologists were looking peeling. It is the most commonly used product peel, with full healing in 7-10 days, although for other peeling agents they could use to perform among those who perform medium-depth peels. redness may remain. Some clients heal more superficial chemical peels because the side Fine surface wrinkles, superficial blemishes and quicker than others. effects of their current peels were sometimes pigment problems are commonly treated with ▪▪ A TCA peel may cause edema (swelling), severe. Among those were the Jessner’s and depending on the strength of the peel used the modified Jessner’s peels. Following is a and the patient’s skin. discussion of these peeling agents. ▪▪ The individual must be told to assume he or Safer TCA formulas she will not want to be out in public for 5-7 Jessner’s peel TCA is now being combined in days, longer with some patients and more The Jessner’s and modified Jessner’s are not much lower percentages with than one layer. timed applications; they are self-neutralizing in resurfacing-level chemicals to ▪▪ The recovery can also be dependent on the about four minutes between applications. The achieve resurfacing, not peeling, percentage of the chemical in the peel. TCA peel at any percentage must be neutralized and to incorporate some of the ▪▪ TCA is usually applied in 1-2 layers in a to prevent it from progressing deeper than safety TCA capabilities, such as effective medical-level percentage in a physician’s allows. This is usually performed with a cool treatment of hyperpigmentation. office, and one layer in a lower percentage in water rinse (no wiping motions allowed). an esthetic-level setting. These formulas are designed to allow The Jessner’s is a medium-depth peel designed ▪▪ TCA peels are usually done more than once for more extensive peeling than AHA’s but less safe use by estheticians. four months apart to achieve the desired than phenol or TCA. It is a solution of 17 percent results, stopping at 3-4. www.elitecme.com Page 3 As with the traditional Jessner’s peel, this peel and they soon were adopted as safe for the Ask your client varies in the amount of desquamation according esthetic skin care room. (See Developing AHAs) to the number of layers applied. The number of The definitions of exfoliation, resurfacing and Always ask potential peel or resurfacer layers in a modified Jessner’s usually is from 1-6, peels are pertinent to a professional’s outlook in clients if their skin turns dark easily with the esthetic level being maximum 4 by an the use of AHAs. Following are the definitions. following injury, acne or insect extremely experienced esthetician; most wisely do Exfoliation of the skin is the physical (mechanical) bites. This indicates a tendency to not layer over 2. (Some states limit the layering and chemical removal of loose, dead epidermal hyperpigment, and these clients need to 2.) Training, experience and layering provides cells and debris from the surface of the skin to to precondition for an extensive time. optimal control of the depth of the peel. The smooth the surface of the skin. Physical/mechanical number of layers allowed for estheticians to apply exfoliation will be performed with products such as is stated in some state regulations and others will scrubs. Enzymes are the chemical exfoliate. salicylic acid (a beta hydroxy acid), 17 percent not allow this peel to be performed. For your own lactic acid (an alpha hydroxy acid) 17 percent protection, check your state regulations. Resurfacing is performed chemically and resorcinol, usually antioxidants and inactive mechanically by influencing the speed of the The numbers of layers also determine whether turnover of cells in the epidermis of the skin. ingredients. Resorcinol is a derivative of phenol, the treatment is a resurfacer or peel. A single though without most of its problems. Resurfacing is performed with chemicals such layer of the modified Jessner’s and TCA 10 as alpha hydroxy acids 30-40 percent and by The Jessner’s peel is tolerated well by all traditional percent may initiate flaking (resurfacing), microdermabrasion. Resurfacing by AHAs and skin types, though the patient’s Fitzpatrick while multiple layers will cause desquamation microdermabrasion stimulates the turnover of Phototyping Scale should be considered in the of the skin. For that reason, these peels can be cells in the epidermis and the development of potential for hyperpigmentation. It is effective in superficial or medium-depth peels. With more collagen and elastin in the dermal layer of the desquamation of the face, neck, hands and upper than one layer, in about two days, the skin will skin. Beta hydroxy acid (salicylic acid) stimulates chest. It works well for patients with acne or oily darken to a dark tan and crack first in the areas the turnover of cells in the epidermis but is not skin because it tends to decrease oil production around the mouth and eyes, the areas of the most shown to stimulate the development of collagen and opens clogged sebaceous follicles. It also movement. Then it will begin to peel in sheets, and elastin in the dermis. Resurfacing does not contributes to the healing process of acne through with completion in approximately seven days cause desquamation (peeling). its anti-bacterial activity against Propionibacterium post-peel. [Root, pg 55] acnes, the causative bacteria in acne vulgaris. Chemical resurfacing is chemical softening of the Post-peel intercellular adhesives that retain dead cells to As with all peels and AHA treatments, Education of the client must be performed before the surface of the skin (epidermis). The cells then preconditioning is important for Jessner’s the peel, and post-peel instructions should be more quickly slough from (are released from) the patients. (For a discussion of preconditioning, written and given to the client. Be certain the surface naturally and reveal more youthful skin. see Preconditioning of the skin,) The length of papers are in the client’s possession in a familiar Chemical peels coagulate the protein in the cells time in preconditioning is determined by the place to the client. Tell clients that their skin will Fitzpatrick Scale of the patient; the higher the of the epidermis and possibly the dermis to cause sting, and that they must be ready to tolerate it death and peeling of the cells. Fitzpatrick, the longer the preconditioning. (See from TCA for 20-30 minutes and for Jessner’s Fitzpatrick Phototyping Classification Scale). No and modified Jessner’s, about four minutes With these definitions, you see the differences sedation is needed for a Jessner’s patient. between each layer. Immediately following a among the acids, their effect on the surface and the peel, the skin will be red and flushed. dermis and can understand that estheticians should Modified Jessner’s not perform treatments that have downtime. Modified Jessner’s peel is a blend of 14 percent Your clients should never pick or pull on the salicylic acid, 14 percent lactic acid and 14 percent flaking or peeling skin during healing because Effects on the layers of the skin citric acid. As with the traditional Jessner’s, some it can cause infection to spread all over the face The typical exfoliants, resurfacers and peels will manufacturers include lighteners or brighteners and then cause scarring. They should also avoid have specific effects on the skin and downtime such as hydroquinone, kojic acid, azelaic acid or sun exposure and sweating – which cancels out or none. If you know how the product is others to counter hyperpigmentation in the process. exercise. Moisturizer can be applied to the peeled categorized, you will know what to tell the client It is recommended for light to medium Fitzpatrick skin or a calming serum applied, but only the about what to expect. skin types (1-3). This peel is indicated for the ones suggested or approved by the physician and treatment of hyperpigmentation, acne scars, acne only in the timing he or she directs. Epidermis Dermis Downtime and general sun damage. It achieves desquamation Moisturizing as directed with the proper product Exfoliation x x x and normalization of the keratinization process for will heal these areas more quickly and lessen Resurfacers x x thick, oily and acneic skin and reduces the amount cracking and bleeding, which can scar newly of comedones, pustules and inflammation. uncovered skin. Warn patients their skin may Peels x The development of this peel is credited to burn a little when they apply the moisturizer or Margaret Ancira, CEO of Physicians Choice, serum on their raw skin. It is extremely important Scottsdale, Arizona, who has an esthetician that they follow closely the recommendations of background and worked extensively with a physician when having a medium peel. About Jessner’s The Jessner’s and Modified Jessner’s physicians. Replacing the resorcinol with citric Most physicians will have the patient return on the acid avoids the potentials for allergic reactions second and fifth days for a check on the progress of are not timed applications; they are that developed when resorcinol was repeatedly healing. If appropriate, some will have a treatment self-neutralizing in about four minutes used in a peel. In researching this peel, you will that will speed up the removal of dead skin. between applications. The TCA peel find many variations in the chemical that replaces at any percentage must be neutralized resorcinol, and in the stated percentages; these Exfoliation, resurfacing and peels defined to prevent it from progressing deeper are the original ingredients and percentages of Reality is that the development of chemical than safety allows. This is usually the modified Jessner’s peel. Any variation in esthetic-level acid treatments was a major performed with a cool water rinse (no ingredients and percentages will change the influence in the birth of American skin care wiping motions allowed). effects of the peel. Know your product well and profession. The research in AHAs by Drs. Eugene the implications of the ingredients. Van Scot and Ruey Yu raised interest in AHAs,

Page 4 www.elitecme.com Exfoliation ▪▪ Rejuvenates the dermal layer through ▪▪ Smooth and rejuvenate the skin. Generally, exfoliation does the following: stimulation of the collagen and elastin. ▪▪ Has no recovery time. ▪▪ Softens the skin. ▪▪ Produces more even tones, and more taut, ▪▪ Great dual modality with LED. moist and softer skin. ▪▪ Enhances penetration of the treatment products. Non-series treatments can: ▪▪ Enhances moisturization. ▪▪ Provides a glow to the skin. ▪▪ Awaken dull and lethargic skin to bring a new ▪▪ Enhances appearance of the skin. glow to the surface – clients who have been ▪▪ Enhances the natural process of cell release. Microdermabrasion exfoliation or ill or have otherwise developed dull skin can resurfacing Scrubs awaken it with a microdermabrasion treatment. Microdermabrasion is the physical removal of Scrubs perform a physical exfoliation through ▪▪ Maintain open pores for a controlled acne surface cells from the epidermis with a vacuum mechanical removal of surface cells and debris client – clients with no open lesions or black system that works in concert with a delivery system with some residual stimulation of the turnover heads can keep the surface of their pores of particles to aspirate used particles and dislodged of cells by removal of surface cells and there is a open through microdermabrasion. tissue debris, which is deposited in a used material moisturization response by intercellular materials. ▪▪ Brighten skin for an event – an “event facial” container. It is a technologically proven exfoliation Scrubs produce a smoothing of the surface and – that can be on the menu to brighten skin to and resurfacing treatment that has no side effects especially enable products to better penetrate the a glow before a special event. when performed by a trained skin care professional. skin. They are used in home care and in the deep ▪▪ Anti-aging maintenance – the cleansing step of facials. The stimulation of the dermis is thought to be microdermabrasion treatment can be used due to the physical action of the suction and the monthly in a post-peel, laser and resurfacing It has been found that natural ingredients with percussion of the particles. to maintain treatment results. sharp edges, such as walnut hulls, can cause miniscule scratches on the skin, a cause of aging. Whether the microdermabrasion treatment is Microdermabrasion precautions The best ingredients are rounded particles; exfoliation or resurfacing is defined by how many Should not be used on patients who have taken examples are polyethylene beads and jojoba beads. passes are made over the face, how aggressive the medications Retina A, Accutane® or similar the suction in the hand piece is and how slow the products in the previous 12 months: Enzymes hand piece is passed across the face. Control of ▪▪ Had waxing of the area in the last 24 hours. Enzymes produce an exfoliation of the surface of this is through control of the suction and speed of ▪▪ Have active acne. the skin. The enzyme products are usually masks the hand piece in the hand of the esthetician. ▪▪ Have brittle diabetes. for use during the deep cleansing step of a facial, ▪▪ Have viral lesions, including herpetic even before an AHA treatment, and in cleansers Development of microdermabrasion breakouts and shingles. or can be a major mask in a cleansing facial. The original microdermabrasion, called open ▪▪ Have used oral blood thinners (Coumadin or The masks are mix-at-the-chair of an accelerator microdermabrasion, was invented in Europe in aspirin therapy). and powdered enzyme or a lotion mask applied the 1930s to treat hypo- and hyperpigmentation ▪▪ Are long-term steroid users (Prednisone). directly to the skin. The enzymes usually are and scarring. The debris was not vacuumed ▪▪ Had pretreatment before resurfacing series activated by steam or water and are active for 5-7 away, so the emergence of HIV and the rise in or peels. minutes and then removed. hepatitis B resulted in a redesign to the closed microdermabrasion machine in the 1980s. The Pregnancy is not a contraindication, though results were more controlled, so the treatment physicians generally suggest it not be performed on By another name became simply microdermabrasion. In 1996, it new clients in the first trimester of the pregnancy. A scrub with more or larger exfoliating was approved by the Federal Drug Administration Alpha hydroxy acids in the United States, and by 2000, it was a staple beads is sometimes called “manual These special acids (see below) stimulate the treatment in skin care rooms for anti-aging. microdermabrasion,” but reality is that turnover of cells and are the base stimulus of the the product is still only a scrub. The particles were originally only aluminum surge in the skin care industry in the U.S. carbide. Now there are non-particle machines that in principal are diamond exfoliants on the Development of AHAs The enzymes most used in our industry in beauty ends of a suction wand. Salt is an example of Drs. Eugene Van Scott and Ruey Yu are products are pepain from papaya fruit and natural particles. internationally recognized for performing the bromelain from pineapple. These are proteolyic groundbreaking research showing alpha hydroxy enzymes that appear to digest proteins by breaking Microderm series acids (AHAs) have profound and beneficial effect their long, chainlike molecules of proteins into This treatment has multiple uses in anti-aging on human skin. Since their discovery, scientists shorter fragments (peptides) and eventually treatments, prevention of aging, in acne treatment, all over the world have researched and studied into their components, amino acids. Papayas preparation for series, and in exfoliation and AHAs to find out how they work and what they and pineapples are nature’s safest sources of resurfacing. It also treats keratinized skin, do to the skin. This research in universities proteolytic enzymes (capable of the breakdown of asphyxiated skin, dehydrated skin and can and laboratories shows this group of chemicals proteins or peptides into amino acids). jump-start home care; it can be a great pre-series produces phenomenal changes and rejuvenation treatment to prepare the skin for penetration of There is a small amount of residual stimulation in the skin. Since their research, AHAs have product. However, optimum results for anti-aging of the turnover of cells through the effect of the been the most used ingredient applied to faces to are achieved with a microdermabrasion series and removal of cells. reveal younger, more youthful looking skin and are visible after three or four of six treatments, with to generally improve its appearance. Resurfacing 10-14 days between the visits and a partnership with Since Drs. Van Scott and Yu discovered AHAs, Examples of resurfacing are microdermabrasion the client in home care. There is virtually no healing estheticians have been performing 30-80 percent and AHA acids. Generally, resurfacing does the time after a treatment when performed correctly, AHA peels and resurfacing. Reports of damages following: with immediate return to normal lifestyle and during their misuse drew the attention of the ▪▪ Enhances the process of cell release by minimal discomfort post-treatment. FDA, which requested guidelines from The stimulating the turnover of epidermal cells. Cosmetic Ingredient Review Board (CIR). In ▪▪ Produces a more youthful appearance of the Benefits of microdermabrasion 1997, the CIR defined the use of these products skin through removal of dead cells and faster ▪▪ Exfoliation of dead cells and debris. according to their action at specific percentages exposure of the more youthful cells beneath. ▪▪ Reduction of fine lines. ▪▪ Tightening of the skin. and then made recommendations for the FDA. www.elitecme.com Page 5 The FDA passed these recommendations on to Many estheticians call AHAs “fruit acids,” which ▪▪ Chemical concentration – A 10 percent the regulatory agencies in the states for their use is incorrect. Lactic acid is one of the most used concentration will, of course, be less concerning the activities of their estheticians resurfacers, and is not from a fruit nor is mandelic aggressive than an 80 percent concentration when using acids. Many of the states inserted acid. Every AHA has its own unique properties, (not considering other properties of products), these recommendations into their regulations, and the properties of each must be considered in and esthetic-level concentrations will respond with Ohio and Colorado being first. Know the the choice of the one to use. Always take training differently than medical-level concentrations. regulations within your state. The wording of the from the company you purchase your acids from The same ingredient can be progressive or CIR AHA report, in part, is as follows: and follow its instructions closely. aggressive, depending on the concentration. “These ingredients are safe for use in salon ▪▪ The skin – What is the Fitzpatrick of the products at concentrations of 30 percent, Alpha hydroxy acids skin? The Glogau? What is the condition? at final formulation pH 3.0, in products Generally, the following are the benefits of using The skin type (oily, dry, combination)? Is it designed for brief, discontinuous use AHAs on the skin: thin? Thick? You must know all these issues followed by thorough rinsing from the skin, ▪▪ Promotes healthier, softer and more radiant skin. before deciding which ingredient or product when applied by trained professionals, ▪▪ Normalizes keratinization. to use and how to use it. and when application is accompanied by ▪▪ Smooths the skin. ▪▪ PH – The acidic or basic qualities of a directions for the daily use of sun protection.” ▪▪ Prevents clogging of follicle surface openings. product drive penetration when combined ▪▪ Stimulates epidermal cell renewal. with all the other aspects of the results. For this reason, most product lines are producing ▪▪ Reduces fine lines and wrinkles. Generally, the more acidic (1-7) the product resurfacers that meet these recommendations, such ▪▪ Stimulates collagen and elastin development is, the more aggressive it is. as a glycolic acid product that is 30 percent and in the dermis, as well as GAGs. ▪▪ Time on the skin – Consider the skin 3.0 pH. It is not their responsibility, however, to ▪▪ Reduces photo-damage. type, condition and Fitzpatrick from the know what the laws are in each state and whether ▪▪ Is useful on all skin types. first series appointment before defining the the products or treatments are legal to perform; it time the product will be left on the skin. is the purchaser’s responsibility to know what is When used improperly: Serious irritation can be caused by leaving legal within his or her state to purchase as product ▪▪ AHAs can cause irritation and erythema. the product on skin that cannot handle the and perform as a treatment. Again, know the ▪▪ AHAs can overstimulate the melanocytes, exposure too long. treatments that are legal for you to perform within causing hyperpigmentation. ▪▪ Degreasing prior to the application – Skin your state, and stay within those boundaries. ▪▪ Over-and improper use of AHAs can cause sensitivity to the molecule and thinning of that is clear of all oils and debris will allow the The acids the skin. product to penetrate faster and deeper, no matter The use of the words “alpha hydroxy acids” the ingredient. For example, some product lines Education and hands-on training are the keys to indicates more than just one acid. Actually, there suggest a double cleansing of the skin (two success with AHAs and the key to preventing are hundreds. The following are the ones most full cleansing protocols) with a 10-15 percent problems. Also, patch tests are recommended used in cosmetics: glycolic-based cleanser to ensure the skin is below the ear and slightly towards the back of ▪▪ Glycolic acid – Originally was from sugar clear of oils and debris. If left on the skin, oil the neck. The day the series is sold to the client, cane but is now synthesized to allow more and debris can perform as an initial barrier to apply the product for five minutes, then remove it stability and control. The first AHA in the penetration of the skin by the resurfacing to check for erythema. cosmetics and the most frequently used ingredient in the product. Other degreasing in products, it has the smallest molecule, ingredients used by estheticians are acetone, a The strength of a resurfacer glycolic 10 percent wipe and enzyme masks. making it the most penetrating of the AHAs Many estheticians gauge the strength or power frequently used in the skin care industry. ▪▪ Formulation – A high quality formulation of an AHA resurfacing product by the major that is stable and has supportive ingredients ▪▪ Lactic acid – Originally from sour milk, ingredient, such as glycolic or lactic acid, or bilberry and tomatoes, it penetrates the will respond different from one that is not. possibly by the percentage of the ingredient, Always check to determine whether the epidermis well, but has larger molecules than but those pieces of information are only a part glycolic, allowing slower penetration and product is buffered. of the story. The potential effects on the skin ▪▪ Pre-series, in-series and post-series less stinging than with glycolic at the same of a resurfacer are defined by many further pH. For that reason, it is often suggested as treatments and home care – Treatments and considerations, as follows: home care can improve the health of the skin the resurfacer for sensitive skin, and that it be ▪▪ The chemical – The attributes of a chemical the first AHA treatment in a series for a new and affects the response to the resurfacing resurfacer as per its main ingredient must be product. Preconditioning and maintenance of client. Glycolic and lactic acids are the two considered before making a choice for use on most used AHAs in the skin care industry. results are a newer concept in the industry, a particular client. For example, a glycolic but their effects have proven to be highly The following three AHAs are usually used has smaller molecules, so will go deeper in positive. (See Preconditioning of the skin.) synergistically in a resurfacing formula to enhance the skin than other AHAs and the skin may ▪▪ Time between applications – For optimum the performance of other active AHA ingredients. respond with more irritation. Lactic acid has results, the collagen and elastin regeneration They also have bactericidal properties. larger molecules and will penetrate slower. must be complete, as far is it will progress, ▪▪ Tartaric acid – Grapes and wine. Glycolic may not be the AHA for a client before the next treatment or the total regeneration ▪▪ Citric acid – From citrus fruits such as with sensitive skin. The larger molecules will be lessened. For that reason, anti-aging AHA oranges, lemons and pineapples. of lactic acid allow it to lay longer on the treatments should be two weeks apart. ▪▪ Malic acid – Apples. surface of the skin, slowing penetration and producing less stimulation and irritation. It “Our glycolic is unbuffered” Also: has the same benefits overall as glycolic, so When purchasing a chemical resurfacer, you often ▪▪ Mandelic acid – From bitter almonds, it may be the better choice for this client. hear the sales representatives say, “our product is this AHA has enjoyed a new popularity Mandelic acid has even larger molecules not buffered,” insinuating that is a good thing, that in the skin care world. It has the largest and is especially effective on skin when it makes the product more effective. To determine molecules of the AHAs most used in skin the purpose is to treat the outer layers of whether you believe this is a good or bad quality, care treatments, so it lays or remains on the the epidermis only, as in acne. Knowledge you must know what buffering is. surface of the skin for a longer time. Several of ingredients is important in the choice of Buffering is a means of maintaining pH at a companies are using it in acne products and products for chemical resurfacing. to maintain the health of the skin. nearly constant value in a wide variety of chemical Page 6 www.elitecme.com applications. Buffering agents are the main Resurfacing vs. chemical peels components that regulate the pH of a solution and Resurfacing Chemical peels enable the product to resist changes in pH. They are added to an already acidic or basic solution to Esthetic level Medical level modify it to a certain pH state and then prevent a No pain Painful change in this pH (freeze it in place). There is, of Flaking Peeling course, a more in-depth explanation, but this is what is important to you as an esthetician. No healing process A healing process is experienced No downtime Downtime of 5 to 21 days As pH managers, buffers are important in many chemical applications, including biochemical Not permanent Permanent changes products such as aspirin and antacids – and Flaking surface sometimes Layering/peeling from the surface resurfacers. For example, buffered aspirin has Progressive Aggressive magnesium oxide (MgO) as a buffering agent that will maintain the correct pH of the aspirin Beauty professional treatment Medical professional treatment as it passes through the stomach of the patient. Epidermal depth Epidermal/dermal depth The buffering agent in an antacid maintains the Dissolves lipids between dead cells Coagulate the proteins in the stratum corneum and possibly basic pH (7-14) of the product to allow lowering the reticular dermis of the acidity of the stomach. The buffers in a resurfacing product maintain the specific pH event facial. It is for those clients who need a special post-treatment procedures. Red LED light to allow it to promise and produce the desired quick glow to their skin because of an important rays (620-630 nm) are an effective treatment for effectiveness in a state of maximum safety. Do event that is happening within days. aging skin as well as other particular conditions you want a resurfacer (or peel) that changes pH, such as rosacea. Other wavelengths and colors becoming more acetic or basic? A more acid pH Dual (or more) modalities treat the skin also, such as blue (415 nm), which resurfacer may result in damage, possibly even A modality is a therapeutic method or agent; treats acne by killing the acne bacteria. scarring, and become uncontrollable; a more dual or multiple modalities are two anti-aging basic pH compromises its efficacy. Though it is a great standalone anti-aging modalities or more combined in a treatment treatment, most estheticians add it to another The insinuation that the product has fewer to enhance results. The modalities that work modality, such as resurfacing. (See dual efficacies if it is buffered is incorrect. Buffering together well might be an AHA series, light modalities) It’s not only an excellent dual agents do not influence the activity of the solution; emitting diode (LED), microdermabrasion or modality, it is the ideal third modality in an they merely freeze the pH to the number the microcurrent. Examples of dual modalities are: anti-aging treatment. An example would chemist desires to be maintained to reach optimum ▪▪ LED and microdermabrasion. be adding LED as the third modality to the activity, and, thus, optimum results on the skin. ▪▪ AHA acids and microdermabrasion. microdermabrasion and resurfacer dual modality ▪▪ LED and microcurrent. The reality is that a buffered product is safer to treatment. The skin is cleansed, then a one-pass ▪▪ AHA and LED. use over time than one that is not. Also, you can microdermabrasion treatment follows, and then ▪▪ An AHA wipe as a prep before a salicylic assume that most likely there is a buffering agent a resurfacer. After the resurfacer is neutralized, a acid treatment or peel. in the product, if merely to prevent lawsuits. You red LED (a peak wavelength 660nm) treatment is can also probably