Ep 304 – Keep it Clinical and Handle Delicately

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0:01:45.8 Maggie Staszcuk: Hello and welcome to ASCP Esty Talk. I'm your co-host Maggie Staszcuk, ASCP's program director.

0:01:51.7 Ella Cressman: I'm Ella Cressman, licensed esthetician, ingredient junkie and content contributor for Associated Skin Care Professionals.

0:01:58.8 MS: Ella, I want to talk with you about something a little less glamorous but just as important and that is the herpes virus. Herpes is super common and as estheticians, it's something we really need to be aware of.

0:02:13.0 EC: Absolutely.

0:02:14.9 MS: Yeah. As estheticians we're constantly around clients faces, necks, sometimes other body parts. So knowing how herpes shows up and how to manage it is huge. And we don't wanna be the one spreading cold sores or dealing with that awkward, is that a cold sore? Moment when we're working on someone's skin.

0:02:33.6 EC: It is very interesting. I cannot wait to dive into this topic because it is not just something we have to be aware of, hyper aware of goes back to the consultation, but it's also like an incredibly awkward conversation.

0:02:48.5 MS: It really is. And when people hear the word herpes, at least in my mind, you automatically are going to either cold sore or STD. But there's actually a lot of viruses that are classified as herpes that people are maybe not even aware of.

0:03:03.8 EC: Like what?

0:03:05.1 MS: We're gonna dive into it, but I know you have some statistics for us that we're gonna get to. Let's just talk in general first. What is herpes, anyway?

0:03:13.0 EC: That is a great question because it's a lot of things.

0:03:15.6 MS: Yeah, it's a virus. There's a lot of variations. Like I said, we're usually thinking of it like the cold sore or the STD. Let's start first with HSV-1.

0:03:25.1 EC: Yes, HSV-1. This is the one that we're going to most likely come into contact with as a professionals. It's what we usually call oral herpes. This is the classic cold sore that you will see on lips or in the inside of mouth. Basically, it's a party crasher. No fun, not invited. It's highly contagious. And avoiding treating the skin when there's an active outbreak is key, but also being aware of it in your consultation so that you're not sparking an outbreak. One key thing is, of course, always sanitize your tools and avoid touching any affected area. I like to just completely avoid the treatment at all and reschedule the appointment, which is not an easy conversation.

0:04:11.4 MS: It's not. No. It can be embarrassing for the individual and you wanna approach it in such a way that they aren't feeling awkward. It's not embarrassing. It happens to a lot of people.

0:04:22.6 EC: It does happen to a lot of people. In fact, let me tell you, I just kind of took a peek to see and here's the thing. Globally, as estimated that 64% of people under 50 have HSV-1.

0:04:36.2 MS: That's huge. And the thing too is that some of the treatments that we're doing in our treatment room can stimulate an outbreak. It can aggravate an outbreak and spread it further. And so really important, if someone is experiencing that, you don't wanna have this mindset that, well, just avoid the area and carry on. You really should be rescheduling that appointment.

0:04:57.2 EC: And there is treatment that you can take preemptively. Your client that goes right back into consultation is key.

0:05:04.3 MS: Yeah.

0:05:04.7 EC: So if you're a practitioner, it doesn't mean you have to cancel that appointment that day. You can perform something preparatory for the next treatment, but then have them start their medication that they usually are prescribed by their doctor and then reschedule or not reschedule, but schedule the treatment that may instigate it, like chemical peels, microneedling, microdermabrasions and sometimes even dermaplaning. Even dermaplane can start that cascade, though. It's like, peekaboo. I heard there's a party.

0:05:33.7 MS: Yeah. Let me share this story with you. I knew this girl back in the day when I was an instructor, and she had a little cold sore outbreak on her lip. And it was right around the time that we were learning chemical peeling. And we are educating reschedule, don't do it. It could stimulate that outbreak. And she went and had a chemical peel, anyway. She got with her partner, did a chemical peel, and literally within 24 hours, that cold sore outbreak had spread to her entire chin.

0:06:02.1 EC: Oh, my God.

0:06:02.5 MS: I mean, we're talking like full blown. It was a horrible outbreak. I mean, I really felt for her and the thing for estheticians to know and for the client to know now every time that she has an outbreak, it could potentially spread to her entire chin.

0:06:19.4 EC: That is so unfortunate. Like, I feel empathy for her on another side. What an amazing learning experience for those students, though.

0:06:29.0 MS: Yeah.

0:06:29.3 EC: Not only her, but those students who got to see that. Because I don't feel, feel like there's a little touch on it in school. Like we, we go through the checklist and all these things, but they got to all have this firsthand experience with just how bad it can be.

0:06:43.4 MS: Yeah. Yeah.

