It is very important to examine the skin thoroughly before giving massage. The skin can be affected by many problems, which must be identified prior to massage. Some will have to be avoided whereas others may need medical referral. If you have to encourage a client to see the doctor, you must do so in a very tactful manner and not alarm nor offend the client.
Macule: this is a mark or discoloured patch that lies flat on the skin.
Papule: this is a small elevated pimple.
Vesicle: this is a very small scaly blister containing fluid (bulla is a large blister).
Milia/whiteheads: these are small plugs of sebum covered by the stratum corneum and look like tiny white spots.
Comedone: this is a blackhead: it is a plug of compressed sebum that is oxidised on the surface giving a black spot. Blackheads are very common. Advise proper cleansing routines and a healthy diet. If the condition is excessive and accompanied by pimples and pustules, then refer for medical advice. Avoid the area when massaging.
Seborrhoea: this is a skin condition caused by over-activity of sebaceous glands. The nose, forehead and scalp are very oily and shiny and the hair appears greasy. Avoid the area, as massage may further stimulate the activity of sebaceous glands.
Acne vulgaris: this is a chronic inflammatory condition of the skin generally appearing at puberty, but it may also be seen in adults. It is thought to be due to hormonal changes and over-activity of sebaceous glands. It may be found on the face, chest, back and across the shoulders. In severe cases the skin will be red and inflamed and covered with pimples, pustules and blackheads. As the problem progresses, cysts appear, which are red swollen lumps beneath the skin. Advise good personal hygiene, a healthy diet, exercise and drinking plenty of water. If the condition is excessive or troubling the client, seek medical advice. Avoid massaging over the affected area.
Rosacea: this is a chronic inflammatory condition found on the face. The skin is flushed and red due to dilation of blood vessels, and appears coarse with enlarged pores. Papules and pustules may develop. It is thought to be caused by intolerance to certain food or drink or over-exposure to extremes of climate. Tea, coffee or alcohol may exacerbate the condition as will exposure to sun and wind. These clients will usually be under medical supervision: if they are not, suggest medical referral. Do not massage over the area.
Sebaceous cysts: these are a swelling of the sebaceous glands under the skin, which form a lump (sometimes called a wen). They usually appear as a small lump on the scalp, neck or back. Do not massage over the area.
Urticaria (hives): these are itchy, red, raised wheals formed on the skin that can be caused by an allergic reaction to certain foods such as shellfish, strawberries etc. It is usually widespread; do not massage.
Dermatitis: this is inflammation of the skin and has many causes. It may be due to contact with a substance to which the person is sensitive. It may be caused by a reaction to specific drugs or exposure to irritants.
Psoriasis: this is a chronic skin disease that may affect small areas behind the knees or elbows or it may be found over the entire body. It results in reddish patches covered with silvery scales that continually flake away. It is non-infectious but affected parts should not be massaged.
Skin cancer: there are three types of skin cancer:
1 I basal cell carcinoma
^^ squamous cell carcinoma ^^ malignant melanoma.
When examining the skin be particularly aware of small ulcerated spots or moles that change shape or change colour. Dark-brown raised patches of skin with uneven edges should be medically referred.
Naevus: this is an abnormality in the pigmentation of the skin and is often present at birth:
^ Spider naevus: this consists of a central dilated blood vessel with small ones radiating from it - like a spider. Frequently found on the face. Avoid massaging the area as the blood vessels in the face may be fragile.
^ Strawberry mark: this is an area of pink to red skin. Avoid the area.
^ Port wine stain: this may be quite a large area of dark red to purple skin. Usually found on the face. Does not usually fade. Do not massage the area as capillaries are already dilated.
Freckles: (ephelides) small brown pigmented areas of skin that become darker when exposed to sunlight.
Chloasma: this is a light-brown pigmentation of the cheeks, nose and forehead. Usually occurs during pregnancy and disappears after the birth.
Vitiligo: this is a total loss of pigmentation of the skin. It starts as small white patches, which can join up to form quite large areas of white skin.
Papilloma: (moles) these are small growths on the skin that vary in size and colour. They may be pale to dark brown and may lie flat to the surface or be raised above the surface attached by a short stalk. There is a danger of trapping these with the fingers when massaging. Massage around the area, avoiding the mole.
Bacterial infections include:
Pustule: this is an elevated lump of skin containing pus: pustules often develop when hair follicles are infected by bacteria.
Furuncle or boil: this is an abscess under the skin filled with pus, which is caused by bacteria entering the skin, usually through a hair follicle. Boils can be painful and should be medically treated. Do not massage over the area.
Carbuncle: this is a collection of boils, which can be very painful and must be referred for medical treatment. Do not massage over the area.
Impetigo: this is a highly contagious bacterial infection of the skin. Usually located around the mouth, it begins as an itchy red patch that develops into pustules and further into flaky crusts.
It is usually found in children, but adults may also be affected. This condition should be medically treated. Do not massage anywhere near the area.
Viral infections include:
Warts: these are caused by a virus causing rapid cell division. Common warts are raised with a rough surface and are usually found on the hands. Plantar warts (verrucae) are found on the soles of the feet and grow inwards. They are painful upon pressure and should be referred for medical treatment. Warts are very contagious: avoid touching them and avoid working on clients if you have a wart. Do not massage over the area.
Herpes simplex/cold sore: this is caused by a virus living in the skin of the lips. It produces an eruption around the mouth that starts as an itchy red patch and develops into vesicles or a weeping blister, which then form a crust. It is very contagious. Do not treat the face of a client with cold sores.
Herpes zoster/shingles: is caused by a virus that attacks the posterior root ganglion of a sensory nerve. It may lie dormant until the body is under stress when it erupts and produces vesicles along the pathway of the nerve. This condition can be very irritating and the pain may be severe. Clients with shingles would normally feel too ill to come for treatment, which is contra-indicated anywhere near the area.
Fungal infections include:
Ringworm (tinea): this is a fungal infection and has different names according to the part of the body affected.
Tinea pedis, known as athlete's foot, is the most common: this infects the skin around and between the toes, forming red, itchy, scaly patches on the soles and between the toes. The skin may become sore, soggy and white. It is highly contagious. Do not treat the feet and cover them with disposable socks when treating other areas.
Maintain high standards of hygiene in showers, steam rooms etc to prevent spreading the infection.
Tinea corporis, known as ringworm, infects the skin all over the body. Red, round, scaly patches that spread outwards can appear anywhere on the body. Do not massage.
Tinea capitis: this infects the skin and hair shafts of the head. Greyish, scaly areas with short, broken hairs are found on the scalp. Do not massage.
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