assume that the “no buffering” performed to 1) reduce the inflammation, and 2) statement is marketing hype. If this is so, do you stimulate the development of collagen and elastin want to purchase products from a company that is Check the rules immediately. The treatment is calming and causes not honest in its marketing statements? Multiple modalities, meaning more no irritation or erythema while enhancing the than one modality in the same When you compare exfoliation and resurfacing vs. development of collagen and elastin. chemical peels, you see the esthetic level of care treatment, are illegal in some states, is far less aggressive than medical-level. Always so check your state regulations before Designer peels know that if your product produces pain, more than performing them. In recent years, formulators have been combining flaking from the epidermis and takes time to heal, it different acids at lower percentages, finding they is generally outside the esthetic scope of practice. are less aggressive than in their prior form, but produce great results. A combination may be Light emitting diode (LED) glycolic acid (10 percent), lactic acid (10 percent) Series Some clients want to look younger without the and peptides, or TCA (7 percent) and salicylic Esthetic level resurfacing treatments must generally pain and downtime of peels and the irritation acid (2 percent). These specially designed be performed in a series, a group of treatments that of resurfacers. One of the newer ways to deal resurfacers are producing great results with less are spaced a specific distance in time apart to allow with aging skin with a pain-free modality and no irritation. In choosing to use them, however, the stimulation and regeneration of the collagen and downtime is photo rejuvenation, also known as a esthetician must pay close attention to instruction elastin. The series allows optimized regeneration photo facial. A photo facial, is simply that; lights from the formulator. The use of these resurfacers of the dermis and is necessary for maximum of certain wavelengths stimulate rejuvenation cannot be formulated by their ingredients alone visible results. (Again, optimum regeneration in in the cells using light energy. There are several because the new combinations change them. AHA series is achieved when there are two weeks methods of photo facial and a good one that between treatments.) Improvements in the skin is esthetic level is light emitting diode (LED). become notable after the third or fourth treatment Hyperpigmentation It has long been known that our cells have Facial hyperpigmentation takes many forms, if home care is performed as instructed and the photoreceptors, but now it has been proven that treatments are two weeks apart. though once the melanocytes deposit the color into stimulation of these receptors can initiate repair the skin, all are treated similarly for lightening. One treatment with an AHA or microdermabrader to the cells and thus rejuvenation. can provide a hydration response by the skin Post-inflammatory hyperpigmentation is the LED is a very fast, safe and affordable treatment most common hyperpigmentation and is a response and a temporary glow, but does not stimulate the technology that enhances the appearance of the turnover of cells sufficient to causing a change to inflammation caused by injury; the inflammation skin. It treats wrinkles, fine lines, even sunburn is a trigger for the melanocytes to be overactive. in the dermis of the skin. The one treatment is and is noninvasive, causes no inflammation and a good facial for a menu that can be listed as an actually reduces inflammation, and requires no www.elitecme.com Page 7 Some common pigmentation-causing injuries ▪▪ Microdermabrasion – striping, a track of There is consideration for this ban in the U.S., but include: hyperpigmentation across a client’s face, the final ruling has not been made. ▪▪ Abrasions, cuts, wounds – Inflammation is caused by pulling the hand piece too Though they take longer than hydroquinone, causes the area to be dark post-healing. aggressively (high suction, slow movement) some other ingredients also reduce ▪▪ Acne lesions, cysts, excoriations (picking across the skin in a microdermabrasion hyperpigmentation. Retinoid products are the pimples). treatment. This hyperpigmentation usually most popular, and most clients will choose them ▪▪ Aggressive extraction – Lesions should not can only be lightened by a laser (if then), because a side effect is the reduction of wrinkles. be extracted until they are “ready.” and the client is always extremely unhappy. They will also choose azelaic acid and other ▪▪ Aggressive removal of loose skin after a peel. Many will sue for the cost of the spa ingredients that reduce hyperpigmentation better ▪▪ Insect bites – Usually after infection. treatments, the medical treatments, and than hydroquinone when compared with products ▪▪ Sunburn – When an inflammation occurs, the more. Many owners and estheticians believe at the same percent. A good product may contain melanocytes respond. the microdermabrasion treatment is easy a formulation of L-arbutin, azelaic acid, salicylic ▪▪ Waxing – Skin that has not been prepped prior and needs very little training. Not true; you acid and retinol, with a penetrating delivery to waxing will darken in Fitzpatrick 4-6 people. must be trained by an experienced trainer in system and other ingredients that will work well. Medication-induced hyperpigmentation is how to do it and the precautions in order to a side effect of some systemic medications, prevent stripes. Progressive vs. aggressive including phenolphthalein, non-steroidal anti- “Progressive” and “aggressive” are ambiguous inflammatory drugs (NSAIDs), sulfonamides Treatment of hyperpigmentation terms when used in skin care, but they have and barbiturates. This information is on the drug Behind anti-aging, hyperpigmented areas are the a particular meaning for this discussion. education sheets that are given to the patient with largest complaint by clients, so as a professional Progressive skin care here indicates conservative each prescription; be sure to stress how important esthetician, you must understand how to treat care, with the strength of treatments and home it is that the client read the sheet and point out this condition. First, educate the client that the care indicated by the client’s skin type, within some of the most important instructions. You must treatment of hyperpigmentation is slow going and the lines of safety for prevention of damage to ask each client if they are on any medications that demands, that both you and the client be diligent in the skin, and always within the laws for esthetic might cause darkening, and educate them on the working toward the goal. Professional treatments care of the state in which it is being performed. potentials. Suggest they read every sheet carefully. for hyperpigmentation include alpha hydroxy acid It progresses toward client goals, but may be Sometimes this prompts them to remember (AHA), modified Jessner’s, salicylic acid, TCA considered slow by some practitioners. medications they otherwise might not remember. and other peels allowable within your state and within the percentages allowed by state law. They Progressive care does not suggest an esthetician Periorbital melanosis is not actually are most beneficial when combined with home not perform chemical exfoliations, such as AHAs hyperpigmentation, but a reflection of expanded care products. The multiple modality approach or use mechanisms such as microdermabrasion blood vessels through the thin skin under the eyes. works at the esthetic level with microdermabrasion in the care they provide their clients. They must, The tendency may be inherited and appears as first, then the resurfacer plus LED. The home however, be used in a safe and correct treatment darkness under the eyes. Formulations containing care regimen will include AHAs, azelaic acid, program that does not damage or irritate the skin. peptides are said to reduce this expanded hydroquinone, retinoids and salicylic acid. The true difference between progressive and vascularization, reducing its dark appearance. aggressive care is the concept of potential damage to the skin, and the liabilities and legalities of the Hyperpigmentation high-risk treatments Show the client care. In progressive care, no damage occurs, it Some treatments may cause hyperpigmentation A picture should be taken of the is legal and there are few liabilities; in care that if not carefully and knowledgeably performed. client’s skin during the appointment is too aggressive, there is a potential for damage Following is a list of those treatments. where the series is sold. The results and performance of illegal treatments, which can ▪▪ Waxing – Strip waxing can cause are not immediate with resurfacers; magnify liabilities that result in lawsuits. hyperpigmentation, especially around the it is progressive, so sometimes the Aggressive skin care, for this discussion, mouth, under the arms and in the bikini indicates skin care that always focuses on the area. When the strip is pulled from the client forgets the appearance of her goal, doing whatever it takes, with the care skin, it causes irritation that stimulates the skin prior to the resurfacing. Pictures being speedy and producing fast, immediate melanocyte. For that reason, use hard wax in demonstrate the improvement. and obvious results. It usually leaves the skin these areas because it shrinks away from the reddened and even peeling, and many of these skin even as it adheres to hair. treatments require downtime for the client. ▪▪ TCA – The high irritation, wounding and Hydroquinone, the only ingredient approved by desquamation factors associated with this the FDA as a skin-bleaching agent, is sometimes The interpretation for some is that aggressive care ™ peel can cause hyperpigmentation, sometimes used in conjunction with Retin-A or an AHA may mean a treatment is performed too often or in large patches. This possibility is the reason topically in the home care regimen, especially too soon, or with higher concentration products or many estheticians use modified Jessner’s when the client has hyperpigmentation problems. more aggressive pressure with the machines than rather than the TCA for peel. The modified It is the most effective home care treatment for are legal. It also could mean that a professional Jessner’s peel has anti-inflammatory salicylic hyperpigmentation, a tyrosinase inhibitor that bypasses contraindications of the treatment to more acid in its formulation, so it does not have above 2 percent is prescription-only. The usual quickly reach the desired result the client wishes. percentage sold by a physician is 4 percent. There a high tendency to hyperpigment the skin Some skin care experts use time of irritation in is some evidence that it may act as a carcinogen unless the peel is incorrectly performed. designating a treatment aggressive. They describe (cancer-causing chemical), although it’s not been ▪▪ Extractions – Clients who are highly an aggressive treatment as the use of products or proven in humans. It also has been associated with inflamed may become hyperpigmented machines that make a client’s skin irritated for a condition, ochronosis, on black women and men during extractions. Preconditioning with more than 30 minutes post-treatment. acne-calming home care products used for a in South Africa, Britain, and the U.S in which the week before performing extractions prevents skin becomes dark and thick, and dome-shaped Aggressive estheticians who constantly the hyperpigmentation. In addition, the area yellowish and grayish-brown spots appears. It has exfoliate their clients are called “acid artists” is infected by the P. acnes bacteria, making been seen in persons who have used hydroquinone or “microderm artists,” meaning, no matter the it illegal to perform extractions on highly for even a short time. Japan, the European Union skin type or goal of the client in their chair, they irritated and sore pores. and Australia have already banned hydroquinone. recommend microdermabrasion or an acid series.

Page 8 www.elitecme.com Many do the treatments too often on their clients, hour, and for those who have had exfoliation and protection. Passing the broad spectrum test shows and repeat the entire series too often. Others may resurfacing treatments. Dermatologists generally that the product provides UVA protection that is not recommend pretreatment home care to build advise patients to apply sunscreen every two proportional to its UVB protection. up the skin because they do not believe there is hours at least while exposed to the sun, and to Sunscreen products that pass the broad spectrum any accomplishment without pain and peeling apply it liberally, about a shot glass worth on the test are allowed to be labeled as “broad and because it delays the treatment too long. body and a teaspoonful on the face. spectrum.” These broad spectrum sunscreens Clients often ask you for higher percentages Sunscreens are lotions designed to help prevent protect against both UVA and UVB rays. of acids or for you to “turn it up” during a the sun’s ultraviolet radiation from reaching Scientific data demonstrated that products that microdermabrasion treatment. The clientele today the skin. But there are two types of ultraviolet are broad spectrum SPF 15 (or higher) have been is educated about treatments and ingredients and radiation, UVA and UVB, out there, and UVA shown to reduce the risk of skin cancer and early feel they know what they want when they come is the one that is most damaging to the skin and skin aging when used with other sun protection through the door. These clients dictate what you increases your risk of skin cancer. Sun protection measures, in addition to helping prevent sunburn. are to do, and if it is not aggressive enough, they factor was designed to protect us from UVB, the Other sun protection measures include limiting won’t be back. In this case, you must take control, rays that cause sunburn, but as estheticians, we time in the sun and wearing protective clothing. even if you lose the client. It is your responsibility know that the damage to the skin and 90 percent These testing and lebeling requirements are to listen to their concerns, re-educate them with of aging is through exposure to UVA. necessary to provide consumers with the proper knowledge when necessary, and then to The rules for measuring UVA capabilities for information they need to make informed choices tell them what they need as opposed to what they protection products are changing. In June 2011, when selecting sunscreens. want. Through this policy, new clients will know the Food and Drug Administration (FDA) issued that you will be developing a protocol that is right Q. When will these changes take effect? the first new regulations for sunscreen in more and safe for them. Your clients must understand A. The final rule will take effect by the summer than 30 years. The changes, which are be the that you have their best interests at heart, and of 2012, but consumers may begin to see changes final rule to the FDA’s 2007 proposed guide, that you only work within the law. They must to sunscreen labels before the effective date. implement new testing and labeling practices to trust your judgment to provide the best skin care clear up the confusion over the reliability of the Q. When will these changes take effect? available within the confines of your licensure. sun protection factor (SPF), and whether products A. The final rule will take effect by the summer This trust is gained through education of the actually do what they advertise, such as lasting all of 2012, but consumers may begin to see client and demonstrating professionalism in your day, being waterproof or qualifying as sunblock – cchanges to sunscreen labels before the effecctive decisions, no matter the consequences. meaning they protect against both UVA and UVB date. rays and allow no rays to enter the skin. Requirements on the use of SPF Many years ago, the sticky, thick white When you, as a skin care professional, are asked On June 14, 2011, the U.S. Food and Drug products, called sunblock then, were the only “what is the most important skin care product Adminstration (FDA) announced new sun protection. It was usually an opaque cream I should purchase,” you should not hesitate, requirements for sunscreens curently sold over- or paste and provided a physical block, they and say: “sunscreen.” While this product does the-counter (OTC) (i.e., non-prescription). These said, that reflects rays to prevent them from not change or improve the skin, it does prevent requirements support the agency’s ongoing being absorbed in the epidermis. Sunblocks future sun-induced hyperpigmentation and other efforts to ensure that sunscreens meet modern- usually contained zinc oxide. The FDA in its damage. It is believed to be the most important day standards for safety and effectiveness. The 1999 initiative made it illegal to use the word product in the skin care industry, and it is new requirements, as well as several proposed “sunblock” on the labels of SPF products because especially important when the client is having changes for future rules, are outlined in four the agency believes nothing blocks the sun 100 exfoliation, resurfacing or peel treatments. regulatory documents that include a final rule, percent. Diligent use can prevent further sun damage. a proposed rule, an advance notice of proposed You need to be educated about critical health- rulemaking, and a draft guidance for industry. In the 1997 recommendation by the CIR on use of preserving products like sunscreen so you can AHAs, the esthetic professionals applying AHAs The following questions and answers provide a educate your clients. Learning and paying attention to their clients were given the responsibility to brief overview of the recent regulatory actions to the following sunscreen label information will educate those clients on the use of sun protection and highlight the most important information ensure you protect yourself and your clients from that reflects the sun or absorbs its rays. The for consumers to know when buying and using misleading advertising and label information. statement on the need for this esthetician education sunscreen products. is linked to the application of the AHA treatments, Teach your resurfacing clients about safe Q. Why is the FDA making changes to how and approval of estheticians using AHAs is sun time sunscreens are marketed in the United States? qualified with the words “when application is Your clients and you can determine their protected A. FDA is making changes to how sunscreens accompanied by directions for the daily use of sun sunning time by multiplying the SPF number by are marketed in the United States as part of protection.” For that reason, you must know about the amount of time it normally takes to show signs the agency’s ongoing efforts to ensure that and educate your clients on the use and safety of of burning if unprotected. For example: SPF 8: 8 x sunscreens meet modern-day standards for safety the sun protection factor. 15 = 2 hours of increased protection. SPF 15: 15 x and effectiveness and to help consumers have 15 = 3 ¾ hours protection. Also in 1997, the American Dermatology the information they need so they can choose Association released a statement that said “every the right sun protection for themselves and their If you burn in 5 minutes (usually very sensitive person should wear a sun protection product of families. Prior rules on sunscreens dealt almost skin), with an SPF 15: 15 x 5 = 1 hour 15 minutes at least SPF 15 for protection from exposure exclusively with protection against sunburn, increased protection. from the sun.” But is SPF 15 enough? This level which is primarily caused by ultraviolet B (UVB) One way to simplify renewing SPF all day of SPF protects the wearer from 96.5 percent of radiation from the sun, and did not address for your clients is to suggest they use a broad- the ultra violet B (UVB) rays of the sun. With ultraviolet A (UVA) radiation, which contributes spectrum SPF before they go out in the morning increased SPF, the percentage of protection rises, to skin cancer and early aging. After reviewing and then, when the time to re-apply arrives, but not much. There is no level of protection in the latest science, FDA determined that sufficient apply mineral makeup and continue to do so to sunscreens that will totally protect the skin from data are available to establish a “broad spectrum” maintain the SPF coverage all day. exposure to the sun, but protection is advised test for determining a sunscreen product’s UVA for those who are in the sun for more than a half www.elitecme.com Page 9 The Australians actually have it right. A 1981 it a half hour before you go out, but wait to put applied in light layers, allowing the client to health campaign on the use of sun protection had protection on your arms, hands, or back until just define her own coverage. this theme: Slip, Slop, Slap, interpreted as “slip before you leave home. The theory is that this  SPF of 15-22 – SPF is an important part on a shirt, slop on sunscreen, and slap on a hat” will allow the skin to be exposed for development of the client’s daily regimen. Mineral when going into the sun. It was later expanded of your dose of Vitamin D. makeup has a natural, verified SPF of to include moving to the shade and wearing One way to persuade your clients to maintain their 15-22, according to the formulation, and is sunglasses and became “slip on a shirt, slop on SPF all day is to suggest they use a broad-spectrum a wonderful physical barrier against skin the sunscreen, slap on a hat, seek shade and slide damage from the rays of the sun. SPF before they go out in the morning under  on some sunnies”: Slip, Slop, Slap, Seek, Slide. mineral makeup. Then, when the time to re-apply Anti-inflammatory – Zinc oxide and The campaign was very successful with its catchy arrives, refresh the mineral makeup and continue titanium dioxide are naturally anti- advertisements, featuring a mascot seagull named to do so all day to maintain the SPF coverage. The inflammatory ingredients that can help calm Sid, and a jingle that every Australian hums. The SPF of mineral makeup is from 15-22 and will do irritation. The healing properties of zinc are incidence of the two most common forms of skin the job without removing your makeup to reapply. well known. cancer (basal-cell carcinoma and squamous cell  Non-comedogenic – Many products are carcinoma) in Australia decreased dramatically. Mineral makeup comedogenic and cause ongoing problems Appearance has always been a problem for patients for clients with oily skin. Mineral makeup Protection from rays vs. Vitamin D and clients after medical and esthetic skin care does not clog pores, no matter the skin type; development treatments. They say, in a voice of desperation, this allows the client’s makeup to support Too much of a good thing can be bad. Though their goals, not work against them. “When can I apply makeup again?” Until now,  dermatologists recommend SPF 15, which most estheticians would tell them they could not Antioxidants – Many mineral makeup lines protects against 96.4 percent of UVB rays, reapply makeup for a certain amount of hours. Most are adding antioxidants to their formulation concerned consumers are purchasing higher medical and esthetic treatments require a delay in to support the health of the client’s skin. SPFs, for example SPF 50, which protects against time before the application of the typical makeup, Cosmetic advantages 98 percent. The reality is that you don’t really and longer if the treatment is aggressive. The more The advantages of mineral makeup over need a higher SPF unless you have had skin aggressive the treatment, the longer the delay traditional makeup after medical and esthetic peeling or resurfacing, and that high SPF can be because of the side effects it might cause. Many level treatments are wonderful, but the purely negative to your health. patients remain confined past the necessary time cosmetic advantages are what encourage Sunscreens interfere with the production of because of their appearance. Then, as soon as the purchasers to continue to wear the products. Here Vitamin D, and sun exposure is essential in the time has arrived that will allow makeup application, are reasons they become mineral makeup fans production of this important vitamin. A recent heavy camouflage makeup is often required. It is and continually return to purchase the products: study suggested that most Americans are deficient difficult to apply well and requires reapplication ▪▪ Control coverage – Women like to wear in Vitamin D, an essential vitamin for optimum and monitoring throughout the day. These patients different amounts of makeup. This makeup is health and growth, with most of the deficient do not use it any longer than necessary and do not applied in light layers. They can choose the persons being in temperate climate areas. Vitamin continue to purchase. coverage they want to wear. D is absolutely necessary for the growth and Mineral makeup is the answer to this dilemma. ▪▪ Comes in all forms of makeup – Initially these development of bones and teeth and is required for The ingredients in true mineral makeup products came only in powder form, but now the proper absorption and utilization of calcium products are primarily natural minerals with are available in pressed and liquid forms as well. and phosphorus in the body. The application of no unnatural colors or preservatives in the Patients can have the one they are accustomed to an extremely high SPF can interfere with this formulation. These products can be applied along with the benefits of minerals. exposure. However, sufficient exposure for most immediately after treatments such as superficial ▪▪ Feels light – One of the biggest complaints people is possible without harming the skin peels and microdermabrasion and as soon as about camouflage makeup is that it feels with overexposure to UV rays. Fifteen minutes reestablishment of the initial epithelia has heavy on the face. Mineral makeup feels light in the sun twice a week is enough to stimulate occurred on the more invasive treatments. as a feather, no matter how much is applied a sufficient amount of Vitamin D. How do you The benefits of the products are supportive of for coverage. An immediate comment from compromise to meet both the absolute need for the application post-treatments, and patients and many patients is. “I don’t feel like I have sun and protection of your skin from UV rays? clients love that they can just go on with their makeup on!” ▪▪ Males can use it – Men can use it, when One suggestion on how to maintain protection lives after treatments. Another benefit is that necessary, without that whisper behind by wearing SPF and still develop Vitamin D mineral makeup has increased lunchtime traffic in their back, “can you believe he’s wearing is centered on when you apply your first SPF spas because the clients can go right back to work makeup?” This allows them to go back to in the morning. For complete protection from with redness covered, if it occurs. work immediately after a treatment if there UV, experts say to apply a 15 or higher SPF is redness or at least in less time for more one-half hour before leaving your home in the Mineral makeup is especially supportive aggressive treatments with remaining redness. morning. Consider this, instead, to help your skin of esthetic treatments ▪▪ Water resistant – Mineral makeup is manufacture Vitamin D while providing sufficient  Covers redness – Clients can now come amazingly water resistant. Perspiration, even protection for your skin: Twice weekly, apply the in for a microdermabrasion or resurfacing rain, will not displace it. SPF within a short time (minutes) before leaving and still go out to dinner or back to work. ▪▪ “It’s good for your skin”— What is better home. Full coverage develops within a half hour, The minerals cover any redness, without for your skin than a makeup product that and during those 15 minutes, if you are in any potential side effects. is SPF 15-22 without chemicals, is non- sun – it does not have to be direct sun – you will  Antimicrobial – Minerals do not support the comedogenic, and has zinc in it, a healing develop Vitamin D. This has not been studied, growth of microbes so do not expose healing ingredient? You can feel good about but it may be something to consider unless you skin to potential infections. The companies prescribing this product for daily use. burn in 15 minutes. It also assumes that you are who make these products guard this property actually in the sun during that time. because they want to maintain the benefit. Client success  Great coverage – Mineral makeup covers Another consideration: If you are concerned Analysis is the central and pivotal point of results more with less product. The product is about the UV exposure of your face even for that and safety of treatments and in pleasing clients. It time, twice weekly apply the SPF as needed to all begins at the base point of analysis, and that is

