Seek a Physician

When a skin change needs a physician, not a facial.

A plain-language guide to symptoms, diseases and disorders that call for a medical evaluation and fall outside an esthetician’s scope of practice.

Please read first

Skin Glow Glossary does not diagnose, treat or prevent any disease. This page is general education to help you decide when something is worth showing a physician. It cannot tell you what a skin change is.

Estheticians and skincare professionals work within a scope of practice, and that scope varies by state, province and the local governing body that licenses them. In general, diagnosing a condition, treating disease and prescribing medication are medical decisions, not esthetic services. Check the rules where you live.

Descriptions and photos are examples only. The same condition can look very different on different skin tones, and many conditions look alike. If something worries you, see a physician, such as a primary care doctor or a dermatologist.

Get emergency help now

Call your local emergency number (911 in the US) or go to the nearest emergency room if you have:

Trouble breathing, or swelling of the face, lips or tongue, especially after a reaction to a product or medicine.
A rash with blisters or peeling skin together with fever, or with sores in the mouth, eyes or genitals.
A red, hot, swollen area that is spreading fast, with fever or chills, or skin turning purple or black.
A chemical burn or product in the eyes.

Index

What to look out for

About these photos. The photos are examples only. They are not a diagnosis and cannot tell you what a skin change is or how serious it is. The same condition can look very different from person to person and on different skin tones, and many conditions look alike. Some photos show skin problems that may be upsetting. If you are worried about a skin change, see a physician.

Widespread rash on a child's torso — Example: Stevens-Johnson syndrome. Photo: Kaleysmom71, Public domain, via Wikimedia Commons. Example only, not a diagnosis.

Emergency: get help now

A blistering, peeling rash with fever or mouth sores

A painful, spreading rash with blisters or skin that peels off in sheets, often with fever, sore eyes and sores in the mouth, usually a few days to weeks after starting a new medicine.

Signs to note and why it needs a physician

Painful red or purplish rash that spreads quickly.
Blisters or peeling skin, and sores in the mouth, eyes or genitals.
Fever, and a recent new medicine.

Why a physician: This pattern can be a severe drug reaction and needs emergency care.

Swollen upper and lower lips — Example: angioedema. Photo: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons. Example only, not a diagnosis.

Emergency: get help now

Hives or swelling, especially with trouble breathing

Raised, itchy welts that appear and move around, or sudden swelling of the lips, eyelids, tongue or throat.

Signs to note and why it needs a physician

Swelling of the lips, tongue, face or throat.
Trouble breathing or swallowing, wheezing, or feeling faint.
Hives after a new product, food or medicine.

Why a physician: Swelling or breathing trouble can be a life-threatening allergic reaction (anaphylaxis). Call emergency services. Hives without those signs still deserve a physician's advice if they keep coming back.

Cluster of small blisters on a red patch of skin — Example: shingles (herpes zoster). Photo: NIAID, CC BY 2.0, via Wikimedia Commons. Example only, not a diagnosis.

See a physician today

A painful, blistering band or patch on one side

A burning, tingling or painful area, followed by a cluster of fluid-filled blisters in a band or patch on one side of the face or body.

Signs to note and why it needs a physician

Pain, burning or tingling before the rash appears.
Blisters in a band on one side that crust over in days.
A rash near the eye or on the forehead or nose, or with hearing or facial changes.

Why a physician: This can be shingles. Antiviral medicine works best when started early, and a rash near the eye can threaten sight. See a physician the same day if possible.

Red, irritated patch on the palm and fingers — Example: contact dermatitis. Photo: Rleffmann, CC BY-SA 4.0, via Wikimedia Commons. Example only, not a diagnosis.

See a physician today

A severe or blistering reaction to a product

Skin that is intensely red, swollen, blistered, weeping or burning after using a product, hair dye, adhesive or metal, often with a clear edge where the product touched.

Signs to note and why it needs a physician

Swelling of the eyelids or face.
Blisters, oozing or skin that feels burned.
A reaction that keeps spreading or does not settle in a day or two after stopping the product.

