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Permalink Reply by coldsalineplexus on May 28, 2013 at 5:23am

I think he did want to know your opinion, and it sounds like you did have an opinion, but just didn't feel confident about delivering it.  We can and must defer certain things to dermatologists, but we certainly are skin professionals.  We see a lot of skin, and our opinions and observations are valid, and we certainly do not need to shove all our business out the door towards the derms if we can use observation and deduction to help solve a problem.

That said, I would have started with some follow-up questions.  How long since he noticed them?  Is he shaving with or against the grain?  What product is he using to shave?  Would he be willing to put some of his shaving product in a sample jar so that you can test the pH?  Could he be nicking his skin with his razor?  Is he doing any other exfoliation besides shaving in that area?  If so, does his other exfoliation method (scrub, AHA's, etc) exacerbate the spots too?  What has he tried doing to reduce them?  

Then I would just go ahead and say my opinion about them, mention that a dermatologist would be able to tell for sure, and then I would go about making recommendations that I believed would help to diminish the spots (based on my opinion that they were caused by sensitivity and irritation).  From what you described, I would probably try having him ice them for a minute or two right after shaving, and add a peptide product to his routine if he doesn't use one yet.  There would be the question of avoiding exfoliating those spots - for example, skipping AHA's or retinol on those spots for a couple weeks, avoiding anything (including shaving cream) that might be too alkaline and compromising the barrier function, and possibly dabbing some vaseline on them  before shaving cream in order to get less of a close shave on those spots (I'd also be occluding them this way when performing any peels on him in the treatment room).  From there, you could also recommend OTC strength hydrocortisone - not necessarily a long-term solution, but a good way to test for a couple weeks and see whether it was inflammation based.  I would also throw in things that I know would strengthen the skin - have him eat avocados and salmon, anti-inflammatory foods like turmeric, and avoid inflammatory foods like sugar and dairy.  Basically, if you don't see signs that there is an urgent dermatological issue (cancer, identifiable eczema, etc.), I think it is perfectly within our scope to set up a several-weeks plan to try to improve something like this (basically a cosmetic concern that is likely to be helped by improving skin's barrier function), and let the client know that we will try these things and then send to the derm in a month if no improvement. 

What do other estheticians think about a situation like this?

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Permalink Reply by Katayoun Hokmollahi on May 28, 2013 at 11:32am

Thank you Christine, this helps me a lot.

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Permalink Reply by coldsalineplexus on May 28, 2013 at 5:07pm

Thank you!  I hope it did not sound critical.  I think it's normal and good to be cautious!  At the same time, I think it is important to assert our relevance as knowledgable practitioners.  Basically I feel that good esthetic treatment should support the health and beauty of the skin, and if you are able to do that without medical intervention, so much the better.  I feel this is also why many of our clients choose to see us rather than frequent a dermatologist for their peels, etc., because they can actually get more of our time and more hands-on recommendations and coaching for the health of their skin (instead of being seen for 30 seconds and shoved a bunch of prescriptions).  Whenever I have a question about making a referral, I ask myself whether I see anything urgent (whether I would go immediately to a dermatologist if it were on my own skin), and then if not, I set a reasonable timeframe for achieving a positive outcome, after which I will recommend the referral.  I do also like to explain all this to clients and that they have the option to see a dermatologist sooner if they would prefer.

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