Page 10 www.elitecme.com the defining of the client’s skin type. Professional treatment. However, this time becomes an asset to products to clients can be highly profitable. treatments may also be included in pretreatment the treatment in the following ways: However, some physicians and skin professionals such as a microderm facial, enzyme facial and Safety. When Dr. Van Scott and Dr. Huey Lu are uncomfortable with selling products to their moisturizing facials. brought alpha hydroxy acids to the aesthetic clients. These feelings are misguided. Instead, the world, their technology was welcomed as a new products should be seen as necessary, as per the Defining skin type and effective treatment; additionally, it presented previous discussion, and viewed as enhancement Estheticians have always thought defining skin type a new profit center, anti-aging. Potential clients of care and prevention of negative treatment is difficult. Two estheticians may disagree in their discussed the new treatments, rushing to request responses. They should be discussed with the opinions of the same client’s skin type. So, let’s them from doctors and estheticians. They were client as a primary aspect of the treatment, not as simplify it and get it done in less than 30 seconds on accommodated, with little preparation of the purchasing product, and sold as pretreatment care. every client. Frankly, it is all about the pores: skin. Immediately, complaints began coming into ▪▪ The person who has tiny pores all over is a Preconditioning products and treatments the FDA, with this regulatory agency believing dry skin type. Balanced skin – skin that is healthy and in its best they were only receiving 1 complaint in 10,000 ▪▪ The person with large pores all over is oily. condition – reflects its full beauty and responds instances of the actual damage being done. Since ▪▪ The person with large pores in the center positively and optimally to corrective treatments. that time, many other new technologies and panel (nose, frontal chin, mid-forehead) It is strong, with a good immunological system ingredients have been added to the professional and small pores on the rest of the face have that wards off damage and heals quickly. A good toolbox for changing the skin, with the added combination skin. skin professional’s first goal is to bring the skin potential for reactions and damage. These ▪▪ The person who has normal pores all over the into balance. Then, it’s ready for corrective care. problems can be minimized or prevented through face has normal skin – though it may swing preconditioning of the skin. Of course, correct Skin that is “in balance” with a hydrated from oiliness to dryness and back, according treatment protocol is a requirement for preventing epidermis, a healthy dermis and suppressed to what is physically and mentally going on damage, but other facts support preconditioning melanocytes, will sting less during the treatment, with the client, but that is a condition, not a as an important preventive and an aid to respond with less irritation and not react with skin type. maximized treatment results, as follows: hyperpigmentation. The typical preconditioning Pay no attention to the dryness of the skin or regimen will include the appropriate home care Maximum results. A healthy skin condition scaliness, or other features. You want to know for the condition of the skin to bring it to this allows the skin to respond to the treatment to its the basic skin types, and above is how you define healthy, treatment-positive condition. maximum potential. Prepared skin allows full a skin type on the face. Again, it’s all about the penetration of the ingredients and achievement of The amount of time for pretreatment is pores. They dictate what the true skin type is of the highest potentials for the treatments. determined by the condition of the skin. For every client. example, a client who has been using soap and Minimizing negative responses. Healthy skin will Next you go to the skin condition. Dry? Aged? no sunscreen will need more time in the regimen not respond negatively to a service performed Acne? Dehydrated? and different products than the client who has correctly and appropriately. For example, ▪▪ Dry skin is skin that is dry from the outside, been on professional products for three months. hydrated skin does not flake excessively and meaning the moisture (sebum) has been This unprepared skin will need the basics: first, become overdry; a skin prepared with melanocyte removed by a situation from the outside. This a cleanser, a moisturizer, a dermal builder and suppressants will resist hyperpigmentation; a skin will have a rougher texture than normal a sun screen, and will be assigned to use them healthy skin will not respond with as much pain skin. (This has nothing to do with skin type; for at least four weeks. Before beginning this and stinging as an unhealthy one. this is a condition.) care, she will need a preparation facial, utilizing ▪▪ Aged skin has fine lines and wrinkles, Client commitment to the treatment. A an enzyme mask to dissolve the superficial discolorations, keratosis and may be thinner. preconditioned client is mentally and physically dead cells and debris to allow penetration of the ▪▪ Acne skin is usually oilier, but maybe not, ready for the treatment. He or she has bought preparation products. because acne can be hormonal. into the care and is more likely to remain on the After four weeks, the client will be treated with ▪▪ Dehydrated skin is “dry from the inside,” maintenance schedule, and to purchase many a second preparation enzyme facial and sold a meaning there is not enough moisture inside the more treatments and products. melanocyte suppressant and a glycolic home care skin and produced by the skin (called sebum or treatment or another appropriate pretreatment moisture); this skin will have tiny lines all over. Benefits of preconditioning The benefits of preconditioning are simple. It product. The esthetician now evaluates how long This course focuses on aged skin, so we have brings the skin to a more healthful state for the client should be on these products, and at this addressed that topic only. The analysis and treatment. Professional treatments and home care appointment appoints the first of the treatment consultation protocol of a client with aged skin is products exfoliate dull, unhealthy skin, bringing series, or other treatments, anticipating the as follows. First, you define the skin’s type; second, more healthy cells to the surface. Hydration highest possible results for the skin. you determine whether it is aged; and third, you supports the healthy state, and ingredients in the A client who has been on good professional develop a treatment for this skin. Developing a treatments and home care products stimulate treatment and home care before can be treatment plan means you must know the skin well the production of more collagen, elastin and prepared quickly. An enzyme facial will be the for safety and results. An important aspect of the glucosaminoacids than was previously present pretreatment performed; her home care will treatment plan for aged skin is the preconditioning in the non-prepared skin. Further, melanocyte include her usual products plus a pretreatment before a treatment that may change the skin. response has been actively tempered, and home care product such as an AHA, and a the treatment will be less likely to trigger melanocyte suppressant for a time designated by Preconditioning: Taking the time hyperpigmentation after irritation. The skin is the skin care professional. (Of course the client is In simplistic terms, preconditioning is the use prior brought into a healthy balance, with a readiness given the speech about using an SPF religiously.) to treatments of professionally prescribed products to reach the goals of the coming care. An alpha hydroxy acid treatment(s) may be in a regimen of home care designed to bring less the pretreatment of choice for many future than healthy skin to its optimum (or ‘balanced’) Home care support treatments, enhancing the turnover of cells and condition. In doing so, negative responses such The primary advantages of preconditioning the stimulation of the dermal layer. as hyperpigmentation or undue stinging and skin are treatment-based, but it is also a source damage, even scarring, can be reduced, potentially The time until a series begins or the chosen of income for a salon or spa. The sale of these prevented. It does add time to the client’s target treatment is performed is determined by www.elitecme.com Page 11 the condition of the skin and the Fitzpatrick and your client. Now, due to development of new Glogau Class 3. Advanced. This client will need Glogau skin types. A sensitive skin or a skin ingredients and technology, clients may be far all the above, plus combination therapies such as in poor condition will require longer on the older than their appearance, so look closely and microdermabrasion and a 30 percent AHA series. balancing products. A high or low Fitz skin type fit each into a classification that will tell you Lower percentage will also dictate a longer time on the melanocyte what the client needs. There are four Glogau TCA may be a suppressant. Professional evaluation of the Photoaging classifications: choice for mid- preparation time is important to achieving optimal Pre-Glogau. There is no Glogau 0; this is for level Fitzpatrick responses to the skin treatments and to safety. you to establish the base for aging skin. This clients, as well as client is before the Glogau classification, literally herbal peels and In-series care just above a zero in aging, and will need mostly microcurrent. Her In-series care is the use of home-care products education, sunscreen and topical antioxidants. home care needs during a series of treatments, such as an alpha to be intense now, hydroxy acid or beta hydroxy acid series. During an This client has youthful, supple skin with even with many peptides acid series, the client should continue the defined tones, excellent firmness and elasticity, and only and exfoliants home care according to the recommendations of inherited wrinkles, meaning the familial laugh with retinol and an informed esthetician to help treatments reach lines. The purpose of skin care for this person is 15 percent AHAs. She has advanced photoaging, their optimal results. A melanocyte suppressant to keep it that way, through the products the chart dyschromia and telangietasia, visible keratoses, continues to be very important during this time, as indicates. This client has special glow on the skin. and wrinkles at rest. does hydration and an exfoliant product. In-series Glogau Class 1. Mild aging. This client has Glogau Class 4. Severe. This client will need care may also include moisturizing facials between youthful, supple skin with even tones, good (not all the above, plus combination therapies such acid treatments to ensure the skin does not become excellent) firmness as microdermabrasion, AHA series and LED. overly dry and dehydrated, and to support a and elasticity, with These clients have maximum response by the skin. A requirement for only inherited severe photoaging, in-series care includes attentive monitoring of the creasing and the dynamic and skin by the esthetician. foreshadows of wrinkling while wrinkles, those Post-treatment maintenance at rest, multiple elusive fine lines actinic keratoses, The products are continued in-series, and then around the eyes and established continued into post-series care, including the that are not there wrinkles. Intense exfoliants. Estheticians who recommend this when the face is at pulse light protocol for post-series say the maintenance rest. The purpose (IPL) and laser of results is amazing. Post-treatments are also of skin care for treatments at a physician’s office will be a important to maintenance. It is best to suggest this client is to keep it that way, with a special consideration for these clients. post-series maintenance treatments such as glow. She has a hint of fine lines during facial microdermabrasion or resurfacing every one to movement. Enzymes may be in the cleanser in the The Fitzpatrick Phototyping Classification Scale is three months and LED to continue the look the home care; the deep cleanse or treatment mask will designed to indicate the tendency of different skin client has achieved. remove surface debris through gentle enzymes. to hyperpigment, but it also can be thought of as a tolerance scale in the realm of treatment care. Pre- and post-care have enhanced the Some estheticians recommend an occasional light legitimization of the esthetic industry through the microdermabrasion. It also allows her skin to The Fitzpatrick is designed for aiding in decisions enhancement of safety and results, and through easily accept home care product ingredients. She concerning potentials for hyperpigmentation in maximizing client retention and profits. They are will not need peels or resurfacing to speed up the treatments – anywhere the word “tans” occurs, important protocols to adopt in every spa. turnover of cells yet. Her home care products are change the word to “hyperpigmentation,” and you rich in antioxidants to capture errant UVA and in will know the potentials for skin reaction with Glogau and Fitzpatrick scales peptides to keep the elastin and collagen in their hyperpigmentation. Another use that few know These classifications can alleviate the terror of rightful position. for this chart is in determining the potential for developing a treatment play for aging skin. The Glogau Class 2. Moderate. This client will need irritation. Change the word “burns” to “irritation” Glogau Photoaging Classification was devised all the above with superficial resurfacing and and you will have a more accurate tool to by dermatologist Richard Glogau, and the microdermabrasion, and anti-aging home care irritation – except in V and VI. Change these Fitz Fitzpatrick Phototyping Scale was developed by products with 8-10 skin types to “may burn,” and it is more accurate. dermatologist Thomas Fitzpatrick. These scales percent AHAs. When defining a treatment for a new client who can aid you in designing your treatment plan Her skin will have has not used skin care, its use for determining for your client by determining certain properties early to moderate possibilities for irritation is more an upside-down of the skin. The Glogau scale will indicate the photoaging, some bell curve as in the following: amount of photoaging through classification early pigment ▪▪ I-Always irritates. of the fine lines and other indications of aging. changes but no ▪▪ II-Usually irritates. The Fitzpatrick Phototyping Classification Scale visible keratosis. ▪▪ III – Sometimes irritates. determines the potential for hyperpigmentation She has fine ▪▪ IV – May irritate. and irritation. When you combine these tools, you lines and a hint ▪▪ V – May irritate. will define a safe and effective treatment without of wrinkles. Use enzyme deep cleanse with This new chart can be used in determining how any guessing involved. You will more accurately every facial as the client’s deep cleanser to keep long a new client should be on preconditioning know what you can or cannot do, and whether a the surface open to home care ingredients. If a products. Start with a minimum of four to six product is appropriate. resurfacer series is chosen as the treatment program, weeks with I-II, IV-V; 2 to 3 weeks with a Fitz Glogau classifying will show you that the it should be a gentle lactic acid, not glycolic. LED III classification. chronological age of the client is not an exacting is a great dual modality to team up with the lactic Irritation and aging measure of aging. This classification indicates acid and continue the cell rejuvenation. It can also The new chart on irritation is a reflection of the the real age of the skin, meaning the amount of be used in her moisturizing and other facials for theory of aging that considers inflammation photoaging. Forget about chronological age of maintenance of the rejuvenation results.

Page 12 www.elitecme.com Glogau Photoaging Scale at times avoid their use, some completely avoid them, and others use them only when indicated. Skin type Age range Conditions Here are some of the reasons alternatives are becoming popular. 1 – Mild 20s-30s Early photoaging: Early pigmentation changes, no keratoses, fine lines. Summer hiatus. A general belief in the 2 – Moderate 30s-40s Early to moderate photoaging: Early senile lentingines. industry is that acids should not be utilized as professional treatments in the summer months Advanced photoaging: Dyschroia and telangiectasia, visible 3 – Advanced 50+ because of potential damage by the more keratoses, wrinkles at rest. aggressive sunrays. Alternatives are also widely considered by estheticians who live in areas Severe photoaging: Dynamic and gravitational wrinkling, multiple 4 – Severe 60s – 70s where the sun is high more months of the year. actinic keratoses. These professionals are concerned about the commitment of their clients to sunscreen during Fitzpatrick Phototyping Scale the high-sun months, so shy away from acid- based treatments for some clients and seek out White, very fair, red or blond hair, blue eyes, other treatment measures, basing much of their I Always burns, never tans. possibly freckles. practice on alternatives to acids.

White, fair, red or blond hair, blue, hazel, or Stripping the skin. Holistic esthetic practitioners II Usually burns, tans with difficulty. green eyes. believe that using acids in certain percentages, either in professional treatments or through Cream white skin, fair with any eye or hair color. ongoing use in home care, can strip the skin of III Sometimes a mild burn, gradually tans. Most common its healthful barrier, ultimately causing damage and aging. These professionals believe in Brown, typical Mediterranean, Spanish, dark hair, building the hydration and health of the skin, IV Rarely burns, tans with ease. brown eyes. Also Asian. allowing it to holistically fight off the ravages of the environment, acne and aging, and look for alternatives to meet these goals. V Dark brown, Middle eastern skin type. Very rarely burns, tans with ease. No to acids on young skin. For years, estheticians were applying glycolic to anyone that would sit VI Black Never burns, darkens very easily. in their chair. Even 30-year-olds and younger with youthful skin were accepted as candidates. Now, however, experienced and “thinking” as a cause of aging (first stated by Dr. Nicolas with it helping you determine what professional estheticians are wondering. … The skin of these Perricone, dermatologist and researcher). treatments to use and the “irritation chart” a clients is still turning over at a healthful rate. According to this theory, inflammation can be consideration. Will you use glycolic on new clients? What are we doing to their skin when applying subclinical on the cellular level where it cannot You probably can on Fitzpatrick IIIs, with only two acids unnecessarily at an early age? What be seen or on the surface of the skin where it weeks of preconditioning, while the rest will need alternatives other than acids will provide their is obvious irritation or inflammation and can to ease into it with I, and V having to stick to lactic skin with the glow and health they are seeking? cause aging. The skin is irritated (inflamed) and acid and longer preconditioning. The II and IV the cells generate free radicals as a part of the may be able to start with lactic acid, then move to Developing sensitivities. Many clients are now metabolic functions of healing. Free radicals age glycolic in the last two or three treatments. seeing the results of constant and aggressive the skin through oxidation. This theory focuses glycolic use: the development of sensitive skin. In these days of powerful home care products and on preventing irritation as much as is reasonable For those who do, high acids are no longer more effective and gentler products, you can be in treatments. In treating aging progressively a choice for anti-aging. Should estheticians more successful than ever with progressive skin instead aggressively when possible, you can consider ways to help prevent the development care. Practice use of the Fitzpatrick and Glogau perform anti-aging that supports progressive of sensitivities by using fewer acids when other classifications when choosing a client’s treatment treatments and yet produces results. At the same treatments are available and until they are a must- plan to bring maximum success for the client time, you stay within your scope of practice. use? That is something to think about. while avoiding irritation and scarring. The inflammation theory. Many estheticians have Defining treatments Alternatives to acids become concerned about the irritation produced After determining the client’s skin type, skin For many years, acids were the profit-producing by the use of constant acids in home care and condition, her Fitzpatrick and her Glogau, you darlings of the skin care industry, and estheticians high acids used in treatments. Their theory will be ready to determine her treatment and believed they were the answer, the only answer, concerns the production of free radicals by skin home care. In discussing the home care before for clients wanting younger-looking skin as well irritation during treatments and home care. Is resurfacing, products with glycolic or retinol were as those with acne-prone skin. But with new the treatment causing aging instead of repairing recommended. But clients who “always,” ‘‘may,” products and services developing, the days of it? Are there alternatives to acids that can deter and “usually” suffer from irritation need to start “always make ’em peel” are moving into the the irritation that causes the free radicals? New slowly on these products, alternating days and only past, and estheticians are coming to believe ingredients are being developed every day that in the evening initially, and working up to every acids should not be the only tool for anti-aging can perform anti-aging without irritation. night on the product at least two weeks before treatment, but instead a tool among many. More The Fitzpatrick Skin Evaluation Scale. There is the resurfacing appointment. Note that if the and more are utilizing them in specifically client experiences any stinging or erythema, the a higher tendency to hyperpigment with higher indicated cases only and are finding other Fitzpatrick grades, 4, 5 and 6. The lower Fitzpatrick preconditioning is longer and the road to full use alternatives available to them. of the exfoliation home care products is slower. grades, 1 and 2, tend to become erythemic. So should the skin professional consider the Fitzpatrick When deciding on the resurfacing treatment Reasons for alternatives grades in treating these clients? product, the Glogau will be added to the equation, Acids have been very important to the success of the skincare industry, but some estheticians www.elitecme.com Page 13 Alternative choices and intense hydration in home care, this series can frequency, especially when performing anti-aging Vitamin C series. A client with young skin that is produce good results for the anti-aging client. It’s services, such as acids. Yet with the safety net of turning over at a nice rate asks her esthetician for a also a great series for acne-prone and oily skin for an easily obtained insurance plan, peace of mind peel. She sees her skin as aging, and though it is in removal of debris from the surface, preventing can be a piece of cake. But many salon and spa good condition, possibly just needing more glow or blockage and enabling penetration of products. owners forget about their insurance except when a more even tone. Perform an acid? Turn her down? Enzymes “turn off” naturally so there is no the premium comes due, and when it does, they say She is going to get her treatment somewhere, so danger of over-exfoliation and harmful side to themselves, “Should I keep it?” Salons and spas instead, the esthetician can offer her a Vitamin C effects. They produce a more youthful, glowing that view insurance as a low priority are courting series. Though it is an acid, it’s not the aggressive and even-toned skin surface as a result of the disaster. Liability insurance needs to be a major acid we are discussing. It is gentle and pleasant. removal of the dull, dead cells. priority for them to stay in business, especially when acids are among their services. This treatment can also be offered the acid fan Herbal peels. These resurfacers are plant- and who wants more and more. You can call the herb-based exfoliators that resurface with no The esthetic industry is getting its share of Vitamin C series a Citric Acid Series. It will give down time and no irritation. The products are lawsuits. According to a survey performed her skin a glow and extend the treatment she had applied to the skin then used either as a scrub by the National Coalition of Estheticians, last. She will like it! or allowed to sit on the skin for a specific time. Manufacturers/Distributors and Associations (NCEA) of their insurance company members, Many companies offer mix-at-the-chair Vitamin They are non-acid resurfacers offered by several liability claims ranging from $25,000 to $1 C treatments that are highly antioxidant and companies that do not support use of AHAs, million have been paid out to plaintiffs. The lightening/brightening; they are great for the skin, BHAs or microdermabrasion. Certain ones survey also states that services related to these even for older skin that just needs more even tones. are used as a series, but others are used only claim payouts included damage from glycolic After mixing at the first treatment, the product seasonally or, at most, monthly. treatment of the face, microdermabrasion and holds its efficacy well during the series of six, and The depth and resurfacing of this peel can be laser hair removal. Sixty-six percent of the produces the results the clients want. At the end of controlled by the esthetician. Training is needed respondent companies listed burns, scarring the series, the skin has developed an even tone and by the manufacturer, however, to get their and hyper- and hypopigmentation as the most a healthy glow the client will appreciate – without maximum use. commonly reported incidents. the side effects of the more aggressive acids. LED (light-emitting diode). LED is non- For these reasons, the question of whether a spa This mix-at-the-chair treatment is performed wounding, with no downtime or discomfort. needs liability insurance is moot. The legal costs much like an acid, with an enzyme deep Results are apparent in three to four treatments, to defend even a claim with no validity can be cleansing first, then application of the Vitamin so take a picture for comparison. Red and $30,000-$40,000. This makes liability insurance C mixture. Many estheticians apply a highly near-infrared LEDs use photostimulation on the a bargain. But it’s not just the financial loss. The moisturizing mask after Vitamin C to push up the fibroblasts to trigger the reproduction of collagen loss of time and the stress of dealing directly hydration of the skin. It’s perfect for this client. and elastin in the dermis, bringing rejuvenation with the legal system can be crippling. Access to Dermafile. This implement is actually a set of to the skin. experienced support – their insurance company – several wands of increasing coarseness. The Microdermabrasion. Of course, in these instances can be a great relief. professional chooses the wand according to the microdermabrasion also is an alternative to Many states consider liability insurance a condition of the skin, the skin’s Fitzpatrick and acids. This service has the same efficacy as acids protection for the consumer, not the business, the desired result. Prepared the skin as you do but from a physical resource, not a chemical and require it to apply for, obtain or maintain a for an acid treatment, then move the implement one. It resurfaces, stimulates the production of license to operate a spa or salon. For example, across the skin in a coverage pattern, gently collagen and elastin, and brings the skin to a Washington and Minnesota require salons exfoliating the skin. After the treatment, apply a glow, just like with the use of AHAs. But most to carry a minimum of $100,000 in liability mask to hydrate the skin. skin professionals follow the same restrictions insurance, and they must provide proof of The Dermafile exfoliates the skin with little or no for microdermabrasion as for acids, such as insurance upon inspection. (Most spas maintain irritation while stimulating the dermis to reproduce for erythema or hyperpigmentation through $1 million or more coverage.) In some states, like after the removal of the stratum corneum. The evaluation of the skin’s Fitzpatrick Scale, and no Florida, proof of insurance is not required, but the surface of the skin is smoother and more even, treatments during the summer. For these reasons, county or city may have insurance requirements producing more youthful and even-toned skin. microdermabrasion is an alternative to acids, but in place within their respective jurisdictions. has more restrictions than many of the others Many estheticians prefer the gentleness of the listed. It is a great alternative for those sensitive to Owners and professionals must guard their assets, Dermafile to microdermabrasion and acids – and acids, however, keeping in mind the restrictions. and liability insurance is an important part of that the cost is much less than a microdermabrasion armor. It requires information and monitoring, machine. They also like the high amount of control Home care needs and must be kept up-to-date at all times by those that they can have versus the microdermabrasion These series need the same supportive home care whom it is guarding. It must hold a priority role machine and acids. The results are similar to the as acids and other treatments do for attaining and in the act of doing business. microdermabrasion series, so clients love them maintaining results. The home care should be Acids are an important part of our industry, and also. There is a learning curve, though. prescribed according to the condition of the client’s their use should be learned and understood, along Enzymes. Though many in the industry call these skin and her goals, and should contain hydrators with their indications and contraindications, treatments peels, they are not peels, they are, as and supportive treatment ingredients. SPF (sun to support their positive use. However, a wise discussed before, chemical exfoliants, valuable protection factor), as with all the other treatments professional develops a complete toolbox of ones that do not have the side effects of acids. discussed, is also a must for skin-care professionals treatments, including alternative products for A client who is not a candidate for an acid can to prescribe for the alternative treatments. when acids are not the best choice for their enjoy enhancement of the appearance of her skin clients. Many alternatives exist and should be Are you covered? through a series of six of these treatments, followed learned and available for our clients. in each treatment by a deep hydration mask. All It’s an unfortunate but established fact that we live Fitzpatrick grades can enjoy enzyme treatments in an age of litigation. And no matter how remote with no problems, as can clients with sensitive skin the threat of a lawsuit may seem, it can and does and rosacea. Teamed with dermal building peptides happen to spas and spa professionals with alarming