0:06:43.7 EC: So I feel so bad for her. But it's a great cautionary tale.

0:06:47.6 MS: Yeah. HSV-2 is the other type of herpes virus that is very commonly or mostly known that is genital herpes. But honestly, both types can swap locations. So I like to think they're like the interchangeable characters of a soap opera.

0:07:05.3 EC: Soap opera or horror story.

0:07:06.0 MS: Yeah. Exactly.

0:07:07.8 EC: Oh, my God. It's scary.

0:07:09.4 MS: Exactly. So it can spread even when there's no visible sores. You wanna avoid treating the area if the client has an active outbreak. So same like HSV-1, HSV-2. If your client has an outbreak, you do not want to move forward with the treatment. So thinking like Brazilian wax or bikini wax, if somebody has an active outbreak, you want to reschedule them.

0:07:29.9 EC: Even intimate brightening.

0:07:31.5 MS: Yes.

0:07:32.1 EC: Something that's growing in popularity. And I would think also this would be something very important to have in your consultation. I know when I used to do a lot more waxing, I didn't really have a consultation.

0:07:45.6 MS: You know what? I didn't either. I mean, there was maybe a quick conversation about, you know, let's talk about what you're here for today or what is the shape we're giving you today?

0:07:53.8 EC: Exactly. Landing strip are all gone.

0:07:55.7 MS: Right. Right.

0:07:56.0 EC: Yeah.

0:07:56.3 MS: And certainly, I'm not examining the area. We're just gonna get this thing done and get you out.

0:08:00.1 EC: Yeah. Seven minutes or less.

0:08:01.8 MS: Right.

0:08:02.8 EC: Yeah, that so, consider that. Make that part of, and consider it delicately. Let me tell you a story that happened to me. It's also a school story, but this is one that stuck with me. So in the case that the story that you shared, that client, if you will, or that student, that professional, she's always gonna have something that sticks with her. But in mind, this was my experience. So I had an instructor in school and I had a client come in and we had to have them evaluate our plan of action. And I didn't really know what was going on, but she had like a little tiny red dot on her bottom lip by the outer corner. The instructor came over and she's looking at her face. She goes, "Is that a cold sore? Are you prone to cold?" She goes, "Is that a cold sore?" And the client was like, "I don't think so. I'm not quite sure." Are you prone to cold sores? Have you had cold sores? Like in this tone of fright and assertiveness. And the client was stammering and like felt, I was so embarrassed for the client. She was, "We can't treat you. You can't be treated. We can't even touch your face. We can't even cleanse." Like going in on it, in my opinion. And I was mortified for all parties, and especially us. So one thing that I always do is I try to handle it super delicately with empathy and everything. So it's definitely a part of my facial consultation. Are you prone to this? Do you need medication? I do. Very gentle, but also try to keep it clinical.

0:09:33.6 MS: Yeah.

0:09:34.5 EC: So this is something I would think that you would want to consider also, because it's all probably even more embarrassing for the belly button down is keeping it gentle and clinical. And there's a clinical reason why we don't proceed. But it's not like something's wrong with you, 'cause that's how I felt that that client felt, who came into the school. And she rebooked, she didn't show up. And she would have, I don't think she would have ever gone back because she was, in my version, completely mortified, or perhaps it was that I was mortified for her. So you don't want that to happen. You don't want people to not come back to you 'cause of the language you use.

0:10:11.0 MS: Yeah. Having tact is really important in these situations. And there's a lot of things that can happen in the treatment space that you have to handle delicately. This is just another one of those. And I think for the esthetician as well, you know, they get worried about what is contagious. There are so many things that are contagious. So don't freak out about this situation in particular.

0:10:30.1 EC: Right. Your pimples are contagious.

[laughter]

0:10:34.9 MS: That brings me to another story. I had a client that had a cold sore that thought it was a pimple.

0:10:40.9 EC: Oh.

0:10:41.9 MS: Yeah. Oh, poor thing. She was attempting to extract it on her own and came in to say, this pimple won't go away. It keeps coming back. You know, this was kind of, a one off situation, but making sure they understand that I'm doing this for your best interest because we don't want to spread it, we don't wanna exacerbate it.

0:11:00.9 EC: Right. Yeah. Did it resolve?

0:11:03.9 MS: It resolved, yeah.

0:11:04.6 EC: Okay.

0:11:05.4 MS: Yeah, we had to rebook her.

0:11:06.6 EC: Good. I'm glad she got relief at least. Hold that thought. We'll be right back.