Why a physician: Stop the product and see a physician. Severe contact reactions can need prescription treatment, and a patch test by a physician can identify the cause.

See a physician today

Blisters, burning or pus after a peel, laser, wax or facial

Skin that blisters, turns very dark or very light, weeps, forms a dark scab, or feels like it is burning more and more in the days after a treatment, or any pus or increasing pain.

Signs to note and why it needs a physician

Blisters, open skin or oozing.
Pain, swelling or heat that is getting worse after the first day or two.
Fever, or pus.

Why a physician: A treatment can burn or infect the skin. See a physician rather than treating it yourself, and tell the person who did the treatment so they can stop and report it.

Red, swollen leg with the edge of the redness marked in pen — Example: cellulitis. Photo: John Campbell, CC0, via Wikimedia Commons. Example only, not a diagnosis.

See a physician today

Red, warm, swollen skin that is spreading

A patch of skin that is red, hot, swollen and painful, with edges that seem to move outward over hours or days, sometimes with red streaks, fever or chills.

Signs to note and why it needs a physician

Warmth, swelling and tenderness that are getting worse.
Red streaks moving away from the area, or swollen glands.
Fever or chills.

Why a physician: This can be a bacterial infection such as cellulitis that needs prescription antibiotics, and it can become serious. See a physician today. Go to emergency care if it spreads quickly or you feel very unwell.

Yellow tint in the white of the eye — Example: jaundice. Photo: Bobjgalindo, CC BY-SA 4.0, via Wikimedia Commons. Example only, not a diagnosis.

See a physician today

Yellowing of the skin or the whites of the eyes

Skin or the whites of the eyes taking on a yellow tint, sometimes with dark urine, pale stools or itching all over.

Signs to note and why it needs a physician

Yellow skin or eyes.
Dark urine or pale stools.
Abdominal pain, or itching with no rash.

Why a physician: Yellowing (jaundice) can be a sign of a liver, gallbladder or blood problem and needs prompt medical evaluation.

Irregular dark brown and red patch with uneven edges on the skin — Example: melanoma. Photo: Larry Meyer, National Cancer Institute, Public domain, via Wikimedia Commons. Example only, not a diagnosis.

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A mole that changes or looks different

A mole or dark spot that is changing, or one that stands out from your other moles. Melanoma can be brown, black, pink, red or even skin-colored, and it can appear on skin that is rarely in the sun.

Signs to note and why it needs a physician

Asymmetry: one half does not match the other.
Border: edges that are ragged, notched or blurred.
Color: more than one shade, or an unusual color.
Diameter: larger than about 6 mm (a pencil eraser), although smaller ones can also be a problem.
Evolving: any change in size, shape or color, or new itching, crusting or bleeding.

Why a physician: Only a physician's exam, and sometimes a biopsy, can tell a harmless mole from a dangerous one. Finding melanoma early makes a large difference. Estheticians should not assess or treat moles.

Redness across both cheeks and the bridge of the nose; eyes covered for privacy — Example: lupus butterfly rash. Photo: CNX OpenStax, CC BY 4.0, via Wikimedia Commons. Example only, not a diagnosis.

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A rash across the cheeks and nose, with fatigue or joint pain

A flat or slightly raised rash over both cheeks and the bridge of the nose, sometimes worse after sun, along with tiredness, joint pain, fever or mouth sores.

Signs to note and why it needs a physician

A rash across the cheeks and nose that is worse in the sun.
Joint pain or swelling, long-lasting tiredness, or fever.
Mouth sores or hair loss.

Why a physician: A rash like this together with other symptoms can be a sign of an autoimmune condition such as lupus. It needs medical tests, not a skincare routine.

Round, scaly, ring-shaped patch on the arm — Example: ringworm (tinea corporis). Photo: CDC / Dr. Lucille K. Georg, Public domain, via Wikimedia Commons. Example only, not a diagnosis.