Page 14 www.elitecme.com CHAPTER 2 reported. Therefore, the municipal health be indirectly linked to the stylist or her customers. SANITATION, STERILIZATION, department depends upon the consent and full During the week that the first infected customer was cooperation of index patients and contacts for identified (in April 2006), another customer was Infection Control and Ohio further investigation of outbreaks. Consequently, hospitalized with an abscess in the groin. in this instance, household contacts for screening Laws and Regulations Unfortunately, no culture was taken from this were identified but had not presented themselves (4 CE Hours) patient. The partner of the second infected for screening. Contacts who had complaints customer was also infected with MRSA that was Learning objectives sought treatment at the emergency department, ! related to an abscess on his leg. By the end of ! Describe recent events that require your where the observant infection control practitioner knowledge of sanitation techniques. (ICP) and microbiologists related them to the 2006, an MRSA-positive couple was identified ! ! Explain the difference between pathogenic MRSA outbreak. Nurses obtained specimens as a contact of the second infected customer. In and nonpathogenic bacteria. by swabbing each patient’s nose, throat, and August 2006, another couple was reported to be ! ! Contrast disinfectants and antiseptics and wounds. A case was defined as a patient who had MRSA positive; both had abscesses on the thighs. explain the significance of those differences. a culture-confirmed MRSA infection during the Because no further epidemiologic data could ! ! List the steps necessary to properly sanitize outbreak period July 2005-December 2006 and a be obtained, whether the couple’s infection was your hands and to disinfect, handle and store direct epidemiologic link to the index patient. linked to the beauty salon is not clear. tools appropriately. A total of 45 persons who had been in direct !! List infection-control responsibilities in the In April 2006, a salon customer was hospitalized with an abscess of the breast caused by MRSA; or indirect contact with the stylist were practice of cosmetology in Ohio. screened for MRSA: three family members, !! List infection-control responsibilities in July 2006, another customer who had had boils since February 2006 was found to be MRSA three roommates, 11 other persons (including according to universal sanitation precautions. secondary contacts), six beauty salon employees, !! Contrast sanitation and sterilization and positive. Both customers had been given wax and 22 customers (including regular customers). explain the significance of those differences. treatments by the stylist during the period in which Fifteen persons had skin infections and 10 !! Describe the proper way to use an autoclave. she had an infected hair follicle in her armpit. Swabs taken from this site showed that the stylist of them were colonized with MRSA (stylist, Why do I have to complete sanitation was infected with the same MRSA strain as before. family member, roommate, ex-partner of the roommate, customers and partners of customers). continuing education? Concern arose about the risk for infection to customers through instruments, materials (wax), Although skin infections never developed in Salon professionals need to be aware that or contact with other employees. The index patient the stylist’s family members, tests did show we have reached a time where, quite simply, and the other six employees of the salon regularly MRSA colonization in one of them. The stylist’s antibiotic-resistant organisms can kill, and the provided services to each other. boyfriend, a native of the United States, had frequency of infections from them are increasing. already lived for two years in the Netherlands. Due to the sheer nature of people touching people A nurse and the infection control practitioner of in a salon atmosphere, the killer organisms can the municipal health department visited the salon Although he had skin lesions, no S. aureus occur in your facility if you aren’t informed and in June 2006 to check on hygiene protocols and was found. The girlfriend of a sport mate who following the proper procedures. The following to advise on preventive measures to reduce risk regularly exercised with the partner of a customer articles/studies emphasize how important for further transmission. All working procedures was colonized with MRSA at the end of 2006. sanitation is in your salon. and protocols were investigated, and the salon She had emigrated recently from the United was advised to clean and disinfect instruments States to the Netherlands, but her first screening Methicillin-Resistant Staphylococcus and procedure rooms. More specifically, the test results were negative. The mean age of the aureus in a Beauty Salon (Summary practitioner observed a total waxing procedure patients was 29 years (range 21-40 years). performed by the staff. Ten swabs were taken from the Centers for Disease Control, Eleven people were found to be MRSA positive. November 2008) from used wax, wax implements and the treatment room. All six employees were screened and Of these 11, three persons with a direct link to In September 2005, a medical microbiologist the beauty salon (the stylist and two customers), from a regional medical microbiology laboratory informed about MRSA and the current situation. Arrangements were also made to test 22 regular six with an indirect link (family member, in the Netherlands reported to the municipal roommate, ex-partner of roommate, partner of health department a recurring MRSA – customers who had received wax treatments by the index patient in the previous two months. a customer, sport mate of partner of a customer methicillin-resistant Staphylococcus aureus and his partner), and a couple from whom no – infection in a stylist. From December 2004 In the following weeks, these customers were epidemiologic data could be obtained were onward, the woman had recurrent infections on screened at the municipal health office and infected with the same MRSA strain as the the legs, buttocks and groin resulting in incision informed about MRSA. Of the 22 regular stylist. Outbreaks of CA-MRSA strains have and drainage of lesions. When an abscess customers, 21 completed a questionnaire and 19 been reported with increased frequency. Several developed in the genital area in July 2005, MRSA were actually screened for MRSA by culturing reports involved outbreaks among competitive was cultured from a wound swab. In December samples from nares and throats. sports participants, military personnel, 2005, the stylist was declared MRSA-free after All employees and the 19 selected regular prisoners, Native Americans and drug users. antimicrobial treatment. customers were negative for MRSA colonization. Skin treatments in a beauty salon likely led to Swabs were taken three times in one-week All environmental swabs were also negative for MRSA transmission as a result of contact with intervals from nose, throat, perineum and wounds MRSA. It was noted that the 70 percent alcohol an infected stylist. Clearly, the study and others and used for enrichment culture of MRSA. In used to disinfect the skin after waxing was diluted show that CA-MRSA is an emerging problem in March 2006, the woman was tested again for with water because customers had complained the community setting. MRSA colonization; test results showed that she about the stinging effect of the alcohol on treated In the Netherlands, patients are generally had been reinfected or that therapy had failed. skin. Furthermore, it became apparent that after only tested after recurrent infections. Unless The stylist had eczema. Because of the “hands performing waxing treatments, the stylist would outbreaks occur in a defined group, MRSA on” nature of her work, she was advised to touch the waxed skin of customers with ungloved remains undetected in the general population temporarily stop providing services to customers. hands to check for remaining hairs. She did not wash her hands after removing the gloves. because reporting is not mandatory. Although The municipal health department conducted the prevalence of MRSA is still low, local a risk assessment of the woman’s household During the outbreak investigation, more background microbiologic laboratories should report contacts and the beauty salon. The Netherlands information became available from those who outbreaks, when detected, to the local municipal does not require that MRSA infections be were MRSA colonized or infected and who could health department for further investigation. More www.elitecme.com Page 15 research is necessary to better understand the The suit claims Jessica Mears contracted a ▪▪ Kristina Preston was diagnosed with herpes risk factors involved in these outbreaks. You will bacterial infection during a 2004 pedicure at after receiving a manicure, and was awarded learn more about MRSA later in this chapter. the salon that left a large lesion on her left calf. $3 million in a settlement. Jessica Mears had lupus, a chronic disease that ▪▪ Reba Burgess (Kansas City) had to have a Deaths from dirty salons compromises the immune system, and the lesion finger amputated after receiving an infection Most salon professionals are surprised when never completely healed, said Robert Bohn Jr., as a result of poor sanitation techniques. they hear that people can actually die if proper the San Jose attorney representing Diana Mears. ▪▪ Jeanine Camerlengo (New York) contracted sanitations techniques are not followed. Licensees A number of women have reported similar herpetic heratoconjunctivitis after an eyebrow think that these types of infections occur only in infections following pedicures. They are believed waxing. health care settings. The following summarized to be caused by harmful bacteria that accumulate ▪▪ A woman (Aurora, Colo.) was awarded $3.75 articles describe how deaths have been suspected in improperly cleaned whirlpool footbaths. million after contracting herpes in a salon. in dirty salons in Texas and California: An outbreak traced to a single salon in Santa ▪▪ Geremie Hoff (St. Louis) was awarded $6,000 because of a bad hair treatment. A case in California Cruz County affected more than 100 pedicure customers in October 2000. Another outbreak of ▪▪ Mary Reddish (Georgia) was awarded An infection contracted from a pedicure may have skin infections, involving 33 different salons and $15,000 because of a bad hair treatment. caused the death of Gerry Ann Schabarum, wife of over 140 customers in Santa Clara County, was former California State Assemblyman and longtime Are cases being unreported? reported in November 2004. Los Angeles County Supervisor Pete Schabarum. Many doctors believe that salon bacterial No previous deaths in California had been infections are not being linked or reported to state According to the Pasadena Weekly, Schabarum attributed to bacteria from pedicures, according agencies, health departments or the CDC. Dallas had been battling a staphylococcus infection for to California’s Department of Consumer Affairs. County’s Chief Epidemiologist, Dr. John Carlo, more than a year and because she suffered from has been quoted as saying that serious infections rheumatoid arthritis, it was able to take hold in Family is sure pedicure led to woman’s are often mistaken as other illnesses, such as bites her body. death from insects or spiders. Dr. Carlo believes that an “It is tragic that another life may have been lost Kimberly Jackson believed something as simple emerging threat is at hand. because of an unsanitary salon,” said Sen. Leland as a pedicure caused what eventually led to her Dermatologist Shelley A. Sekula, MD, has Yee (D-San Francisco/San Mateo), the author of death. A MRSA staph bacteria that is sometimes suggested that states need to modify current legislation signed into law to help clean up dirty found in salons is extremely aggressive. David cosmetology and barbering industry regulations. salons. “While progress has been made to address Jackson is confident that his ex-wife got the these outbreaks, clearly more needs to be done to infection from a dirty salon during a pedicure. Before AIDS and hepatitis became household protect the health of nail salon consumers.” David said Kimberly went to the salon in June names, the cosmetology and barbering industries 2005 and was receiving a pedicure when she were under little scrutiny as risks for spreading In September 2007, Gov. Arnold Schwarzenegger looked down and saw that she was cut by a infectious diseases. However, since the 1980s, signed Yee’s AB 409 into law. AB 409 allows pumice stone and was bleeding. Several days an epidemic of blood-borne diseases has forced a the Board of Barbering and Cosmetology to later, she sought out medical help for an infection reexamination of the beauty industry. immediately suspend any license without advance on the foot and was treated over a course of hearing if the action is necessary to protect the seven months. Doctors treated it with a strong Based on her experience in Texas, it is Dr. public health and safety. A licensee found in combination of antibiotics, but on February 12, Sekula’s belief that legislators and public health violation could be placed on probation for one 2006, she lost her life. officials need to look seriously at the risks that year, required to undertake remedial training in threaten both clients and operators of the beauty health and safety laws and regulations, subject to The Texas Department of Licensing and industry. “Poorly trained technicians using dirty re-inspection at the cost of establishment owner, Regulation (TDLR) could not link the death to instruments are a cause of great concern for as well as new citation fines. the salon, but the family is confident that it is the consumers,” said Dr. Sekula. source of the infection. “AB 409 was a good first step, but we need more The health risks associated with the beauty inspectors and we need better testing,” said Yee. Violations continue industry include viral infections such as HIV, “Currently, only visual inspections are made at Brad Watson from WFAA TV has done several hepatitis B and C, and warts; bacterial infections salons; I plan to pursue further legislation that undercover investigations and has found that such as staphylococcus, streptococcus, and will require bacterial testing at salons to make while improvements have been made, many pseudomonas; fungal infections such as athlete’s sure consumers are protected from potentially salons continue unsanitary practices. foot, nail fungus and yeast; reactions to nail, hair deadly infections.” and facial products such as hand eczema, eyelid Watson’s investigations showed evidence of dermatitis, chemical burns and loss of hair or nails; There has been a dramatic rise in the number salon professionals not washing hands between and toxicity from acrylic and lacquer fumes and of people complaining of persistent lesions and customers, illegal blades, improper cleaning inappropriate use of chemical peeling solutions. infections after visiting salons. California has been and disinfecting of spa chairs, and the potential especially hard-hit by the outbreak, with hundreds cross-contamination of creams/lotions and reuse Although each of these risks poses considerable of women reporting cases of a rare bacterial of buffing blocks, which expose a customer to the health problems for consumers, there are simple infection linked to pedicures and manicures. previous customer’s nail and skin tissue. ways beauty establishments can modify their current practices and reduce the potential transmission Mother blames pedicure for daughter’s Other recent salon incidents of infectious diseases. Dr. Sekula explained that death These cases are not isolated. Below is list of other using disposable instruments whenever possible, SAN JOSE, CALIF. – The mother of a recent reported injuries from salon mistakes. properly sterilizing instruments, employing proper woman who died in June 2006 has sued a nail ▪▪ An unnamed woman nearly died after getting hand washing practices, and teaching the Center for salon alleging an infection from a pedicure a bikini wax and then contracting a life Disease Control’s (CDC) “universal precautions” contributed to her daughter’s death. Jessica threatening bacteria, Streptococcus pyogenes. in cosmetology and barber schools would virtually Mears, of Sunnyvale, died in late June at age ▪▪ Paula Abdul’s injury made worldwide news, eliminate the risks of contracting viral, bacterial and 43. Her mother, Diana Mears, filed a wrongful and she nearly lost her thumb because of an fungal infections. death lawsuit in Santa Clara County Superior infection following a manicure. “Since there is an inherent risk that customers Court against Top Hair and Nails Salon of may accidentally be cut during a routine hair or Mountain View. Page 16 www.elitecme.com nail appointment, it makes sense to use sterile on the earth, bacteria are found virtually their own, but are usually transported through the instruments,” said Dr. Sekula. “Nail clippers, everywhere around us, existing in dust, dirt air in dust particles or other substances. Bacilli acrylic nail drills, cuticle scissors, callus paring and decay, our skin and body tissues, the air we and spirilla are both capable of self-movement blades, reusable razors and blades all have the breathe and the water we drink. Bacteria produce (motility), using hairlike projections (flagella or potential to transmit infectious diseases if they slimy fluids or waxy coatings, which moisten cilia) to propel themselves. are not properly sterilized. Unfortunately, we them and help them survive in inhospitable Methicillin-resistant Staph aureas (MRSA) are finding that not all salons are following this environments. Fimbri, hairlike tendrils that anchor Methicillin-resistant Staphylococcus aureus simple rule of thumb.” the bacteria to an object, make bacteria sticky, (MRSA), the bacteria that killed Kimberly requiring one to use some degree of pressure when “As more and more consumers frequent hair and Jackson as noted above, is caused by bacteria scrubbing, to break the hold of these tenacious nail salons each year, the risk of becoming infected known as staphylococcal aureas. Staph aureas is fibers. Bacteria exist in one of two modes: an with hepatitis, HIV and other transmittable a common bacteria found on skin and mucous active, vegetative mode, and an inactive, spore- diseases increases as well,” said Dr. Sekula. membranes. In MRSA, a type or strain of Staph forming mode. In the active stage, bacteria grow aureas has become resistant to antibiotics in the Among the diseases that have the potential to be and multiply at an astonishing speed. transmitted at a hair or nail salon, hepatitis B and penicillin family, which includes methicillin. Reproducing through binary fission (a process C pose the biggest threat to public health. There People can become either colonized or infected in which one bacteria splits into two), bacteria are over 5 million people infected with hepatitis with MRSA. In colonization, people have MRSA produce millions of copies within hours. Bacteria in the U.S. Every year, approximately 100,000 on their skin or mucous membranes without signs are only able to reproduce when the environment people in the U.S. contract hepatitis B – which is of infection. With infection, the bacteria have meets their specific needs in temperature and 100 times more contagious than HIV. Between entered the body and have begun to multiply degree of moisture. They require a warm, damp, 28,000 and 140,000 people contract hepatitis C. and cause damage to the organ or body tissue usually dark and often dirty environment that Hepatitis B can be infectious for at least a week involved. Signs of infection include fever, provides a supply of food adequate to sustain on surfaces commonplace to salons, such as warmth, redness of the area, pain, and an elevated the bacteria and provide fuel for reproduction. If headrests, chairs and tools and instruments. white blood cell count. MRSA is spread by direct conditions are not favorable for reproduction, the contact with affected areas and is normally not There is now evidence that hepatitis C, which prior bacteria will move into a spore-forming stage, spread by casual contact. Good hand washing to 1990 was commonly transmitted through blood producing spores with tough outer surfaces that and the use of gloves for contact with mucous transfusions, can be transmitted by razors, nail files are almost impervious to wind, heat, cold, harsh membranes will avoid transferring the bacteria and barber’s scissors, among other things. cleaners or disinfectants. These characteristics from one person to another. help spores survive for long periods between Your responsibilities reproductive phases. As a salon professional, you have responsibilities How common are Staph and MRSA to the state and your profession to learn and While there are hundreds of different kinds of infections? use appropriate precautionary measures and bacteria, they are primarily sorted into one of Staph bacteria are one of the most common cleaning procedures, to protect both you and your two types, according to the danger they pose causes of skin infection in the United States and clients, reduce the incidence of bacterial, viral, to us. Potentially harmful bacteria are called are a common cause of pneumonia, surgical and fungal infection, and prevent the spread of pathogenic; harmless or beneficial bacteria are wound infections and bloodstream infections. disease. You, your instruments and workstation called nonpathogenic. The great majority (about The majority of MRSA infections occur among must be kept as clean as possible, meaning no 70 percent) of bacteria are nonpathogenic. patients in hospitals or other health care settings. shortcuts or omissions of any precautionary Called saprophytes, these organisms do not But they are becoming more common in the measures discussed in this chapter. Violations can produce disease and carry out necessary community setting. result in penalization by the state of Ohio, as well functions, such as decomposing dead matter, as infection. for example. Nonpathogenic bacteria also exist What does a staph or MRSA infection in the human digestive tract and in the mouth look like? The remainder of this chapter will review these and intestines, where they facilitate digestion by Staph bacteria, including MRSA, can cause skin subjects: breaking down food. infections that may look like a pimple or boil ▪▪ The biology of pathogens, how they function, and can be red, swollen, painful, or have pus or reproduce, and infect. A much smaller minority (about 30 percent) other drainage. Infections that are more serious ▪▪ Universal sanitation and sterilization precautions. of organisms are pathogenic organisms, also may cause pneumonia, bloodstream infections, or ▪▪ State of Ohio regulations that apply to called microbes or germs. These are harmful surgical wound infections. cosmetology. and produce disease when they invade animal or ▪▪ The difference between decontamination, plant life. Pathogenic bacteria commonly exist in the salon environment. Bacterial infection Are certain people at increased risk for sanitation, sterilization, and disinfection. community-associated staph or MRSA ▪▪ How to effectively disinfect tools and surfaces occurs when a body is exposed to and cannot in your environment, and sanitize hands. successfully fight off bacterial invasion. infections? Factors that have been associated with the spread General infections typically begin as local Microorganisms and Infectious Agents of MRSA skin infections include: close skin-to- infections, which may start as a boil or pimple Microorganisms are tiny living particles skin contact, openings in the skin such as cuts accompanied by pus (a compilation of bacteria, (organisms) with many different characteristics. or abrasions, contaminated items and surfaces, decayed tissue, waste and blood cells) that is They live in our air, water and earth, and are found crowded living conditions and poor hygiene. often associated with infection. Bacterial toxins everywhere on the planet. Some microorganisms from local infections can spread to different parts are associated with infection or disease; others How can I prevent staph or MRSA skin of the body through the bloodstream, increasing are harmless or even helpful. Bacteria, viruses infections? the likelihood of general infection. and parasites are three major categories of Practice good hygiene: microorganisms that you encounter every day. Pathogenic bacteria are distinguished by their ▪▪ Keep your hands clean by washing characteristic shapes: Bacilli are rod-shaped, thoroughly with soap and water or using an Bacteria and the most common bacteria, causing diseases alcohol-based hand sanitizer. Bacteria are tiny one-celled vegetable such as influenza, tetanus and diphtheria. Spirilla ▪▪ Keep cuts and scrapes clean and covered microorganisms (plants) that can be seen only are spiral-shaped bacteria, and cocci are round with a bandage until healed. with a microscope. The most plentiful organisms bacteria that produce pus. Cocci rarely move on www.elitecme.com Page 17 ▪▪ Avoid contact with other people’s wounds Viruses are hardy organisms. They can live for up ▪▪ Discard any implements, including or bandages. to 48 hours on the surfaces of toys, coffeemakers, orangewood sticks, items with porous ▪▪ Avoid sharing personal items such as doorknobs, computer keyboards and other hard surfaces, and any abrasives used. towels or razors. surfaces in a salon. It can take up to a week for ▪▪ Disinfect all implements and work surfaces. ▪▪ Practice good disinfection techniques. that virus that infected you to produce symptoms. ▪▪ Refer the client to a physician for treatment Plant parasites, such as fungus or mold, mildew once the natural nail is exposed. If I have a staph or MRSA skin infection, and yeasts are multicellular organisms that are as Animal parasites what can I do to prevent others from prevalent as bacteria and consume both live and Animal parasites may be single-cell (protozoans) being infected? dead tissue to survive. Fungi usually prefer a damp like amoebas or malaria, or multicell, like mites You can prevent spreading staph or MRSA skin environment, but can also survive in a warm, dry or lice. Protozoans consume both plant and infections to others by following these steps: climate. They reproduce and spread a number of animal tissue, and are found in blood and body ▪▪ Cover your wound. Keep wounds that are different ways, and can invade the human body fluids, water and food. Multicell animals, such draining or have pus covered with clean, dry easily, requiring no break in the skin. as lice and mites, can hide in the hair and burrow bandages. Follow your health care provider’s Ringworm and athlete’s foot are two common under the skin. Be aware of the signs of scabies, instructions on proper care of the wound. Pus contagious diseases that are spread by fungi. identified by bite marks on a client; Rocky from infected wounds can contain staph and Another is favus, which affects the scalp. Mountain spotted fever, or typhus, caused by MRSA, so keeping the infection covered will Cosmetologists should not serve any individual rickettsia; and animal parasites carried by fleas, help prevent the spread to others. Bandages or with signs of any fungal infection. If you have a lice and ticks that are even smaller than bacteria. tape can be discarded with the regular trash. fungal infection, do not work and seek treatment For any individual with a visible communicable ▪▪ Clean your hands. You, your family and immediately. If you think a client has ringworm, disease, like pediculosis (head lice), open sores others in close contact should wash their identified by a ring-shaped, circular pattern on the or marks suggesting scabies, it is recommended hands frequently with soap and warm water skin, or athlete’s foot, do not provide service to that the person furnish a statement signed by or use an alcohol-based hand sanitizer, the individual, as it is highly contagious. Tell the a physician that the disease or condition is not especially after changing the bandage or individual to consult a physician for treatment. touching the infected wound. in an infectious, contagious or communicable ▪▪ Do not share personal items. Avoid sharing Precautions with plant parasites stage. The same is true if the cosmetologist has personal items such as towels, washcloths, Fungal infections can be stubborn. Many affect symptoms or indications of a visible disease, razors, clothing or uniforms that may have had the skin, but fungal infections can also cause lice or open sores; he or she should not practice contact with the infected wound or bandage. severe respiratory infections. More common cosmetology until obtaining a statement signed Wash sheets, towels and clothes that become versions of fungal infections are those caused by by a physician stating that the disease or soiled with water and laundry detergent. yeast, including nail fungus, athletes foot, jock condition is not in an infectious, contagious or Drying clothes in a hot dryer, rather than air- itch and ringworm. Both over-the-counter and communicable stage. drying, also helps kill bacteria in clothes. prescription treatments are available for relief Modes of contamination ▪▪ Talk to your doctor. Tell any health care from the unpleasant, itchy symptoms of many Diseases are communicable or contagious providers who treat you that you have or had yeast infections. when they move from one individual to a staph or MRSA skin infection. Plant parasites, like fungus and mold, are another. Working with the public means Viruses contagious, with nail fungus a significant risk encountering potentially dangerous pathogens Viruses are infectious biological entities that are to clients receiving nail services, as fungi can and opportunistic organisms every day. Always very small – much smaller than bacteria – and spread, not only from one nail to another but also assume your clients, co-workers and environment cause disease by entering a healthy cell, maturing from a client to a technician or the reverse, given could be carrying illness, and use proper infection and reproducing. Unlike bacteria, viruses do improper sanitation techniques at a salon. Nail control procedures every day. not survive for any length of time without the fungus appears as discoloration of the nail plate Humans have some level of immunity against protection of a living cell. Viruses are dangerous (on either the fingernails or toenails), initially infection, but our level of protection varies with age, because their replication inside the cell eventually appearing white, but growing darker over time. health and a range of other factors. Skin is our first causes the death of that cell. They are parasites, Clients with nail fungus should be referred to a line of defense. When there are no cuts or scrapes, taking the cell’s nutrients and destroying the physician for treatment. skin is excellent protection against pathogens. cell in the process. The cell is then used to breed hundreds, thousands and even millions of new Molds and mildews do not infect fingernails, and In the vast majority of cases, bacteria, fungi and mature infectious viruses that leave to infect rarely, if ever, appear under the nail. viruses enter the body through the portals of the other cells. Viruses cause diseases like hepatitis, Greenish bacterial infections, which may appear nose and mouth, small tears or openings in the influenza and measles, and are the source of yellowish or yellow-green initially, can continue skin, and to a lesser extent, the eyes and ears. colds, chicken pox, cold sores and genital herpes, to stain the nail plate long after an infection has Once inside the body, the pathogen reproduces mononucleosis, hepatitis and HIV/AIDS. subsided, and are sometimes mistakenly attributed rapidly at a rate that can overwhelm the immune system, resulting in disease. Viruses are a particular concern in salons because to mold. Nails can harbor dangerous bacteria, of their potential severity and the way they which can thrive on the oils and moisture that exist Transmission may occur through direct or spread. Viruses occupy the surfaces of objects between an improperly prepared or unsanitized indirect contact. For example, indirectly inhaling you touch, including door handles, coffee mugs nail plate and an applied enhancement. contaminated droplets in the air (airborne and scissors; they can be inhaled on tiny dust Clients with nail fungus or other infections transmission), or touching a contaminated surface particles or travel on the minute amount of saliva should not receive nail services, but can be and then touching one’s nose, eyes or a mucous expelled in a cough. Viral infections can be assisted in removing an artificial nail from the membrane is an easy way for transmitting germs. transmitted from one person to another through infected natural nail. If you are asked to expose Try to avoid touching your face during the day, casual contact with an infected individual or the natural nail, follow these precautionary steps: and always wash your hands between clients. contact with what he or she touched. Both hand- ▪▪ Wear gloves during the removal of artificial Yeast, scabies, lice and many other skin to-surface and hand-to-hand contact are highly nails. infections do not require an open sore or mucosal effective methods for transferring virus particles ▪▪ Follow the manufacturer’s instructions for surface to infect. Athlete’s foot contaminates from one individual to another. removal. through indirect transmission. When someone

Page 18 www.elitecme.com with athlete’s foot walks barefoot on a wet Pathogenic and opportunistic microorganisms are What do you need to know about bathroom floor, for example, the person leaves able to thrive in a salon’s warm, moist places, like antibiotics? behind spores that will stick to the foot of anyone the drain of the shampoo sink, the footbaths, hot ▪▪ Remember that antibiotics don’t work against else walking barefoot on that floor, infecting and cold-water handles and taps. Implements such colds and flu, and that unnecessary antibiotics the individual even if he or she has no cuts or as scissors, files, brushes or nippers can be major can be harmful. openings on the feet. sources of contamination because they often contain ▪▪ Talk to your health care provider about Fungi, like athlete’s foot, will survive for some organic matter, an optimum growth environment for antibiotics and find out about the differences time on a damp or wet floor. Spa shower stalls pathogenic and opportunistic microorganisms. between viruses and bacteria – and when and soaking baths that retain small amounts of Some of the most dangerous areas in your antibiotics should and shouldn’t be used. water must be thoroughly cleaned and disinfected salon are the places you keep contaminated ▪▪ If you do get an antibiotic, be sure to take it with the appropriate disinfectant. manicuring tools or equipment, including the exactly as prescribed; that may help decrease the development of resistant bacteria. The primary modes of travel for common manicure table and the trashcans in which you deposit dirty implements. Microbes can also ▪▪ Antibiotic resistance is particularly dangerous contagions are: for children, but it can occur in adults as well. ▪▪ Unclean hands. exist on seemingly unlikely products, like bars ▪▪ Unclean implements. of soap, for example. Because germs and other One final note is that taking antibiotics ▪▪ Open sores. microorganisms have been shown to thrive on appropriately and getting immunized will help ▪▪ Pus. bar soap, many salons prefer to use liquid soap prevent having to take more dangerous and ▪▪ Mouth and nose discharge. that can be dispensed from a container for each more costly medications. If we use antibiotics ▪▪ Shared cups or towels. customer. In addition, soaking solutions, lotions appropriately, we can avoid developing drug ▪▪ Coughing or sneezing. and creams that initially are uncontaminated resistance. We just need to take our medicine ▪▪ Spitting. may lose preservatives that keep them safe from exactly as it is prescribed and not expect to take pathogenic or opportunistic microbes from antibiotics every time we’re sick. Pathogenic bacteria can also enter the body through: growing in them. Changes in color, texture, ▪▪ A break in the skin, including pimples, appearance or odor can be signs of contamination. The problem of antibiotic resistance scratches or cuts. Fighting infection may be a matter of staying Overview ▪▪ The nose and the mouth during breathing. The triumph of antibiotics over disease- ▪▪ The mouth during eating and drinking. home when you are sick. Just as you should avoid working with contagious clients, you causing bacteria is one of modern medicine’s Humans are excellent sources of contamination should not go to work if you have an infection, greatest success stories. Since these drugs first because we are constantly leaving organic such as a bad cold or flu. Cover your mouth became widely used in the World War II era, particles behind wherever we go, a mixture of and nose to control pathogens escaping through they have saved countless lives and blunted dead skin cells, with viral, bacterial and fungal sneezes and coughs. Avoid causing wounds if serious complications of many feared diseases particles, along with other microorganisms your client’s skin is dry or fragile; tears and and infections. After more than 50 years of that consume skin cells or use us to travel to breaks can occur easily, even when filing nails. widespread use, however, many antibiotics don’t an appropriate host. Every time you touch Use abrasive instruments with care and a gentle pack the same punch they once did. something, you deposit some of this organic touch, especially around the nail bed. Over time, some bacteria have developed ways to matter on another surface. Simple actions, such outwit the effects of antibiotics. Widespread use of as touching a client’s hair, brushing some of your Viruses antibiotics is thought to have spurred evolutionary hair out of your eyes with your hand or touching Viruses cause: changes in bacteria that allow them to survive a spray bottle can move microorganisms from ▪▪ All colds and flu. these powerful drugs. While antibiotic resistance one item to another, from you to your client, or ▪▪ Most coughs. benefits the microbes, it presents humans with two your client to you. ▪▪ Most sore throats. big problems: It makes it more difficult to purge Individuals who are susceptible to infection, due Antibiotics cannot kill viruses. This is a common infections from the body, and it heightens the risk to a compromised protection system or some misconception. Many of us demand antibiotics of acquiring infections in a hospital. failure in their ability to resist invasion, are also from our doctor when we have a severe cold, but Diseases such as tuberculosis, gonorrhea, malaria the targets of opportunistic microorganisms. In antibiotics in that situation can actually do you and childhood ear infections are now more contrast to pathogens, opportunistic organisms more harm than good. difficult to treat than they were decades ago. do not cause initial illness but will infect Drug resistance is an especially difficult problem an individual once pathogenic organisms Bacteria for hospitals because they harbor critically ill have already weakened its immune system. Bacteria cause: patients who are more vulnerable to infections Opportunistic organisms cling to the skin and the ▪▪ Most ear infections. than the general population and therefore require hair and exist in the bodies of healthy people. ▪▪ Some sinus infections. more antibiotics. Heavy use of antibiotics in these Microbes also contaminate ventilation systems; ▪▪ Urinary tract infections. patients hastens the mutations in bacteria that bring to discourage their growth, vents, filters, Antibiotics do kill specific bacteria. about drug resistance. Unfortunately, this worsens humidifiers and dehumidifiers should be cleaned the problem by producing bacteria with greater and maintained regularly. Investigate any mildew Drug-resistant bacteria ability to survive even our strongest antibiotics. or musty odors, which are a good indication of Each time you take an antibiotic, bacteria are These even stronger drug-resistant bacteria microbe growth. Germs in a ventilation system killed. Sometimes bacteria may be resistant or continue to prey on vulnerable hospital patients. easily spread throughout a salon, landing on become resistant. Resistant bacteria do not respond To help curb this problem, the Centers for people, surfaces and implements, whenever the to the antibiotics and continue to cause infection. Disease Control and Prevention (CDC) provides blower or fan turns on. Each time you take an antibiotic unnecessarily hospitals with prevention strategies and Germs not only float through the air, settling or improperly, you increase your chance of educational materials to reduce antimicrobial constantly on salon surfaces, such as sinks and developing drug-resistant bacteria. So it is really resistance in health care settings. countertops, they can also “hitchhike” on human important to take antibiotics only when necessary. According to CDC statistics: skin, hair and clothing, contaminating anything Because of these resistant bacteria, some diseases ▪▪ Nearly 2 million patients in the United States with which they come into contact. that used to be easy to treat are now becoming get an infection in the hospital each year. nearly impossible to treat. Those patients, about 90,000, die each year www.elitecme.com Page 19 as a result of their infection – up from 13,300 There are several signs that the problem is ▪▪ Is the use of antibacterial agents regulated in patient deaths in 1992. increasing: the U.S.? ▪▪ More than 70 percent of the bacteria that ▪▪ In 2003, epidemiologists reported in The ▪▪ What is the difference between bacteriostats, cause hospital-acquired infections are New England Journal of Medicine that 5-10 sanitizers, disinfectants and sterilizers? resistant to at least one of the drugs most percent of patients admitted to hospitals ▪▪ How beneficial are antibacterials? commonly used to treat them. acquire an infection during their stay, and that ▪▪ Are antibacterial agents safe? ▪▪ Persons infected with drug-resistant the risk for a hospital-acquired infection has ▪▪ Do antibacterials create resistant bacteria? organisms are more likely to have longer risen steadily in recent decades. ▪▪ Can the widespread use of antibacterial agents hospital stays and require treatment with ▪▪ Strains of S. aureus resistant to methicillin lead to bacteria that are more resistant? second- or third-choice drugs that may be less are endemic in hospitals and are increasing ▪▪ Are there other concerns about the use of effective, more toxic and more expensive. in non-hospital settings such as locker antibacterial agents? rooms. Since September 2000, outbreaks of In short, antimicrobial resistance is driving ▪▪ When are antibacterials useful? methicillin-resistant S. aureus infections have up health care costs, increasing the severity been reported among high school football What is an antibacterial and how are of disease and increasing the death rates from players and wrestlers in California, Indiana certain infections. antibacterials classified? and Pennsylvania, according to the CDC. In its broadest definition, an antibacterial is Environment forces evolutionary change ▪▪ The first S. aureus infections resistant to an agent that interferes with the growth and A key factor in the development of antibiotic vancomycin emerged in the United States reproduction of bacteria. While antibiotics and resistance is the ability of infectious organisms to in 2002, presenting physicians and patients antibacterials both attack bacteria, these terms adapt quickly to new environmental conditions. with a serious problem. In July 2002, the have evolved over the years to mean two different Bacteria are single-celled creatures that, CDC reported that a Michigan patient with things. Antibacterials are now most commonly compared with higher life forms, have small diabetes, vascular disease and chronic kidney described as agents used to disinfect surfaces and numbers of genes. Therefore, even a single failure had developed the first S. aureus eliminate potentially harmful bacteria. Unlike random gene mutation can greatly affect their infection completely resistant to vancomycin. antibiotics, they are not used as medicines for ability to cause disease. And because most A similar case was reported in Pennsylvania humans or animals, but are found in products microbes reproduce by dividing every few hours, in September 2002. such as soaps, detergents, health and skincare bacteria can evolve rapidly. ▪▪ Increasing reliance on vancomycin has led products and household cleaners. to the emergence of vancomycin-resistant A mutation that helps a microbe survive exposure enterococci infections. Prior to 1989, no What are some common antibacterials? to an antibiotic drug will quickly become U.S. hospital had reported any vancomycin Antibacterials may be divided into two groups dominant throughout the microbial population. resistant enterococci, but over the next according to their speed of action and residue Microbes also often acquire genes, including decade, such microbes have become common production. The first group contains those that act those that code for resistance, from each other. in U.S. hospitals, according to CDC. rapidly to destroy bacteria, but quickly disappear The advantage microbes gain from their innate ▪▪ A 2003 study in The New England Journal of (by evaporation or breakdown) and leave no adaptability is augmented by the widespread, Medicine found that the incidence of blood active residue behind (referred to as non-residue- and sometimes inappropriate, use of antibiotics. and tissue infections known as sepsis almost producing). Examples of this type are the alcohols, A physician wishing to placate an insistent tripled from 1979 to 2000. chlorine, peroxides and aldehydes. The second patient ill with a cold or other viral condition Other federal agencies are involved in combating group consists mostly of newer compounds that sometimes inappropriately prescribes antibiotics. the problem of drug-resistant microbes. See the leave long-acting residues on the surface to be And when a patient does not finish taking links below for more information. disinfected and thus have a prolonged action a prescription for antibiotics, drug-resistant (referred to as residue producing). Common microbes not killed in the first days of treatment Centers for Disease Control and examples of this group are triclosan, triclocarban can proliferate. Hospitals also provide a fertile Prevention and benzalkonium chloride. environment for drug-resistant germs as close http://www.cdc.gov/drugresistance/community/ contact among sick patients and extensive use of How common are antibacterials in antibiotics force bacteria to develop resistance. Food and Drug Administration consumer products? Another controversial practice that some believe http://www.fda.gov/oc/opacom/hottopics/ All products that claim to kill bacteria and/ promotes drug resistance is adding antibiotics to antiresist.html or viruses have some kind of antibacterial agricultural feed. agent. Alcohols, chlorine and peroxides have National Library of Medicine Medline been used for many decades in health care and A growing problem Database cleaning products. Within the past two decades, For all these reasons, antibiotic resistance has http://www.nlm.nih.gov/medlineplus/antibiotics.html the residue-producing antibacterials once used been a problem for nearly as long as we’ve almost exclusively in health care institutions have been using antibiotics. Not long after the Public Health Action Plan to Combat been added to increasing numbers of household introduction of penicillin, a bacterium known Antimicrobial Resistance products, particularly soaps and cleaning agents. A recent survey reported that 76 percent of as Staphylococcus aureus began developing http://www.cdc.gov/drugresistance/actionplan/ liquid soaps from 10 states in the U.S. contained penicillin-resistant strains. index.htm triclosan, and approximately 30 percent of bar Today, antibiotic-resistant strains of soaps contained triclocarban. Staphylococcus aureus bacteria as well as APUA: Alliance for the Prudent Use various enterococci – bacteria that colonize the of Antibiotics Antibacterial Agent Many cleaning compounds contain quaternary intestines – are common and pose a global health Information Sheet ammonium compounds. Because these problem in hospitals. More and more hospital- ▪▪ What is an antibacterial and how are compounds have very long chemical names, they acquired infections are resistant to the most antibacterials classified? often are not easily recognized as antibacterial powerful antibiotics available, methicillin and ▪▪ What are some common antibacterials? agents on packaging labels. More recently, vancomycin. These drugs are reserved to treat ▪▪ How common are antibacterials in triclosan has been bonded into the surface of only the most intractable infections in order to consumer products? many different products with which humans slow development of resistance to them. come into contact, such as plastic kitchen tools,

Page 20 www.elitecme.com cutting boards, highchairs, toys, bedding and Are antibacterial agents safe? beneficial. Very few bacteria actually cause other fabrics. When used as directed for external surfaces, disease. Antibacterials are not discriminating, antibacterial agents are considered to be and an all-out attack on bacteria in general is Is the use of antibacterial agents relatively non-toxic. However, some may cause unjustified. Constant use of disinfecting agents regulated in the U.S.? skin and eye irritation, and all have the potential tends to disrupt the normal bacteria that act as Whether an antibacterial agent is regulated for doing harm if not stored or used properly. barriers against invading pathogens. This may depends upon its intended use and its Furthermore, evaluations of risk are based on cause shifts in bacterial populations and create a effectiveness. The U.S. Food and Drug single agents and do not consider the effects of “space” for disease-causing bacteria to enter and Administration (FDA) regulates antibacterial multiple uses or multiple compounds. establish infection. soaps and antibacterial substances that will Recently, triclosan has been reported in surface In addition, some scientists have gathered evidence either be used on the body or in processed food, waters, sewage treatment plants, the bile of fish showing that overly hygienic homes during early including food wrappers and agents added to and breast milk, but the significance of these childhood may be linked to the appearance of water involved in food processing. If a substance findings is presently unknown. allergies later in life. In this “hygiene hypothesis,” is not intended for use on or in the body, it is allergies develop because the childhood immune registered by the U.S. Environmental Protection Do antibacterials create resistant system fails to mature properly due to lack of Agency (EPA) under the Federal Insecticide, bacteria? contact with immune-stimulating bacteria. This Fungicide and Rodenticide Act. Substances are Because of their rapid killing effect, the non- hypothesis remains controversial and requires registered either as public health or as non-public residue-producing antibacterial agents are not further research for validation. health antimicrobial agents. believed to create resistant bacteria. Resistance When are antibacterials useful? What is the difference between results from long-term use at low-level concentrations, a condition that occurs when While there is no evidence that the routine use bacteriostats, sanitizers, disinfectants consumers use residue-producing agents such of antibacterials confer a health benefit, they are and sterilizers? as triclosan and triclocarban. Until recently, it useful where the level of sanitation is critical and The EPA classifies public health antimicrobials was accepted that these agents did not affect additional precautions need to be taken to prevent as bacteriostats, sanitizers, disinfectants and a specific process in bacteria, and because of spread of disease. sterilizers based on how effective they are this, it was unlikely that resistant bacteria could Thus, they are important in hospitals, day care in destroying microorganisms. Bacteriostats emerge. However, recent laboratory evidence centers, salons and health care facilities and inhibit bacterial growth in inanimate indicates that triclosan inhibits a specific step in other environments with high concentrations of environments. Sanitizers are substances that the formation of bacterial lipids involved in the infectious bacteria. In the home environment, kill a certain percentage of test microorganisms cell wall structure. Additional experiments found they may be needed for the nursing care of sick in a given time span. Disinfectants destroy or that some bacteria can combat triclosan and other individuals with specific infections, or for those irreversibly inactivate all test microorganisms, biocides with export systems that could also pump whose immune systems have been weakened by but not necessarily their spores. Sterilizers out antibiotics. It was demonstrated that these chronic disease, chemotherapy or transplants. destroy all forms of bacteria, fungi and other triclosan-resistant mutants were also resistant to Under these circumstances, antibacterials should microorganisms and their spores. several antibiotics, specifically chloramphenicol, be used according to protocol, preferably under Disinfectants can be further categorized as broad- ampicillin, tetracycline and ciprofloxacin. the guidance of a health care professional. or limited-spectrum agents. A broad-spectrum Resistance to antibacterials has been found Please visit the following link to learn more disinfectant destroys both gram-negative and where these agents are used continuously (as in about antibiotics: gram-positive bacteria. A limited-spectrum the hospital and food industry); however, at the http://www.cdc.gov/ncidod/op/antibiotics.htm. disinfectant must clearly specify the specific present time, this modest increase in resistance microorganisms against which it works. has not yet created a clinical problem. Decontaminating your environment How beneficial are antibacterials? You have a responsibility to control exposure to Can the widespread use of antibacterial pathogens by decontaminating your environment Antibacterials are definitely effective in killing agents lead to bacteria that are more and tools. Remember that pathogens collect any bacteria, but there is considerable controversy resistant? time an object or surface is exposed to air. surrounding their health benefits. The non- Many scientists feel that this is a potential danger, residue-producing agents have been used for Doorknobs, handles, the telephone, money, but others argue that the laboratory conditions many years and continue to be effective agents cabinets, the cash register – all are surfaces used in the research studies do not represent for controlling disease organisms in a wide touched by co-workers and clients that may harbor the “real world.” So far, studies of antibacterial variety of health care and domestic settings. harmful pathogens, so all must be decontaminated use in home products such as soap, deodorant to some degree. Cleaning is only the first step When used under strict guidelines of and toothpaste have not shown any detectable of the process. The following sections review application, the residue-producing agents have development of resistance. However, such the meaning of sanitation, sterilization, and proven effective at controlling bacterial and products have only been in use for a relatively disinfection, terms that are commonly used fungal infection in clinical settings such as short time, and studies of their effects are still interchangeably, but have very different meanings hospitals, nursing homes, neonatal nurseries and extremely limited. and require different procedures. other health care facilities where there may be a high risk of infection. A certain few consumer Are there other concerns about the use Sanitation products have demonstrated effectiveness for of antibacterial agents? Sanitation is the lowest level of specific conditions: antibacterial toothpaste Yes, experts believe that the use of these agents decontamination. Sanitation will reduce helps control periodontal (gum) disease; creates a false sense of security that may cause germs on a surface, but will not kill all antibacterial deodorants suppress odor-causing individuals to become lax in their hygiene habits. organisms. Sanitation provides a minimum bacteria; and antidandruff shampoos help Antibacterial use should not be considered an level of cleanliness, protecting public health control dandruff. However, to date, there is no alternative to normal hygiene, except where by preventing the spread of some, but not all, evidence to support claims that antibacterials normal hygiene practices are impossible. bacteria and fungi. Instruments that are sanitized provide additional health benefits when used by It should always be remembered that most are not sterile. Countertops and workstations the general consumer. bacteria are harmless and in many cases, even should also be sanitized, wiped down with soap www.elitecme.com Page 21 and water; this process should not be confused ▪▪ Rub hands together to make a lather and medical profession. Sanitation is now a standard with, and does not replace, disinfection, which scrub all surfaces. and thousands of lives have been saved because requires an appropriate disinfectant. Remember ▪▪ Continue rubbing hands for 15-20 seconds. of Dr. Semmelweis’s discovery. that soap and water will kill most of the bacteria Need a timer? Imagine singing “Happy on your hands, workstation or chair, but will not Birthday” twice through to a friend. Cleaning agents for hands kill all the bacteria or fungal spores. ▪▪ Rinse hands well under running water. Cleaning agents assist in the process of removing ▪▪ Dry your hands using a paper towel or air substances from surfaces. Soaps and detergents The term “sanitation” is most often used in dryer. If possible, use your paper towel to are two common cleaning agents that are often reference to cleaning the hands. Hand washing turn off the