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A ring-shaped, scaly, itchy patch

A round or ring-shaped patch with a raised, scaly edge and clearer skin in the middle, which may itch and slowly grow. Fungal infections can also affect the scalp, feet and nails.

Signs to note and why it needs a physician

A ring with a scaly, slightly raised border.
Itching, and patches that grow or spread.
Similar patches on the scalp, feet or nails.

Why a physician: This can be a fungal infection (ringworm or tinea), which needs the right medicine. It is easy to confuse with other rashes, so it should be checked first.

Rough, scaly patches on a sun-exposed scalp — Example: actinic keratosis. Photo: C. Morice, A. Acher, N. Soufir et al., CC BY 4.0, via Wikimedia Commons. Example only, not a diagnosis.

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A rough, scaly patch on sun-exposed skin

A dry, rough, sandpaper-like patch that may be pink, red, tan or skin-colored, often on the face, scalp, ears, lips, hands or forearms, and that does not clear with moisturizer.

Signs to note and why it needs a physician

Feels rough or scaly more than it looks.
Has been there for weeks and does not go away.
Sometimes itchy, tender or burning.

Why a physician: Patches like this can be precancerous (actinic keratosis). A physician can examine them and decide on treatment. Exfoliating or peeling them is not appropriate.

Pink, pearly, ulcerated bump on the tip of the nose — Example: basal cell carcinoma. Photo: M. Sand, D. Sand, C. Thrandorf et al., CC BY 2.0, via Wikimedia Commons. Example only, not a diagnosis.

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A sore that does not heal, or a pearly or scaly growth

A shiny, pearly or waxy bump, a flat scar-like patch, or a red, scaly or crusted spot that bleeds easily, or a sore that heals and then comes back, often on the face, ears, neck, hands or other sun-exposed skin.

Signs to note and why it needs a physician

A sore that has not healed in about four weeks, or keeps returning.
A bump with a rolled edge or visible tiny blood vessels.
A rough, firm or crusted patch that bleeds with little injury.

Why a physician: These can be common skin cancers, such as basal or squamous cell carcinoma, which are very treatable when found early. They need a physician's exam and often a biopsy.

Blister cluster on the lower lip — Example: cold sore (herpes labialis). Photo: Metju12, Public domain, via Wikimedia Commons. Example only, not a diagnosis.

Book a physician visit soon

Cold sores or blisters around the mouth, or near the eye

A tingling spot that turns into a cluster of small blisters, usually on or around the lips, which then crust. The same virus can cause blisters elsewhere on the face.

Signs to note and why it needs a physician

Tingling or burning before blisters appear.
Clusters of small blisters that weep and crust.
Sores near or in the eye, or that are frequent or severe.

Why a physician: A physician can confirm it and prescribe antiviral medicine. Sores near the eye need urgent care. Do not exfoliate, peel or wax over an outbreak, and avoid facials until healed.

Darker, thickened skin in the armpit — Example: acanthosis nigricans. Photo: Mark F. Brady and Prashanth Rawla, CC BY-SA 4.0, via Wikimedia Commons. Example only, not a diagnosis.

Book a physician visit soon

Dark patches that are sudden, one-sided, velvety or streaked

A new dark patch that appears quickly, a dark stripe under a nail, or thick, velvety darker skin in the neck, armpits or groin. Melasma is common, but not every dark patch is melasma.

Signs to note and why it needs a physician

Dark patches that came on fast or are on only one side.
A brown or black stripe in a nail that was not caused by injury.
Velvety, thickened dark skin in folds of the body.

Why a physician: Some pigment changes point to a medical issue, for example a hormone or blood sugar condition, or a skin cancer. A physician should check them before any lightening treatment.

Red, inflamed, deep acne lumps on the cheek and jaw — Example: nodular and cystic acne. Photo: Sedef94, CC BY-SA 4.0, via Wikimedia Commons. Example only, not a diagnosis.

Book a physician visit soon

Deep, painful acne that scars

Large, deep, tender lumps or cysts, often on the jaw, chest or back, that leave dark marks or scars, or acne that has not improved after a few months of consistent, gentle skincare.