faucet. confused for one another, but are composed of is absolutely essential to controlling bacteria ▪▪ Always use soap and water if your hands are very different ingredients, with different cleaning and the most effective way to prevent the visibly dirty. properties. Soaps are the product of a chemical spread of infectious agents from one person to reaction, formed by vegetable oil reacting with another. Hands cannot be sterilized, because it is If soap and clean water are not available, use lye, for example, and chemicals that add a impossible to remove all microorganisms from an alcohol-based hand rub to clean your hands. desirable smell or quality to the soap, such as the surface of the skin. Water and soap, in fact, Alcohol-based hand rubs significantly reduce the glycerine, to make it milder. While soap does not are not sterile, and can introduce new bacteria number of germs on skin and are fast-acting. kill microorganisms, soap and water will help and infectious agents. When using an alcohol-based hand sanitizer: remove them from surfaces. Your hands are populated by both resident and ▪▪ Apply product to the palm of one hand. Detergents are manufactured for the express transient organisms. Resident organisms are ▪▪ Rub hands together. purpose of cleaning specific substances off a normal part of your skin’s environment, their ▪▪ Rub the product over all surfaces of hands specific items, and are created using chemicals natural habitat. They grow and multiply in an and fingers until hands are dry. that can be very harsh to skin. In contrast to oxygen environment, and rarely cause infection http://www.health.state.mn.us/handhygiene/wash/ detergents that do not leave a residue or require or harm the individual who is their host. These fsgermbuster.html rinsing, soaps leave a coating or residue on organisms cannot be removed easily by hand the body, typically one designed to make skin washing. Sanitation controls minimize exposure Hand washing: The beginning of smoother or more attractive. Soaps also remove to transient organisms. These organisms, like E. infection control less fat from the skin than detergents, which coli and salmonella, cause dangerous infections http://www.cdc.gov/Features/HandWashing/ have a drying quality and may strip the skin. Be in humans. In contrast to resident organisms, sure to use the appropriate cleaning agent for the transient organisms cannot live long on the Ignaz Semmelweis, an Austrian-Hungarian job. Different cleaning and disinfecting agents surface of our skin. They function poorly in physician, first demonstrated over 150 years have many different properties. Always read the an oxygen environment, usually surviving less ago that hand hygiene can prevent the spread ingredients, instructions and recommendations than 24 hours. These organisms can be removed of disease. Hand hygiene as a practice includes for use on the item’s label. easily through the process of hand washing, using performing hand washing, or using antiseptic friction, soap and water. hand wash, alcohol-based hand rub or surgical hand hygiene/antisepsis. Sterilization and disinfection Wash your hands “Sterile” means free from all germs; sterilization Dr. Semmelweis worked in a hospital in Vienna is the most effective level of decontamination, (http://www.cdc.gov/Features/Hand washing/) whose maternity patients were dying at such an involving the removal of all bacterial life from Hand washing is a simple thing, and it’s the best alarming rate that they begged to be sent home. a surface. This is the level of decontamination way to prevent infection and illness. Most of those dying had been treated by student required for tools and surfaces in hospital physicians who worked on corpses during an Clean hands prevent infections. Keeping hands surgeries. Hospitals use steam autoclaves to heat anatomy class before beginning their rounds in instruments to a very high temperature and many clean prevents illness at home, at school, and at the maternity ward. work. Hand hygiene practices are key prevention salons are investing in autoclaves to reinsure tools in health care settings, in day care facilities, Because the students did not wash their hands clients that their safety is the number one priority. in schools and public institutions, and for the effectively between touching the dead and the Disinfection is the process of killing specific safety of our food. living – hand washing was an unrecognized microorganisms, bacteria or germs using physical hygienic practice at the time – pathogenic In health care settings, hand washing can prevent or chemical processes. Disinfectants are chemical bacteria from the corpses regularly were agents that destroy organisms on contaminated potentially fatal infections from spreading from transmitted to the mothers via the students’ hands. patient to patient and from patient to health care instruments or surfaces. Disinfectants can be worker and vice-versa. The basic rule in the The result was a death rate five times higher for dangerous and must be used with caution. hospital is to cleanse hands before and after each mothers who delivered in one clinic of the hospital Disinfectants are used to destroy bacteria on patient contact by either washing hands or using than for mothers who delivered at another clinic equipment and implements, but they should an alcohol-based hand rub. not attended by the student physicians. not be used on the skin. In a salon atmosphere, disinfectants must be able to kill viruses, fungus In an experiment considered quaint at best by At home, hand washing can prevent infection and dangerous bacteria. and illness from spreading from family member his colleagues, Dr. Semmelweis insisted that to family member and sometimes throughout a his students wash their hands before treating Disinfectants the mothers – and deaths on the maternity ward community. In the home, the basic rule is to wash Controlling bacteria in a salon requires some fell fivefold. hands before preparing food and after handling degree of effort, vigilance and good sense. uncooked meat and poultry; before eating; after Unquestioned today as the most important tool In choosing a disinfectant, always look for changing diapers; after coughing, sneezing, or in the health care worker’s arsenal for preventing the EPA registration number (awarded by the blowing one’s nose into a tissue; and after using infection, hand washing was not readily Environmental Protection Agency) to ensure the bathroom. accepted in Dr. Semmelweis’s era. Indeed, his you are using an approved disinfectant. This pleas to make hand washing a routine practice number indicates a level of safety for specific Wash your hands: The right way throughout the hospital were largely met with kinds of disinfection. To be registered by the When washing hands with soap and water: derision. Another 50 years would pass before EPA, it must be effective in killing bacteria, ▪▪ Wet your hands with clean running water and the importance of hand washing as a preventive including Staphylococcus aureas, salmonella apply soap. Use warm water if it is available. measure would be widely accepted by the and pseudomonas. Cosmetology salons must

Page 22 www.elitecme.com use not only EPA-approved disinfectants, but 1. Concentration – This is dilution rate. Proper and/or when heavily soiled. Thus, implements also those with an EPA rating of hospital-level dilution is very important. Read label for and surfaces shall first be thoroughly cleaned (tuberculocidal) quality. These disinfectants are complete dilution directions. prior to disinfection. Disinfectants shall be especially effective for salon use and are capable 2. Contact time – For quats, this is very prepared fresh daily or more often if solution of killing viruses, dangerous bacteria and fungus. important and is discussed thoroughly becomes diluted or soiled. Contact Time: Leave throughout this course. For other Disinfectants can be hazardous if prepared surface wet or completely immersed, if possible, disinfectants, such as bleach, contact time is incorrectly. Consult the manufacturer’s Material for a ten-minute contact time or longer as not very critical. Safety Data Sheets (MSDS) for information required by manufacturer for disinfecting against 3. PH – Certain disinfectants work best under on preparing the solution; check the listing “HIV”, “HBV”, and all other viruses, bacteria, acidic conditions (bleach), and others work of chemicals in the disinfectant and how they and fungi. In all cases the disinfectant used best under alkaline conditions (quats). can pose safety hazards, if any. Be certain shall be in accordance with the manufacturer’s 4. Temperature – Certain disinfectants work to follow manufacturers’ instructions and all recommendation or other guidance in this rule. best in cold water (bleach). Most, like quats, written directions for the preparation and use of (B) All used implements shall first be cleaned work best in warm water. a specific disinfectant. Remember to follow all of visible dirt, debris and/or bodily fluids with 5. Soil load – Quats and other disinfectants do directions when using this type of disinfectant warm soapy/detergent water and then disinfected not know the difference between soil and or any other disinfectant. by completely immersing in an “appropriate bacteria. That is why heavy soil should be disinfectant”. To ensure safety, use an appropriate ratio of removed before disinfecting. See explanation ▪▪ (1) All non-porous implements, which concentration in the solution, and clean only above for more details. come in contact with intact skin, shall be approved items, according to label instructions. 6. Organism type – Not all disinfectants work thoroughly cleaned before immersion in an Wear gloves and safety glasses, as indicated on all types of organisms. When in doubt, “appropriate disinfectant”. An “appropriate when mixing and using solutions. Do not read the product label for a complete list. confuse disinfectants, which destroy harmful disinfectant” for objects, which come in microorganisms, with antiseptics, products How can you calculate active parts per contact with intact skin is an environmental designed to slow the growth of microorganisms. million (ppm) of the disinfectant you are protection agency registered, hospital Antiseptics do not kill microorganisms and using? grade bactericidal (esp. pseudomonacidal), should not be confused with disinfectants or used To calculate active ppm, you’ll need three things virucidal, and fungicidal that is mixed for salon disinfection. – the active ingredient list from the disinfectant and used according to the manufacturer’s label, dilution rate of the product and a calculator. directions or household bleach in a ten Household disinfectants, commonly used to The following is an example of how this would percent solution for ten minutes. clean offices and homes, may be used to clean be done using Neutral Germicidal Cleaner: ▪▪ (2) All non-porous implements, which floors, doorknobs, walls, etc., as directed on the Step 1: have come in contact with blood or body container label, but should not be used in place ▪▪ Add together active ingredient percentages fluids, shall be thoroughly cleaned before of a hospital-grade salon disinfectant, which is from the label: immersion in an “appropriate disinfectant”. required to sterilize instruments. ▫▫ For example, 5.07 percent + 3.38 percent An “appropriate disinfectant” includes an Bleach can be used as an effective disinfectant, = 8.45 percent total active ingredients. environmental protection agency registered but it is not a cleaning agent and should only be Step 2: tuberculocides or products registered against applied to clean surfaces. Bleach must be used ▪▪ Multiply by 10,000: “HIV/”HBV” or household bleach in a ten with caution because it can release toxic fumes ▫▫ 8.45 X 10,000 = 84,500 percent solution for ten minutes. For personal when mixed with certain substances. Bleach is Step 3: protection against blood-borne pathogens, far too harsh for day-to-day disinfection and will ▪▪ Divide the result of Step 2 by the dilution rate cleanup should always be done wearing damage instruments. It may be used for washing (128 in this example): protective gloves and also gowns, and eye towels and other salon laundry. ▫▫ 84,500 / 128 = 660 ppm. protection for large spills. All implements, which have come in contact with blood or What are efficacy tests? Parts per million (ppm) is a ratio figure that body fluids, shall be disinfected by complete represents the amount of one substance that is in The tests used to measure the effectiveness of immersion in an “appropriate disinfectant”. one million parts of another substance. disinfectants on various pathogenic (disease- (C) Any non-porous surface that comes in contact with blood or body fluids shall first be causing) organisms are called efficacy tests. The Ohio State Board of Cosmetology Sanitary EPA must pre-approve all “efficacy test methods” cleaned with warm soapy/detergent water, and used to measure the effectiveness of disinfectants Standards then an “appropriate disinfectant” shall be used. against specific microorganisms. The most 4713-15-01 General sanitation An “appropriate disinfectant” for surfaces, common efficacy test prescribed by EPA is The entire licensed facility, including all which have come in contact with blood or the Association of Official Analytical Chemist equipment, employees, and implements contained body fluids, include environmental protection (AOAC) test. Currently, for a disinfectant cleaner therein must be continually maintained in a agency registered tuberculocides or products to be registered by EPA as hospital strength, it sanitary manner satisfactory to the “Board”. registered against “HIV”/”HBV” or household must be effective at its recommended dilution in bleach in a ten percent solution for ten minutes. killing target pathogens in the presence of 400 4713-15-02 Methods of sanitizing For personal protection against blood-borne ppm hard water and 5 percent organic serum and Any implements to be used on any patrons shall be pathogens, cleanup should always be done must kill 100 percent of the target test organisms. properly sanitized. All methods of sanitation shall wearing protective gloves and also gowns, and eye protection for large spills. It is a good idea for you to require the be bacteriologically effective and all commercially manufacturer and/or distributor of a disinfectant prepared sanitizing agents shall be used in (D) Household bleach is an effective disinfectant or disinfectant-cleaner to provide efficacy data to accordance with manufacturer’s instructions. for all purposes in a salon. Bleach solutions shall you before you select it for use in your salon. be mixed daily and used in a ten to one solution 4713-15-03 Disinfection of implements (nine parts tap water and one part bleach). Bleach What factors affect how well a and spills; shall be kept in a closed covered container and disinfectant works? Blood and body fluids (A) Disinfectants not exposed to sunlight. Bleach may produce eye There are six main factors: are inactivated and ineffective when visibly irritation or mouth, esophageal, and gastric burns. contaminated with debris, hair, dirt, particulates Bleach is corrosive to metals. Bleach vapors www.elitecme.com Page 23 might react with vapors from other chemicals, disposable puffs or cotton pledgets, or other 4713-15-17 Rooms Used For Massage and therefore should not be placed or stored disposable applicators. Rooms used for massage services may be used for near other chemicals used in salons (i.e. acrylic other compatible services such as esthetics as long monomers, alcohol, other disinfecting products, 4713-15-10 Walls and floors as no sanitary problems result. If cosmetic therapy, or near flame). Used or soiled bleach solution Walls, floors and fixtures shall be sanitary and massage therapy, or other professional service is shall be discarded every day by pouring down kept clean at all times. Floor covering shall be provided at the salon under section 4713.42 of the sink basin or toilet bowl. totally nonabsorbent and extend at least in a Revised Code, sanitize all instruments and supplies three foot radius from the center of any styling or (E) All bottles and/or containers other than used in the cosmetic therapy, massage therapy, or shampoo service chair. the original manufacturers’ container used for other professional service. application of “appropriate disinfectant” shall 4713-15-11 Proper laundering methods Introduction to the autoclave be properly labeled as to contents, percentage All cloth towels, robes, and similar items shall While autoclaves are not required in Ohio, many solution and date mixed. be laundered in a washing machine with laundry salons are purchasing them. They provide your (F) Cleanup items from minor cuts shall be detergent and chlorine bleach used according to salon with an increased layer of safety and you double bagged or placed in biohazard containers, manufacturer’s directions for sanitation purposes. can market to clients by stressing that you use an regardless of quantity. Double bagging could A closed dustproof cabinet must be provided for autoclave. This section will give you the basics mean use a zip lock baggie for the waste, and clean towels and linen, and a closed dustproof of autoclave procedures. then put the baggie in a normal trash bag. If the hamper or receptacle must be provided for all The autoclave that uses saturated steam under spill or cleaning materials are of a relatively soiled towels and linens. pressure is one of the most dependable methods larger volume, those materials used to clean available for the inactivation of all forms of spills, which do contain blood spills or bodily 4713-15-12 Personal hygiene microbial life. To ensure safety and quality fluids, shall be weighed logged on a disposal Every person engaged in the practice of control, all biohazardous materials and items log sheet and double bagged for disposal in the cosmetology or any of its branches shall contaminated with potentially infectious agents normal trash. If in doubt of what to do, call the thoroughly cleanse his or her hands with soap and should be decontaminated before use or disposal. local health board for directions. water or an alcohol-based handrub immediately Such items include, but are not limited to, before serving each patron. All licensees shall (G) All food and drug administration designated toenail clippers, cuticle nippers and metal cuticle wear a clean washable outer garment while “medical devices” shall only be disinfected pushers. Steam sterilization is not recommended serving a patron in a salon. No licensees shall by appropriate environmental protection for anhydrous substances, flammable materials, carry or store instruments in their pockets, in a agency approved disinfectants, for example electrical equipment or any item that may be belt, in a leather case or in an apron. microdermabrasion service wand, tip or head. damaged in the autoclaving process. (H) Environmental protection agency approved 4713-15-15 Equipment sanitation All How the autoclave works disinfectants are indicated by their registration equipment used in a salon shall The most common steam sterilizer found is the number on the product label and the manufacturer’s be maintained in a sanitary manner. Salons shall gravity displacement type. Saturated steam enters directions for use shall always be followed. maintain a copy of the manufacturer’s/ owner’s the top of the chamber by a steam pressure- manual for all equipment in service. 4713-15-04 Shampoo bowls control valve. As the steam enters, it pushes the All shampoo bowls, shampoo boards, cups, or (A) Electrical equipment, (whether professional air out through a trap in the drain line. Once similar items shall be sanitized after each use. or consumer design) which provides circulating, all the air is evacuated, the trap closes. Steam whirlpool or vacuum effects, (for example, all continues to fill the autoclave chamber until a 4713-15-05 Proper protection of neck microdermabrasion machines, facial machines, pre-set temperature and pressure are reached. No shampoo apron, hair cloth, or similar article pedicure stations, nail drills and body treatment Common autoclave operating conditions are 270 shall be placed directly against the neck of the equipment) shall be cleaned and disinfected after degrees Fahrenheit and 15 pounds per square patron, and they shall be kept from direct contact each use. Such equipment shall also be flushed, inch gauge (psig) pressure. cleaned and disinfected on a bi-weekly schedule. with the patron by means of a paper neck band or The sterilization procedure consists of three A record of such cleaning shall be kept on forms clean towel. No neck band of paper or cloth shall phases. These are the autoclave heat-up time, the provided by the “Board” and available upon any be used more than once. No towels shall be used contact time and the cool-down time. Once the salon inspection. The bi-weekly cleaning shall more than once without proper laundering. temperature has come to equilibrium, a minimum include the use of a hospital grade disinfectant, of 20 minutes contact time for all surfaces ten per cent bleach solution or an equivalent 4713-15-06 Use of creams that require sterilization is necessary to insure solution approved by the “Board” and circulated All creams and other semi-solid substances complete biological inactivation. Usually the through the machine for the minimum time shall be removed from containers with a clean heat-up time section of the sterilization procedure recommended by the manufacturer. sanitized spatula. Spatulas made of a washable is the time given for the autoclave chamber to nonabsorbent material shall be sanitized before (B) Heated electrical equipment such as, all types heat up to the prescribed temperature; therefore, being used again. Spatulas made of wood shall be of thermal irons, pressing combs and stoves are the run time used must be long enough for the discarded after one use. sanitized by the heat source. Unheated parts of such entire package to equilibrate at 270 degrees and equipment shall be cleaned and disinfected as well, still give the load a 20-minute contact time. 4713-15-07 Use of styptics according to manufacturers’ recommendations. Styptics to arrest bleeding shall be used only in Autoclave safety procedures (C) Any other electrical equipment, including liquid or powder form and shall be applied by All potentially infectious materials must be clippers and attachments shall be cleaned and clean gauze, cotton, or any other sanitary item. autoclaved before being washed or stored. disinfected after each use. Electrical clipper Personnel who operate the autoclave must be blades and attachments shall be disinfected using 4713-15-08 Special solution containers trained to understand proper packaging, loading, the following method: All cosmetologists shall use product containers to labeling as well as operation and emergency ▪▪ (1) Remove hair and/or all foreign matter; prevent the contamination of unused solution. procedures. This training should also be ▪▪ (2) Completely saturate clipper blade and documented by the principal owner of the salon. attachment with an EPA-registered high-level 4713-15-09 Use of powder Autoclaves generate high heat and pressure; disinfectant solution, spray, or foam used All powder shall be dispensed from a shaker therefore, all users must understand and respect or similar receptacle and shall be applied with according to the manufacturer’s instructions. Page 24 www.elitecme.com the associated risks. Always manipulate hot items An overpacked autoclave chamber does ▫▫ 15 lb/in2 (15 pounds per square inch). with a thick glove designed for this purpose. At not allow efficient steam distribution. ▫▫ 106 kPa (106 kilopascals). the completion of the cycle, allow the autoclave Considerably longer sterilization times may ▫▫ 1 atm (1 atmosphere). unit to cool down before opening. Then, stand be required to achieve decontamination if an ▫▫ 1 kgf/cm2 (1 kilogram of force per back and crack the door slowly to allow the autoclave is tightly packed. square centimeter). excess steam to escape. Some older autoclaves 3. Do not mix contaminated and clean items ▫▫ 776 torr. have little or no heat shielding. together during the same autoclave cycle. ▫▫ 776 mm Hg (776 millimeters of mercury). Warning signs alerting users to these hot If there is a spill inside the autoclave chamber, Step 6 surfaces should be placed next to the autoclave allow the unit to cool before attempting to clean ▪▪ If the autoclave is automatic, the heat will shut to remind personnel of this hazard. Do not up the spill. off and the pressure will begin to fall once the stack or store combustible materials such as sterilization cycle is complete. If the autoclave cardboard, plastic containers or flammable Steps in cleaning your instruments in an is not automatic, turn off the heat or remove liquids next to the autoclave. autoclave the autoclave from the heat source after 20 minutes if items are unwrapped. Wait until Most autoclaves have a safety interlocking Step 1 the pressure gauge reads “zero” to open the system that prevents the instrument from working ▪▪ In a sink, put instruments in warm water and autoclave. Open the lid or door to allow the if the door is not properly closed; however, same detergent, then hold the instruments under remaining steam to escape. Leave instruments older units may not have such a built-in safety the water and scrub them, paying attention to or items in the autoclave until they dry. mechanism. Should the autoclave that services crevices and grooves with a clean brush. your salon not have an interlocking system, ▪▪ Rinse clean instruments in warm water and Step 7 special precautions must be observed to ensure dry using a lint-free disposable towel. ▪▪ Remove the instruments, trays, or unwrapped that the door is properly sealed before the process Step 2 items from the autoclave using sterile begins. If steam is leaking around the door during ▪▪ Open or unlock all jointed instruments and pickups. To prevent condensation after the sterilization process, the door has not been other items, such as cuticle nippers and nail removing the items from the autoclave, place sealed properly. In this event, shut down the clippers, and disassemble those with sliding them on a surface padded with sterile paper system as safely as possible. Let the unit cool and or multiple parts. This allows steam to reach or fabric until they are cool. reset the door. Give special attention to making all surfaces of the item. Avoid arranging the ▪▪ Wait until the instruments, trays, or items sure that the door is sealed tight, and restart the instruments and other items together tightly reach room temperature (which may take up run. If this problem persists, the unit needs to be because this prevents steam from reaching to several hours) before storing. serviced by a qualified technician. all surfaces. ▪▪ If using autoclave bags, check the indicator color on the bag to be sure the items in the Never leave unsterilized material inside the Step 3 bag have been sterilized long enough. Store autoclave or sitting in the autoclave room ▪▪ If instruments and other items are to be the sealed dry autoclave bag in a clean, dry overnight. Never autoclave materials that contain wrapped before steam sterilization, use protected area. Mark the bag with the date of toxic agents or volatile chemicals. two layers of paper, newsprint or cotton autoclaving for future reference. or muslin fabric (do not use canvas). Autoclave operation parameters Instruments and other items should not be Step 8 The parameters for the sterilization cycle will placed in a closed container. ▪▪ If you are not using autoclave bags, store depend upon the amount and type of material. items in a clean, closed container. Step 4 The cycle time should be developed for a worst- ▪▪ Arrange your instruments according to Conclusions case scenario. Denser loads will take longer operator so they do not get mixed up. While the autoclave is extremely efficient in than less dense loads of the same weight. The ▪▪ If you have multiple sets of instruments and sterilizing instruments, the process requires much exact operating procedure for each autoclave operators in your salon, you may want to longer than chemical disinfection. Therefore, it is model and various loads will differ; therefore, invest in an autoclave that has trays. This highly recommended that you have several sets of the responsible user should write a complete way each tray can be assigned to an operator, standard operating procedure (SOP) for the steam instruments. You must not ever shorten the length and instruments will be easily identified. sterilization operation. This SOP should include of time your instruments are in the autoclave You could also invest in autoclave bags so the sterilization procedure for each type of load or open the autoclave before it has completed that each set of instruments belonging to an autoclaved. It is prudent practice to document sterilizing. Opening an autoclave in the middle of individual operator can have its own bag. each autoclave load in an autoclave log. a cleaning can result in severe burns. This will reduce arguments over whose This log should include the type of load, amount, instruments belong to whom. Cleaning your autoclave run program, date, time and operator’s name. Step 5 Unfortunately, even your autoclave needs Keep charts or printout strips in the logbook ▪▪ Because there are many types of autoclaves cleaning. Experts believe about 25 to 35 percent as documentation of the autoclave operation. in use around the world, it is difficult of repairs could be avoided if autoclaves were Each autoclave unit should have preventative to provide guidance on the specific cleaned on a regular basis. maintenance and be placed on a preventative instructions of operating each. Follow These cleaning tips are for a chamber autoclave, maintenance schedule with a qualified repair the manufacturer’s instructions whenever but no matter what type of autoclave you technician. It should be inspected annually. possible. In general, sterilize items for 20 purchase, follow the manufacturer’s instructions The service technician will ensure that the unit minutes at 121 degrees C (270 degrees F) on cleaning. operates safely and properly. and 106 kPa (15 lb/in2) pressure. (Do not ▪▪ First, be sure to unplug your autoclave. Then, Other recommended guidelines begin timing until the autoclave reaches the move your autoclave to a sink. Remove trays Here are some more guidelines you should follow: desired temperature and pressure.) or racks. Sometimes trays can be somewhat 1. Do not overfill an autoclave bag. Steam and ▪▪ Note: The units of pressure marked difficult to remove, so call your service heat cannot penetrate as easily to the interior on an autoclave’s pressure gauge may representative or manufacturer if you need help. of a densely packed autoclave bag. vary from one autoclave to another. The ▪▪ TIP: It may help to have a slightly warm 2. Whether you are using autoclave bags or not, following amounts of pressure (which are chamber for the cleaning process. be sure you do not overload an autoclave. approximately equivalent) are the desired ▪▪ Pick up the unit and empty the sterilizer pressures for autoclaving: chamber. Replace the unit back on the www.elitecme.com Page 25 counter top and pour some cleaner into the Disease and infestation Part 2 – Ohio Laws and Regulations chamber. You may purchase a cleaner from Salons and schools should not knowingly the manufacturer or buy some CLR (tm) permit a person afflicted with an infection or Learning objectives from your hardware store. If you must use a parasitic infestation capable of being transmitted !! To list and describe your legal responsibilities manufacturer’s cleaning solution to maintain to a patron to serve patrons or train in the according to the Ohio Administrative Code. a warranty, by all means do so. establishment or school. !! Know your duties and responsibilities under ▪▪ Let the cleaning solution soak in for a few In addition, salons and schools should not Ohio Revised Code. minutes and then scrub with a scouring pad. ! knowingly require or permit a licensee or student ! Chapter 4713-8 Standards of Safe and Pour out the solution and rinse with water. to work upon a person with an infection or Effective Practice. Now, pour a small amount of solution in ! parasitic infestation capable of being transmitted ! Chapter 4713-11 Salons. the reservoir with water and run two to ! to the licensee or student. ! Chapter 4713-13 Beauty and Nail Salon three cycles and cancel drying cycles. After Licensing. completion, drain the reservoir and refill with Infections or parasitic infestation capable of being !! Chapter 4713-15 Sanitation; Communicable distilled water and run another cycle. Drain transmitted between licensee or student and patron Diseases. one more time and refill. include, but are not limited to, the following: ▪▪ Wipe the door gasket weekly with a wet damp ▪▪ Cold, influenza or other respiratory illness 4713.02 State board of cosmetology. towel and clean the cabinet gasket as well. accompanied by a fever, until 24 hours after A. There is hereby created the state board of Your autoclave is now ready for use. Repeat resolution of the fever. cosmetology, consisting of all of the following this cleaning about every 10 days or so. ▪▪ Streptococcal pharyngitis (“strep throat”), until members appointed by the governor, with the 24 hours after treatment has been initiated, and advice and consent of the senate: Cleaning the salon computers and 24 hours after resolution of symptoms. 