Signs to note and why it needs a physician

Painful nodules or cysts.
Scarring or deep dark marks.
Acne that is affecting your confidence or mood.

Why a physician: Severe or scarring acne has effective prescription treatments, and early treatment reduces scarring. A physician can also look for hormonal causes.

Red, dry, irritated patches on the backs of both hands — Example: dermatitis (eczema) of the hands. Photo: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons. Example only, not a diagnosis.

Book a physician visit soon

Eczema that is widespread, weeping or not improving

Very dry, itchy, red or darker patches that can crack, ooze or thicken. On darker skin it can look purple, brown or gray rather than red.

Signs to note and why it needs a physician

Intense itch that disturbs sleep.
Weeping, crusting or pus, or sudden worsening (possible infection, which needs same-day care).
No improvement with gentle skincare and moisturizer.

Why a physician: Eczema is a medical condition with prescription options, and infected eczema needs treatment. Facial treatments and active ingredients can make it worse.

Crusted, scabbed sores on a lower leg and foot — Example: impetigo. Photo: Grook Da Oger, CC BY-SA 3.0, via Wikimedia Commons. Example only, not a diagnosis.

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Honey-colored crusts or oozing sores

Small blisters or sores that break open and form a golden-yellow crust, often around the nose and mouth or on areas of broken skin. It spreads easily by touch.

Signs to note and why it needs a physician

Crusted sores that keep spreading.
Oozing or weeping skin.
Spots that appear on a rash, scratch or cut.

Why a physician: This pattern can be a contagious bacterial infection (impetigo). It usually needs prescription treatment, and skin treatments or facials should wait.

Small red and purple spots scattered across the skin — Example: purpura. Photo: User:Hektor, CC BY-SA 3.0, via Wikimedia Commons. Example only, not a diagnosis.

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Itching all over with no rash, easy bruising, or new lumps

Itching with no visible cause, bruises or tiny red or purple dots that appear easily, new lumps under the skin, or skin that has become very dry, thick, pale or swollen along with tiredness.

Signs to note and why it needs a physician

Itching that does not respond to moisturizer.
Bruising or bleeding with little injury.
New lumps, unexplained weight change or ongoing tiredness.

Why a physician: Skin can show problems with the thyroid, kidneys, liver, blood or other systems. A physician can check for the underlying cause, which skincare will not fix.

Pale patches on the backs of both hands and fingers — Example: vitiligo on darker skin. Photo: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons. Example only, not a diagnosis.

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Patches that lose their color

Smooth, milky-white or lighter patches, often on the face, hands, elbows or around the mouth and eyes, that slowly appear or grow. Hair in the patch may turn white.

Signs to note and why it needs a physician

New light patches that are spreading.
Patches that appear on both sides of the body.
Other autoimmune conditions in you or your family, such as thyroid disease.

Why a physician: Loss of color has several medical causes, such as vitiligo, and a physician can tell them apart and discuss options. Skincare products do not treat it.

Persistent redness and visible small blood vessels on the nose and cheek — Example: rosacea. Photo: M. Sand, D. Sand, C. Thrandorf et al., CC BY 2.0, via Wikimedia Commons. Example only, not a diagnosis.

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Persistent facial redness, flushing or eye irritation

Redness across the cheeks, nose and chin that comes and goes or stays, with flushing, visible small blood vessels, bumps like acne, or gritty, red or burning eyes.

Signs to note and why it needs a physician

Flushing that is frequent or painful.
Bumps with persistent redness, or thickening skin on the nose.
Red, dry or irritated eyes.

Why a physician: This can be rosacea, which has medical treatments and can affect the eyes. Other conditions can look the same, so it should be diagnosed first.

Red, inflamed lumps in the armpit — Example: hidradenitis suppurativa. Photo: Ziyad Alharbi et al., CC BY 2.5, via Wikimedia Commons. Example only, not a diagnosis.