1. One person holding a current, valid reception areas ▪▪ Purulent conjunctivitis (“pink eye”), until cosmetologist, managing cosmetologist, Almost all modern salons now work with computers examined by a physician and approved for or cosmetology instructor license at the and computer appointment books. These computer return to work. time of appointment; appointment books are generally at the reception ▪▪ Pertussis (“whooping cough”), until five days 2. Two persons holding current, valid desk and are also found in break areas so that salon of antibiotic therapy has been completed. managing cosmetologist licenses and workers can view their schedules. ▪▪ Varicella (“chicken pox”), until the sixth day actively engaged in managing beauty salons at the time of appointment; Few people think about the germ havens these after onset of rash or sooner if all lesions 3. One person who holds a current, valid areas have become. Experts say the computer have dried and crusted. independent contractor license at the keyboard, phone and desk areas of salons are ▪▪ Mumps, until nine days after onset of parotid time of appointment or the owner or major germ areas that must be sanitized. gland swelling. ▪▪ Tuberculosis, until a physician or local health manager of a licensed salon in which at Believe it or not, you could put your fingers department authority states that the individual least one person holding a current, valid on a toilet seat and collect fewer germs than is noninfectious. independent contractor license practices a the average desk or keyboard. Charles Gerba, ▪▪ Impetigo (bacterial skin infection), until 24 branch of cosmetology; a microbiologist at the University of Arizona, hours after treatment has begun. 4. One person who represents individuals who counted bacteria on several surfaces. ▪▪ Pediculosis (head lice), until the morning teach the theory and practice of a branch of He found the office toilet seat had an average after first treatment. cosmetology at a vocational school; of 49 germs per square inch. When he looked at ▪▪ Scabies, until after treatment has been 5. One owner of a licensed school of keyboards, he found 3,295 bacteria per square completed. No person working or training in cosmetology; inch, 60 times higher than the toilet seat. Even an establishment or school should massage 6. One owner of at least five licensed salons; worse were tops of desks at 21,000 bacteria any person upon a surface of the skin or scalp 7. One person who is either a certified nurse per square inch and telephones at 25,000 per where such skin is inflamed, broken (e.g., practitioner or clinical nurse specialist square inch. People are constantly coughing and abraded, cut) or where a skin infection or holding a certificate of authority issued sneezing on them. Germs from unwashed hands eruption is present. under Chapter 4723. of the Revised Code, can remain alive for days. In other words, if you or a physician authorized under Chapter The cosmetology industry is booming and one of 4731. of the Revised Code to practice share computer keyboards in your salon, a phone the only factors that has a chance to harm your or a desk, you are sharing germs. medicine and surgery or osteopathic industry is if clients do not feel safe. Therefore, medicine and surgery; To combat the problem, you must assign cleaning you must make safe sanitation techniques a part 8. One person representing the general public. duties to staff. First, you should remove the of your daily routine and encourage co-workers B. The superintendent of public instruction shall screws on the underside of the keyboard and to do the same. nominate three persons for the governor to separate the two parts. Brush the debris away and choose from when making an appointment then wipe with a sanitizing cloth. Conclusion under division (A)(4) of this section. As you can see from the preceding section, Once you put it back together, spray the entire C. All members shall be at least twenty-five sanitation issues have a direct impact on the keyboard with a disinfectant spray like Lysol. Do years of age, residents of the state, and health and welfare of clients and the livelihood this lightly so as not to ruin the electronics. You citizens of the United States. No more than of the salon professional. The importance of can also use sanitation wipes commonly found in two members, at any time, shall be graduates maintaining proper sanitation procedures cannot drug stores. of the same school of cosmetology. Except be overstated; it can literally be a matter of life for the initial members appointed under Staff should clean phones daily with a or death! Following proper sanitation guidelines divisions (A)(3) and (4) of this section, terms disinfectant spray and more often when someone will greatly reduce the potential risks to you, your of office are for five years. The term of the is known to be sick or feels sick. Also, remember clients and co-workers. initial member appointed under division (A) to daily disinfect your workstation. Often stylists (3) of this section shall be three years. The forget to perform this important step, yet they term of the initial member appointed under routinely place combs, scissors and other items division (A)(4) of this section shall be four on top of the workstation. years. Terms shall commence on the first day of November and end on the thirty-first day

Page 26 www.elitecme.com of October. Each member shall hold office C. Report to the proper prosecuting officer all under section 4713.37 of the Revised from the date of appointment until the end violations of section 4713.14 of the Revised Code and specify the amount of time of the term for which appointed. In case of a Code of which the board is aware; such a permit is valid; vacancy occurring on the board, the governor D. Submit a written report annually to the 9. Specify conditions an applicant must shall, in the same manner prescribed for governor that provides all of the following: satisfy for the board to issue the the regular appointment to the board, fill 1. A discussion of the conditions in this applicant an independent contractor the vacancy by appointing a member. Any state of the branches of cosmetology; license under section 4713.39 of the member appointed to fill a vacancy occurring 2. A brief summary of the board’s proceedings Revised Code and the fee for issuance prior to the expiration of the term for which during the year the report covers; and renewal of the license; the member’s predecessor was appointed 3. A statement of all money that the board 10. Establish conditions under which food shall hold office for the remainder of such received and expended during the year may be sold at a salon; term. Any member shall continue in office the report covers. 11. Specify which professions regulated by a subsequent to the expiration date of the E. Keep a record of all of the following: professional regulatory board of this state member’s term until the member’s successor 1. The board’s proceedings; may be practiced in a salon under section takes office, or until a period of sixty days 2. The name and last known address of each 4713.42 of the Revised Code; has elapsed, whichever occurs first. Before person issued a license under section 12. Establish standards for the provision entering upon the discharge of the duties of 4713.28, 4713.30, 4713.31, 4713.34, or of cosmetic therapy, massage therapy, the office of member, each member shall 4713.39 of the Revised Code; or other professional service in a salon take, and file with the secretary of state, 3. The name and address of each salon pursuant to section 4713.42 of the the oath of office required by Section 7 of issued a license under section 4713.41 Revised Code; Article XV, Ohio Constitution. The members of the Revised Code and each school 13. Establish standards for board approval of, of the board shall receive an amount fixed of cosmetology issued a license under and the granting of credits for, training pursuant to Chapter 124. of the Revised section 4713.44 of the Revised Code; in branches of cosmetology at schools of Code per diem for every meeting of the 4. The name and address of each tanning cosmetology licensed in this state; board which they attend, together with their facility issued a permit under section 14. Establish sanitary standards for the necessary expenses, and mileage for each 4713.48 of the Revised Code; practice of the branches of cosmetology, mile necessarily traveled. The members of 5. The date and number of each license and salons, and schools of cosmetology; the board shall annually elect, from among permit that the board issues; 15. Establish the application process for their number, a chairperson. The board F. All other duties that this chapter imposes on obtaining a tanning facility permit under shall prescribe the duties of its officers and the board. section 4713.48 of the Revised Code, establish an office within Franklin County. including the amount of the fee for an The board shall keep all records and files at 4713.08 Administrative rules. initial or renewed permit; the office and have the records and files at all A. The state board of cosmetology shall adopt 16. Establish standards for installing and reasonable hours open to public inspection. rules in accordance with Chapter 119. of the operating a tanning facility in a manner The board also shall adopt a seal. Revised Code as necessary to implement this that ensures the health and safety of chapter. The rules shall do all of the following: consumers, including standards that do 4713.06 Executive director - staff. 1. Govern the practice of the branches of all of the following: The state board of cosmetology shall annually cosmetology and management of salons; a. Establish a maximum safe time of appoint an executive director. The executive 2. Specify conditions a person must exposure to radiation and a maximum director may not be a member of the board. satisfy to qualify for a temporary pre- safe temperature at which sun lamps The executive director, before entering upon examination work permit under section may be operated; the discharge of the executive director’s duties, 4713.22 of the Revised Code and the b. Require consumers to wear shall file with the secretary of state a good and conditions and method of renewing a protective eyeglasses and be sufficient bond payable to the state, to ensure temporary pre-examination work permit supervised as to the length of time the faithful performance of duties of the office under that section; consumers use the facility; of executive director. The bond shall be in an 3. Provide for the conduct of examinations c. Require the operator to prohibit amount the board requires. The premium of the under section 4713.24 of the Revised Code; consumers from standing too close bond shall be paid from appropriations made 4. Specify conditions under which the board to sun lamps and to post signs to the board for operating purposes. The board will take into account, under section warning consumers of the potential may employ inspectors, examiners, consultants 4713.32 of the Revised Code, instruction effects of radiation on persons on contents of examinations, and clerks as an applicant for a license under section taking certain medications and of the necessary for the administration of this chapter. 4713.28, 4713.30, or 4713.31 of the possible relationship of the radiation All inspectors and examiners shall be licensed Revised Code received more than five to skin cancer; cosmetologists. The board may appoint inspectors years before the date of application for d. Require the installation of protective of tanning facilities as needed to make periodic the license; shielding for sun lamps and handrails inspections as the board specifies. 5. Provide for the granting of waivers under for consumers; section 4713.29 of the Revised Code; e. Require floors to be dry during 4713.07 Duties of board. 6. Specify conditions an applicant must operation of lamps; The state board of cosmetology shall do all of satisfy for the board to issue the applicant f. Require a consumer who is under the following: a license under section 4713.34 of the the age of eighteen to obtain written A. Prescribe and make available application Revised Code without the applicant consent from the consumer’s parent forms to be used by persons seeking taking an examination conducted under or legal guardian prior to receiving admission to an examination conducted under section 4713.24 of the Revised Code; tanning services. section 4713.24 of the Revised Code or a 7. Specify locations in which glamour 17. (a) If the board, under section 4713.61 of license issued under this chapter; photography services in which a branch of the Revised Code, develops a procedure B. Prescribe and make available application cosmetology is practiced may be provided; for classifying licenses inactive, do both forms to be used by persons seeking renewal 8. Establish conditions and the fee for a of the following: of a license issued under this chapter; temporary special occasion work permit www.elitecme.com Page 27 i. Establish a fee for having a license but may not exceed one hundred dollars per F. Except for apprentice instructors and as classified inactive that reflects the location of such facilities. provided in section 4713.45 of the Revised cost to the board of providing the Code, teach the theory or practice of a branch inactive license service; 4713.081 Posting copies of sanitary of cosmetology at a school of cosmetology ii. (Specify the continuing education standards. without either of the following authorizing that a person whose license The state board of cosmetology shall furnish the teaching of that branch of cosmetology: has been classified inactive a copy of the sanitary standards established 1. A current, valid license under section must complete to have the by rules adopted under section 4713.08 of the 4713.31 or 4713.34 of the Revised Code; license restored. The continuing Revised Code to each person to whom the 2. A current, valid temporary special education shall be sufficient to board issues a practicing license, managing occasion work permit issued under ensure the minimum competency license, or license to operate a salon or school section 4713.37 of the Revised Code. in the use or administration of of cosmetology. The board also shall furnish a G. Advertise or operate a glamour photography a new procedure or product copy of the sanitary standards to each person service in which a branch of cosmetology required by a licensee necessary providing cosmetic therapy, massage therapy, or is practiced unless the person practicing the to protect public health and other professional service in a salon under section branch of cosmetology holds either of the safety. The requirement shall not 4713.42 of the Revised Code. A salon or school following authorizing the practice of that exceed the cumulative number of cosmetology provided a copy of the sanitary branch of cosmetology: of hours of continuing education standards shall post the standards in a public and 1. A current, valid license under section that the person would have been conspicuous place in the salon or school. 4713.28, 4713.30, or 4713.34 of the required to complete had the Revised Code; person retained an active license. 4713.14 Prohibited acts. 2. A current, valid temporary special a. In addition, the board may specify No person shall do any of the following: occasion work permit issued under the conditions and method for A. Use fraud or deceit in making application for section 4713.37 of the Revised Code. granting a temporary work permit a license or permit; H. Advertise or operate a glamour photography to practice a branch of cosmetology B. Aid or abet any person: service in which a branch of cosmetology to a person whose license has been 1. Violating this chapter or a rule adopted is practiced at a location not specified by classified inactive. under it; rules adopted under section 4713.08 of the 18. Establish a fee for approval of a 2. Obtaining a license or permit fraudulently; Revised Code; continuing education program under 3. Falsely pretending to hold a current, valid I. Practice a branch of cosmetology at a salon in section 4713.62 of the Revised Code license or permit. which the person rents booth space without a that is adequate to cover any expense the C. Practice a branch of cosmetology, for current, valid independent contractor license board incurs in the approval process; pay, free, or otherwise, without one of the under section 4713.39 of the Revised Code; 19. Anything else necessary to implement following authorizing the practice of that J. Operate a salon without a current, valid license this chapter. branch of cosmetology: under section 4713.41 of the Revised Code; B. (1) The rules adopted under division (A) 1. A current, valid license under section K. Provide cosmetic therapy or massage therapy (2) of this section may establish additional 4713.28, 4713.30, or 4713.34 of the at a salon for pay, free, or otherwise without conditions for a temporary pre-examination Revised Code; a current, valid certificate issued by the work permit under section 4713.22 of the 2. A current, valid temporary pre- state medical board under section 4731.15 Revised Code that are applicable to persons examination work permit issued under of the Revised Code or provide any other who practice a branch of cosmetology in section 4713.22 of the Revised Code; professional service at a salon for pay, free, another state or country. 3. A current, valid temporary special or otherwise without a current, valid license 1. The rules adopted under division (A) occasion work permit issued under or certificate issued by the professional (17)(b) of this section may establish section 4713.37 of the Revised Code; regulatory board of this state that regulates additional conditions for a temporary 4. A current, valid temporary work permit the profession; work permit that are applicable to persons issued under rules adopted by the board L. Teach a branch of cosmetology at a salon, who practice a branch of cosmetology in pursuant to section 4713.08 of the unless the person receiving the instruction another state. Revised Code. holds either of the following authorizing the C. The conditions specified in rules adopted D. Employ a person to practice a branch of practice of that branch of cosmetology: under division (A)(6) of this section may cosmetology if the person does not hold one 1. A current, valid license under section include that an applicant is applying for a of the following authorizing the practice of 4713.28, 4713.30, or 4713.34 of the license to practice a branch of cosmetology that branch of cosmetology: Revised Code; for which the board determines an 1. A current, valid license under section 2. A current, valid temporary pre- examination is unnecessary. 4713.28, 4713.30, or 4713.34 of the examination work permit issued under D. The rules adopted under division (A)(11) of this Revised Code; section 4713.22 of the Revised Code. section shall not include a profession if practice 2. A current, valid temporary pre- M. Operate a school of cosmetology without a of the profession in a salon is a violation of a examination work permit issued under current, valid license under section 4713.44 statute or rule governing the profession. section 4713.22 of the Revised Code; of the Revised Code; E. The sanitary standards established under 3. A current, valid temporary special N. At a salon or school of cosmetology, do either division (A)(14) of this section shall focus occasion work permit issued under of the following: in particular on precautions to be employed section 4713.37 of the Revised Code; 1. Use or possess a cosmetic product to prevent infectious or contagious diseases 4. A current, valid temporary work permit containing an ingredient that the United being created or spread. The board shall issued under rules adopted by the board States food and drug administration has consult with the Ohio department of health pursuant to section 4713.08 of the prohibited by regulation; when establishing the sanitary standards. Revised Code. 2. Use a cosmetic product in a manner F. The fee established by rules adopted under E. Manage a salon without a current, valid license inconsistent with a restriction established division (A)(15) of this section shall cover under section 4713.30 or 4713.34 of the by the United States food and drug the cost the board incurs in inspecting tanning Revised Code to manage that type of salon; administration by regulation; facilities and enforcing the board’s rules Page 28 www.elitecme.com 3. Use or possess a liquid nail monomer 1. All persons authorized to practice who holds a current, valid manicurist license containing any trace of methyl medicine, surgery, dentistry, and nursing issued by the board may engage in the practice of methacrylate (MMA). or any of its branches in this state; manicuring but no other branch of cosmetology. O. While in charge of a salon or school 2. Commissioned surgical and medical A person who holds a current, valid natural hair of cosmetology, permit any person to sleep officers of the United States army, navy, stylist license issued by the board may engage in in, or use for residential purposes, any room air force, or marine hospital service the practice of natural hair styling but no other used wholly or in part as the salon or school when engaged in the actual performance branch of cosmetology. A person who holds a of cosmetology; of their official duties, and attendants current, valid managing cosmetologist license P. Maintain, as an established place of attached to same; issued by the board may manage all types of business for the practice of one or more of the 3. Barbers, insofar as their usual and ordinary salons and engage in the practice of one or more branches of cosmetology, a room used wholly vocation and profession is concerned; branches of cosmetology as the person chooses. or in part for sleeping or residential purposes; 4. Funeral directors, embalmers, and A person who holds a current, valid managing Q. Operate a tanning facility that is offered to apprentices licensed or registered under esthetician license issued by the board may the public for a fee or other compensation Chapter 4717. of the Revised Code; manage an esthetics salon, but no other type of without a current, valid permit under section 5. Persons who are engaged in the retail salon, and engage in the practice of esthetics, but 4713.48 of the Revised Code. sale, cleaning, or beautification of wigs no other branch of cosmetology. A person who and hairpieces but who do not engage in holds a current, valid managing hair designer 4713.15 No treatment of physical or any other act constituting the practice of a license issued by the board may manage a hair mental disease. branch of cosmetology; design salon, but no other type of salon, and This chapter does not permit any of the services 6. Volunteers of hospitals, and homes as engage in the practice of hair design, but no other or arts that are part of the practice of a branch of defined in section 3721.01 of the Revised branch of cosmetology. A person who holds a cosmetology to be used for the treatment or cure Code, who render service to registered current, valid managing manicurist license issued of a physical or mental disease or ailment. patients and inpatients who reside in by the board may manage a nail salon, but no such hospitals or homes. Such volunteers other type of salon, and engage in the practice of 4713.16 Exemptions. shall not use or work with any chemical manicuring, but no other branch of cosmetology. This chapter does not prohibit any of the products such as permanent wave, hair A person who holds a current, valid managing following: dye, or chemical hair relaxer, which natural hair stylist license issued by the board A. Practicing a branch of cosmetology without without proper training would pose a may manage a natural hair style salon, but no a license if the person does so for free at the health or safety problem to the patient. other type of salon, and engage in the practice person’s home for a family member who 7. Nurse aides and other employees of of natural hair styling, but no other branch of resides in the same household as the person; hospitals and homes as defined in cosmetology. A person who holds a current, B. The retail sale, or trial demonstration by section 3721.01 of the Revised Code, valid cosmetology instructor license issued by application to the skin for purposes of who practice a branch of cosmetology the board may teach the theory and practice of retail sale, of cosmetics, preparations, on registered patients only as part of one or more branches of cosmetology at a school tonics, antiseptics, creams, lotions, wigs, or general patient care services and who do of cosmetology as the person chooses. A person hairpieces without a practicing license; not charge patients directly on a fee for who holds a current, valid esthetics instructor C. The retailing, at a salon, of cosmetics, service basis; license issued by the board may teach the theory preparations, tonics, antiseptics, creams, 8. Cosmetic therapists and massage and practice of esthetics, but no other branch lotions, wigs, hairpieces, clothing, or any therapists who hold current, valid of cosmetology, at a school of cosmetology. A other items that pose no risk of creating certificates to practice cosmetic or person who holds a current, valid hair design unsanitary conditions at the salon; massage therapy issued by the state instructor license issued by the board may teach D. The provision of glamour photography medical board under section 4731.15 the theory and practice of hair design, but no services at a licensed salon if either of the of the Revised Code, to the extent their other branch of cosmetology, at a school of following is the case: actions are authorized by their certificates cosmetology. A person who holds a current, valid 1. A branch of cosmetology is not practiced to practice; manicurist instructor license issued by the board as part of the services. 