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Recurring painful lumps in the armpits, groin or under the breasts

Deep, tender, boil-like lumps that come back in the same skin folds, sometimes draining and leaving scars or tunnels under the skin.

Signs to note and why it needs a physician

Painful lumps that return in the same places.
Draining, scarring or linked lumps.
Pain that limits movement.

Why a physician: This pattern can be a chronic inflammatory condition (hidradenitis suppurativa). It needs medical care, and squeezing, scrubbing or waxing the area can make it worse.

Book a physician visit soon

Sudden adult acne with other changes

Acne that appears suddenly in adulthood, especially with irregular periods, new facial or body hair, hair thinning, or weight changes.

Signs to note and why it needs a physician

A sudden change in your skin without a clear cause.
Irregular or missing periods.
New hair growth on the face or body, or thinning hair.

Why a physician: Sudden changes like this can be linked to hormonal conditions, such as polycystic ovary syndrome, that need a medical evaluation.

Smooth, round bald patch on the scalp — Example: alopecia areata. Photo: Kevlaraz, CC0, via Wikimedia Commons. Example only, not a diagnosis.

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Sudden, patchy or scarring hair loss

Smooth round bald patches that appear quickly, hair coming out in clumps, or a scalp that is red, painful, scaly or shiny where hair has been lost.

Signs to note and why it needs a physician

Round, smooth patches of hair loss.
Burning, pain or scaling on the scalp.
Hair loss with tiredness, weight change or other symptoms.

Why a physician: Hair loss has many medical causes, including autoimmune, thyroid, nutritional and scarring conditions. Treating scarring hair loss early can save hair.

Well-defined darker patches with scale on a lower leg — Example: psoriasis on darker skin. Photo: TealComet, CC0, via Wikimedia Commons. Example only, not a diagnosis.

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Thick, scaly plaques

Raised, well-defined patches covered in silvery-white scale, often on the scalp, elbows, knees and lower back. On darker skin the patches can look purple or dark brown with gray scale.

Signs to note and why it needs a physician

Plaques that are thick, scaly and sometimes itchy or sore.
Nail changes, such as pitting.
Joint pain or stiffness.

Why a physician: Psoriasis is an immune condition that needs a diagnosis and treatment plan, and it can be linked to joint disease. It should not be exfoliated or peeled.

Small rough growth on the sole of the big toe — Example: plantar wart. Photo: Dewdude, CC BY 2.5, via Wikimedia Commons. Example only, not a diagnosis.

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Warts or small dome-shaped bumps

Rough, grainy growths (warts), or small, smooth, shiny, flesh-colored bumps with a dimple in the middle (molluscum). Both are caused by viruses and can spread.

Signs to note and why it needs a physician

Growths that multiply or spread.
Painful, bleeding, or on the face or genitals.
A bump that looks like a wart but changes quickly.

Why a physician: A physician should confirm what a growth is, because some skin cancers look like warts, and treatment is medical. Estheticians should not treat or remove them.

Scope of practice

Where an esthetician’s role ends

Scope of practice is set by the state, province or other governing body where an esthetician is licensed, so it differs from place to place. These are general examples, not legal advice.

Generally within scope

Cleansing, facials and superficial exfoliation of healthy skin.
Choosing skincare products and routines for common, non-medical concerns.
Hair removal and cosmetic skin care within local rules.
Referring a client to a physician when something looks outside their training.

Generally outside scope

Diagnosing a skin condition or telling you what a spot or rash is.
Treating disease, infection or suspected skin cancer.
Removing moles, growths or lesions, or treating open or infected skin.
Prescribing, or advising you to start or stop, medication.

Before your visit

Get the most from the appointment

Note when it started, whether it has changed, and whether it itches, hurts, bleeds or oozes.
Take clear photos in good light now and again every week or two, so you can show any change.
Bring a list of the skincare products and medicines you use, including how long you have used them.
Mention allergies, pregnancy or trying to conceive, other health conditions, and a family history of skin cancer.
Skip makeup, nail polish and heavy product on the area if you can, so the physician can see it clearly.