9. Inmates who provide services related to a may teach the theory and practice of manicuring, 2. If a branch of cosmetology is practiced branch of cosmetology to other inmates, but no other branch of cosmetology, at a school as part of the services, the part of the except when those services are provided in of cosmetology. A person who holds a current, services that is a branch of cosmetology a licensed school of cosmetology within a valid natural hair style instructor license issued is performed by a person who holds either state correctional institution for females. by the board may teach the theory and practice of the following authorizing the person to B. The director of rehabilitation and correction of natural hair styling, but no other branch of practice that branch of cosmetology: shall oversee the services described in cosmetology, at a school of cosmetology. a. A current, valid license under section division (A)(9) of this section with respect 4713.28, 4713.30, or 4713.34 of the to sanitation and adopt rules governing those 4713.36 Location of manicuring practice. Revised Code; types of services provided by inmates. A licensed manicurist or licensed managing b. A current, valid temporary special manicurist may engage in the practice of occasion work permit issued under 4713.35 Permitted practices. manicuring at a nail salon or beauty salon section 4713.37 of the Revised Code. A person who holds a current, valid licensed under section 4713.41 of the Revised E. A student engaging, as a student, in work cosmetologist license issued by the state board Code or a barber shop licensed under Chapter connected with a branch of cosmetology of cosmetology may engage in the practice of 4709. of the Revised Code. taught at the school of cosmetology at which one or more branches of cosmetology as the the student is enrolled. person chooses. A person who holds a current, 4713.41 Salon requirements. valid esthetician license issued by the board may The state board of cosmetology shall issue a 4713.17 Exceptions. engage in the practice of esthetics but no other license to operate a salon to an applicant who A. The following persons are exempt from the branch of cosmetology. A person who holds a pays the applicable fee and affirms that all of the provisions of this chapter, except, as applicable, current, valid hair designer license issued by the following conditions will be met: section 4713.42 of the Revised Code: board may engage in the practice of hair design A. (1) A person holding a current, valid but no other branch of cosmetology. A person managing cosmetologist license or license www.elitecme.com Page 29 to manage that type of salon has charge of person holding the license has an outstanding extension, the board may charge the licensee and immediate supervision over the salon at unpaid fine levied under section 4713.64 of the a fine of up to one hundred dollars. all times when the salon is open for business Revised Code. C. The board may waive, or extend the period except as permitted under division (A)(2) of for completing, any continuing education this section. 4713.58 Reissuance of license. requirement if a licensee applies to the board 1. A business establishment that is engaged A. Except as provided in division (B) of this and provides proof satisfactory to the board primarily in retail sales but is also section, on payment of the renewal fee and of being unable to complete the requirement licensed as a salon shall have a person submission of proof satisfactory to the state within the time allowed because of any of holding a current, valid managing license board of cosmetology that any applicable the following: for that type of salon in charge of and continuing education requirements have been 1. An emergency; in immediate supervision of the salon completed, a person currently licensed as: 2. An unusual or prolonged illness; during posted or advertised service 1. A cosmetology instructor who 3. Active duty service in any branch of the hours, if the practice of cosmetology is has previously been licensed as armed forces of the United States. The restricted to those posted or advertised a cosmetologist or a managing board shall determine the period of time service hours. cosmetologist, is entitled to the during which each extension is effective B. The salon is equipped to do all of the reissuance of a cosmetologist or and shall inform the applicant. The board following: managing cosmetologist license; shall also inform the applicant of the 1. Provide potable running hot and cold 2. An esthetics instructor who has continuing education requirements that water and proper drainage; previously been licensed as an esthetician must be met to have the license renewed. 2. Sanitize all instruments and supplies used or a managing esthetician, is entitled If an extension is granted for less than in the branch of cosmetology provided at to the reissuance of an esthetician or one year, the continuing education the salon; managing esthetician license; requirement for that year, in addition to 3. If cosmetic therapy, massage therapy, or 3. A hair design instructor who has the required continuing education for other professional service is provided at previously been licensed as a hair the succeeding year, must be completed the salon under section 4713.42 of the designer or a managing hair designer, in the succeeding year. In all other Revised Code, sanitize all instruments is entitled to the reissuance of a hair cases the board may waive all or part of and supplies used in the cosmetic therapy, designer or managing hair designer the continuing education requirement massage therapy, or other professional license; on a case-by-case basis. Any required service. 4. A manicurist instructor who has continuing education shall be completed C. Except as provided in sections 4713.42 and previously been licensed as a manicurist and satisfactory proof of its completion 4713.49 of the Revised Code, only the branch or a managing manicurist, is entitled submitted to the board by a date specified of cosmetology that the salon is licensed to to the reissuance of a manicurist or by the board. Every license which has not provide is practiced at the salon. managing manicurist license; been renewed in any odd-numbered year D. The salon is kept in a clean and sanitary 5. A natural hair style instructor who has by the last day of January and for which condition and properly ventilated. previously been licensed as a natural hair the continuing education requirement E. No food is sold at the salon in a manner stylist or a managing natural hair stylist, has not been waived or extended shall be inconsistent with rules adopted under section is entitled to the reissuance of a natural considered expired. 4713.08 of the Revised Code. hair stylist or managing natural hair 4713.61 License classified inactive. stylist license. A. If the state board of cosmetology adopts 4713.56 Posting license or certificate. B. No person is entitled to the reissuance of a a continuing education requirement under Every holder of a practicing license, managing license under division (A) of this section if section 4713.09 of the Revised Code, it license, instructor license, or independent the license was revoked or suspended or the may develop a procedure by which a person contractor license issued by the state board person has an outstanding unpaid fine levied who holds a license to practice a branch of of cosmetology shall display the license in under section 4713.64 of the Revised Code. a public and conspicuous place in the place cosmetology, managing license, or instructor of employment of the holder. Every holder 4713.60 Renewals. license and who is not currently engaged in of a license to operate a salon issued by the A. Except as provided in division (C) of this the practice of the branch of cosmetology, board shall display the license in a public and section, a person seeking a renewal of a managing a salon, or teaching the theory and conspicuous place in the salon. Every holder license to practice a branch of cosmetology, practice of the branch of cosmetology, but of a license to operate a school of cosmetology managing license, or instructor license shall who desires to be so engaged in the future, issued by the board shall display the license in a include in the renewal application proof may apply to the board to have the person’s public and conspicuous place in the school. Every satisfactory to the board of completion of any license classified inactive. If the board person who provides cosmetic therapy, massage applicable continuing education requirements develops such a procedure, a person seeking therapy, or other professional service in a salon established by rules adopted under section to have the person’s license classified inactive under section 4713.42 of the Revised Code 4713.09 of the Revised Code. shall apply to the board on a form provided shall display the person’s professional license or B. If an applicant fails to provide satisfactory by the board and pay the fee established by certificate in a public and conspicuous place in proof of completion of any applicable rules adopted under section 4713.08 of the the room used for the therapy or other service. continuing education requirements, the Revised Code. board shall notify the applicant that the B. The board shall not restore an inactive license 4713.57 Expiration of licenses. application is incomplete. The board shall until the later of the following: A license issued by the state board of not renew the license until the applicant 1. The date that the person holding the license cosmetology is valid until the last day of January provides satisfactory proof of completion submits proof satisfactory to the board that of the odd-numbered year following its original of any applicable continuing education the person has completed the continuing issuance or renewal, unless the license is revoked requirements. The board may provide the education that a rule adopted under section or suspended prior to that date. Renewal shall applicant with an extension of up to ninety 4713.08 of the Revised Code requires; be done in accordance with the standard renewal days in which to complete the continuing 2. The last day of January of the next odd- procedure of Chapter 4745. of the Revised Code. education requirement. In providing for the numbered year following the year the The board may refuse to renew a license if the license is classified inactive.

Page 30 www.elitecme.com C. A person who holds an inactive license C. If a person fails to request a hearing within 2. “Non-invasive” means confined to may engage in the practice of a branch of thirty days of the date the board, in accordance the nonliving cells of the epidermis cosmetology if the person holds a temporary with section 119.07 of the Revised Code, specifically the stratum corneum layer. work permit as specified in rules adopted notifies the person of the board’s intent to Living cells must never be altered, cut by the board under section 4713.08 of the act against the person under division (A) of or damaged. During services performed Revised Code. this section, the board by a majority vote of a by individuals licensed in this chapter quorum of the board members may take the at no time should the basal layers be 4713.63 Restoring expired license. action against the person without holding an compromised. A practicing license, managing license, or adjudication hearing. 3. “Client” means the recipient of instructor license that has not been renewed D. The board, after a hearing in accordance cosmetology services, which may include for any reason other than because it has been with Chapter 119. of the Revised Code, an individual, a group, or a community. revoked, suspended, or classified inactive, or may suspend a tanning facility permit if 4. “Cosmetology Service” means any because the license holder has been given a the owner or operator fails to correct an service provided to a client within the waiver or extension under section 4713.60 of the unsafe condition that exists in violation scope of practice of the individual license Revised Code, is expired. An expired license may of the board’s rules or fails to cooperate types of the “Board”. be restored if the person who held the license in an inspection of the tanning facility. 5. “Advanced Practice” means any meets all of the following applicable conditions: If a violation has resulted in a condition cosmetology service not taught in basic A. Pays to the state board of cosmetology the reasonably believed by an inspector to create cosmetology school courses that require restoration fee, the current renewal fee, and an immediate danger to the health and safety postgraduate training such as chemical or any applicable late fees; of any person using the tanning facility, the mechanical exfoliation, body treatments, B. Pays a lapsed renewal fee of forty-five dollars inspector may suspend the permit without a clipper cuts, or other advanced manual, per license renewal period that has elapsed prior hearing until the condition is corrected chemical or mechanical techniques. since the license was last issued or renewed; or until a hearing in accordance with Chapter 6. “Therapy” means a non-invasive, non- C. In the case of a practicing license or 119. of the Revised Code is held and the medical and non-healing service such as managing license that has been expired for board either upholds the suspension or aroma therapy or other relaxation services. more than two consecutive license renewal reinstates the permit. periods, completes eight hours of continuing 4713-8-02 Board consideration of a education for each license renewal period that Chapter 4713-8 Standards of Safe and violation of a standard of cosmetology has elapsed since the license was last issued Effective Practice practice. or renewed, up to a maximum of twenty- A. A “Board” licensee who does not practice four hours. At least four of those hours shall 4713-8-01 General information. cosmetology services according to acceptable include a course pertaining to sanitation and A. The purpose of this chapter is to establish: and prevailing standards of safe cosmetology safety methods. 1. Minimal acceptable standards of safe care, as set forth in this chapter, may be The board shall deposit all fees it receives under and effective cosmetology practice for a subject to discipline by the “Board” as division (B) of this section into the general cosmetologist, hair designer, esthetician, established in section 4713.64 of the Revised revenue fund. natural hair stylist and manicurist in a Code per Chapter 119. of the Revised Code salon; and with paragraph (B) of this rule. 4713.64 Violations. 2. Criteria for the “Board” to evaluate: B. The “Board” may consider mitigating A. In accordance with Chapter 119. of the a. Safe and effective cosmetology circumstances when making a decision Revised Code, the state board of cosmetology practice; and regarding charges, disciplinary action, or may deny, revoke, or suspend a license or b. Adherence to acceptable and referral to a non-disciplinary program. permit issued by the board or impose a fine prevailing standards of cosmetology 1. Whether the act is willful, intentional, for any of the following: practice. irresponsible, or unintentional; 1. Failure to comply with the requirements B. The “Board” may determine adherence to 2. The frequency of the occurrence of the of this chapter or rules adopted under it; acceptable and prevailing standards of safe act at issue; 2. Continued practice by a person cosmetology practice by using: 3. Whether the act represents a pattern of knowingly having an infectious or 1. “Board” member expertise; commissions or omissions; contagious disease; 2. An expert witness; 4. The outcome of a licensee’s actions; or 3. Habitual drunkenness or addiction to any 3. Current cosmetology or related literature 5. The level of harm or potential harm to habit-forming drug; which emanates from a recognized body a client. 4. Willful false and fraudulent or deceptive of knowledge; C. The “Board” grants the authority to the advertising; 4. Position statements, standards for executive director to oversee the inspection 5. Falsification of any record or application practice, or guidelines for practice from process and to initiate disciplinary required to be filed with the board; nationally recognized cosmetology proceedings pursuant to paragraph (A) of 6. Failure to pay a fine or abide by a entities; or this rule and to issue notices of violation suspension order issued by the board. 5. Other recognized sources which may in accordance with Chapter 119. of the B. The board may impose a separate fine for provide the appropriate expertise or Revised Code. Following the Chapter 119. each offense listed in division (A) of this information. administrative process, and in accordance section. The amount of a fine shall be not 6. When determining adherence the with Chapter 119. of the Revised Code, the more than five hundred dollars if the violator “Board” shall ensure that all practices “Board” will determine whether a “Board” has not previously been fined for that offense. are within the definition of that branch licensee has committed a violation of The fine shall be not more than one thousand of cosmetology as defined in section Chapter 4713. of the Revised Code or the dollars if the violator has been fined for the 4713.01 of the Revised Code. administrative rules promulgated under that same offense once before. The fine shall be C. For purposes of this chapter, the following chapter, and whether it will impose a sanction not more than one thousand five hundred definitions shall apply: when violations have been determined by the dollars if the violator has been fined for the 1. “Exfoliation” means the sloughing off “Board” to have been committed. same offense two or more times before. of non-living (dead) skin cells by very superficial and non-invasive means. www.elitecme.com Page 31 4713-8-04 Standards relating to representative shall be required prior to Chapter 4713-11 Salons competent practice as an esthetician. service to the public. The manufacturer’s 4713-11-01 Application for operation of A. An esthetician shall provide cosmetology certificate of training shall be displayed in a services within an adequately licensed salon, publicly conspicuous place. beauty salon and within the scope of practice of esthetics for G. Estheticians may use a lancet to enhance All applicants for a license for the operation of an esthetician as set forth in section 4713.01 of the opening in a comedo or to create a small a salon under provisions of Chapter 4713.of the the Revised Code and the rules of the “Board”. opening in the dead surface corneum to Revised Code, shall apply on forms supplied B. An esthetician shall maintain knowledge facilitate extraction of a milia in order to better by the “Board” for the operation of a salon of the duties, responsibilities, and extract the contents. Estheticians shall not and for the procedures to follow in making accountabilities of practice and shall practice pierce the stratum corneum or use a lancet application for licensure. No salon shall in accordance with the following: for any other purpose. Estheticians shall not begin operating or providing services to the 1. The laws regulating the practice of perform a comedo enhancement or milia public until the proper license is obtained and esthetics; extraction with a lancet unless they have had displayed. Applications for licensure of a salon 2. The rules of the “Board”; specific documented training for this procedure. are valid for ninety days after approval by the 3. Any other applicable federal and state Only sterile, one-use, disposable lancets shall be Board, failure to obtain an approved inspection laws and rules; and used and they shall be disposed of in a “sharps or temporary certificate for operation within 4. Position statements, standards for box” medical waste container. the ninety days shall invalidate the application practice, or guidelines for practice from H. Estheticians may perform services that are and require new application and fee. nationally recognized professional unregulated by the state in salons upon 4713-11-02 Floor plan and zoning approval esthetic entities; provided these completing postgraduate training for those Applicants for the first five types of beauty salons statements, standards, or guidelines are services as established by policy of the designated in OAC 4713-11-01 must meet the consistent with existing laws or rules. “Board” and required by rule 4713-13-12 following requirements: C. An esthetician shall demonstrate competence of the Administrative Code. These services a. The floor plan shall be drawn to scale, and accountability in all areas of practice include but are not limited to body wraps, ear showing in detail the size of the premises, in which the esthetician is engaged which piercing, hypnosis for relaxation, etc. and each room contained therein, and includes, but is not limited to, the following: describe any areas accessible to the salon 1. Consistent performance of all aspects of 4713-8-08 Services rendered in an through doors or any other openings, all esthetic services according to acceptable unlicensed facility; temporary special equipment, and all plumbing fixtures. This and prevailing standards; and event permits. floor plan shall be legible and clearly labeled. 2. Appropriate recognition, referral or A. No person shall offer or render any of the b. Whenever a licensed salon desires to consultation, and intervention, when a services encompassed within the definition alter the original floor plan filed with the complication arises during or after the and rules of the board of cosmetology in “Board”, or desires to add other services, an performance of a specific service or a place which is not licensed as a salon or approval of the proposed revised floor plan procedure. school except that a practicing licensee may shall be obtained from the “Board” prior to D. An esthetician may provide advanced esthetic render the services for which he or she is commencing any such construction or the services provided: licensed to offer on a limited and temporary offering of other services. 1. The esthetician obtains appropriate basis if the licensee applies for and receives a c. All salons attached to a residence shall education, which emanates from a temporary special event permit. additionally indicate in their floor plan the recognized body of knowledge relative to B. Temporary special event permits shall be exact location of salon and living quarters the esthetic service to be provided; approved by the executive director, or his and obtain proper approval from the local 2. The esthetician demonstrates appropriate or her designee. Temporary special event zoning “Board” indicating that cosmetology knowledge, skills, and abilities to provide permits are only valid for one event lasting may be practiced in that location. the cosmetology service; no more than forty-eight hours. Multiple 3. The esthetician maintains documentation events require the licensee to apply for and 4713-11-03 Water supply; waste disposal satisfactory to the Board of meeting the receive a separate temporary special event Every salon facility shall be equipped with an requirements set forth in paragraphs (D) permit for each event. adequate supply of hot and cold running water (1) and (D)(2) of this rule; C. The types of special events contemplated and proper plumbing. Every salon facility shall 4. The esthetician service does not involve by this rule include, but are not limited to: adhere to the following standards promulgated by a function or procedure, which is charity events, on-location bridal parties, the Ohio department of health: prohibited by any other law or rule and bridal shows and on-location spa parties. A. Safe water supply shall be provided; does not exceed the definition of the Requests that vary from these listed examples B. Sewage and other liquid wastes shall be practice of esthetics in section 4713.01 of must be approved by the board by a majority disposed of in a sanitary manner; Revised Code. vote of a quorum of the board members. C. The storage and collection of solid E. Estheticians shall not provide any service Individual licensees and salon licensees are waste shall be conducted so as to avoid that claims to have a medical or healing permitted to request special event permits. creation of health hazards, rodent harborages, benefit. The scope of practice is limited to D. At a minimum, in the application for a insect breeding areas and accidents; beautification and relaxation services only. temporary special event permit, the licensee D. Solid waste shall be stored in waste containers; The scope of practice is limited to non- must provide the type of event, date of event, E. Solid wastes shall be collected at least once invasive services only. Services offered using time of event, location of event, and the each week. the term therapy shall be within the meaning names and license numbers of the licensees defined in paragraph (C)(6) of rule 4713-8-01 performing the services during the event. 4713-11-04 Permits of the Administrative Code. E. Licensees shall be responsible for ensuring that All salon facilities shall comply with all F. Estheticians may exfoliate stratum they are fully supplied and equipped when they requirements and/or permits required by state, corneum cells only. They may use any perform services outside a licensed facility, in local and federal regulations if applicable. chemical, mechanical or electrical service addition to ensuring compliance with the safety that only exfoliates cells of the stratum and sanitation laws and rules of the board. 4713-11-05 Restrooms corneum. Proper graduate training from the F. The board expressly reserves the right to inspect All salon facilities shall be equipped with at manufacturer or the manufacturer’s certified special events at random and without notice. least one restroom , including a toilet and hand- Page 32 www.elitecme.com washing sink with hot and cold running water. within the salon. Only “Board” licensees as The restroom shall be kept clean, sanitary and required by rules 4713-8-03 to 4713-8-07 of functional at all times. The restrooms shall have the Administrative Code or licensees of other a pump soap container, covered waste containers Ohio regulatory boards shall provide all non- with solid sides or liner, and paper towel regulated services. The services listing shall dispenser or equipment for hand-drying. Salons be posted in a conspicuous public place in the located in a mall, office building or nursing home salon. The salon may on forms provided by the with available public restrooms do not need a “Board” or an equivalent document make the separate restroom internal to the salon. listing. The listing shall have three columns: 1. The services provided: 4713-11-06 Cosmetological substance 2. The regulatory agency for that service; storage 3. The license type of providers. All locations where cosmetology services are B. If the service is unregulated the third column performed shall designate a cabinet or other should list the “Board” licensee or other similar storage container or units that are adequate Ohio board licensee providing the service to safely store chemicals, covered wet sanitizers with a statement that the provider meets and other cosmetological substances. The size of the minimum training requirements of the the cosmetological substance storage containers “Board” for that service. All services in the should be adequate to provide for the number of salon shall be provided by “Board” licensees licensees providing services and square footage or other Ohio board licensees only. of the location. Any deviations from this standard are subject to a vote by the members of the board. 4713-11-12 Non-Cosmetology Ohio Examples include but are not limited to: color bars, Professional Regulatory Board Licensees cabinets and storage closets. All licensees from any Ohio professional regulatory board are eligible to work in 4713-11-07 Display of sign salons in keeping with the laws and rules of Every establishment licensed by the “board” their governing boards. Any issue that arises shall display a sign at its main entrance which concerning a licensee shall be referred to the will be clearly visible from the street using at appropriate governing board. least three inch tall letters, stating the name of business as submitted on application, except that in the case of a beauty salon located within a department store or shopping center the sign may be displayed at the entrance to the beauty salon.

4713-11-08 Resident salons and mobile home salons Except for beauty salons licensed prior to September 5, 1977, salons shall maintain a separate entrance which shall not open off the living quarters, and which shall not have any doors, openings, or any other access leading to the living quarters or residential areas. Entrance through garages or any other rooms into the salon shall not be permitted. Mobile homes, motor homes, trailers or any type of recreational vehicle are not designed for commercial use under the Ohio building codes and therefore prohibited for licensure as any type of salon or tanning facility.

4713-11-09 Exhaust fumes from service areas In any facility licensed as a salon by the “Board,” the service area must be equipped with properly maintained exhaust fans or air filtration equipment that meets local and state building codes. The Ohio building code that applies is rule 4101:2-39-03 of the Administrative Code (Table 403.3).

4713-11-10 Service Listing A. If a salon provides any non-cosmetology services the salon shall post a listing of all services provided, and the regulatory agency that provides oversight of said services, if any. The certificates of specialized training of the providers, if any, shall be posted in the area where services are being provided www.elitecme.com Page 33