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0:11:52.3 MS: Okay, here we go. Let's get back to the podcast. So there are a few more members of this herpes virus family that show up in unexpected ways, like shingles, chickenpox, and even a couple other more rare strains. So herpes zoster is one of those things that also very contagious. If your client is coming in with herpes zoster, you probably want to reschedule and book. So let's talk about the big one that can appear later in life, more commonly known as shingles. So this is related to the chickenpox virus and it shows up as a painful rash. It's often in a band or a strip pattern on the body. It doesn't cross the spinal column. And make sure to avoid this affected area until it is completely healed, because touching that rash, which is basically a herpes outbreak on the body, is very contagious. And if you've had chickenpox, you're at risk for shingles or this herpes zoster virus down the line. And the virus, it actually can hang out dormant in your body and then surprise. It can be activated or reactivated later on. Usually, when you're stressed or immune system is weakened.

0:13:03.3 EC: One of my trainers got this.

0:13:05.2 MS: Really? Okay.

0:13:06.3 EC: In his, like maybe mid, maybe young, 30s, maybe late 20s. And he was like, can you look at this on the side? Do you see anything? He felt it before he saw it, by the way. Just being aware, he's like, it really hurts and you don't see anything. I was like, I don't see anything, I don't see anything. And he then later told me it was shingles. But painful is from what I can understand. So it can happen later, later in life, it's more common, but it can happen at any time. If he had chicken pox, you might want to check it out.

0:13:36.7 MS: Yeah, for sure.

0:13:37.9 EC: So let's talk about chickenpox. Guess what? This is the OG of the herpes viruses. And this makes a mess and then leaves only to come back as shingles. It's adulthood. Yay. Thanks. As a kid, if you had it, you are probably still carrying it and it's just waiting to peekaboo itself out. Did you get it as a kid?

0:14:00.3 MS: I did, yeah.

0:14:00.4 EC: Did you? And was it bad?

0:14:01.9 MS: From what I recall, yeah. It wasn't fun.

0:14:04.2 EC: Yeah. I think most people get it. The earlier you get it, the less severe it is. The older you get it, the more severe it is. And I remember all, both my brothers and I got it at the same time. Older brothers was worse than my younger brothers was not as bad.

0:14:17.5 MS: Yeah. Back in the day, I think the parents had like the chickenpox party, you know when one kid got infected, then you brought all the kids together so everyone got infected. Like you wanted to have it.

0:14:26.6 EC: Yeah. And then done.

0:14:27.2 MS: And then you're done with it. Yeah.

0:14:29.5 EC: So you're later in life.

0:14:30.5 MS: Yeah.

0:14:31.3 EC: I don't think they used to talk about herpes, zoster or shingles. I didn't ever heard. I never heard about it as a kid. So it did feel as a kid like a rite of passage.

0:14:40.6 MS: Yeah.

0:14:41.1 EC: Like, ah, I got it. Did you get it? Anyways, it starts with these itchy red spots that then turn into fluid fills blisters like a rash on steroids, covering the body and waiting, super contagious. So something to consider. If you've gotten it before, you should be okay. But if you haven't and you're client has a kid who has it and usually then it's not going to happen. But just be careful.

0:15:04.1 MS: Yeah, for sure. Another herpes virus that people are maybe not aware of is Epstein-Barr. Have you heard of this?

0:15:10.1 EC: I have.

0:15:11.3 MS: Yeah. This is actually a herpes virus. So some people may not realize they have this, but it's linked to mono and it can cause fatigue, sore throat, and also surprise skin rashes. Yeah. So typically, it's actually not contagious, but fun fact, almost everyone gets the Epstein-Barr virus at some point in their life. And it's one of the most common viruses around, but most of us don't even know we've had it. And it's just like having a bad cold or a flu. For others, it can be much more severe. And then this is when they get that rash outbreak. So the rash related to Epstein-Barr virus can appear as red, bumpy. It often shows up on the body, and clients may come in with a rash that looks like an allergic reaction, or it could also look like acne. But you want to take note if they have recently had a bad flu, a cold, mono. So Epstein-Barr also can be linked to certain skin conditions like chronic fatigue syndrome, rosacea, and even some types of psoriasis.

0:16:14.2 EC: You know what's so funny? Not funny ha ha. But interesting is I had, you know, just my blood drawn, I think, in August of last year, and it had tested for this or it came back EBV on the test, you know. I think I'm a medical professional. So it's reading the test before, I talked to my doctor about it and it said like positive or negative. And so I was trying to analyze myself and I got to this one. I was like, what, what is this? But that's when I found out that I had had it at some point in my life between now and when I was born. So we heard of HSV-1, we heard of HSV-2, but did you know there's HSV-7?

0:16:54.1 MS: Tell me.

0:16:55.8 EC: Herpes simplex virus 7. It's less commonly discussed, but it's generally associated with other skin conditions like eczema herpeticum, which there's your sign, right? What this is, this is an infection that occurs in people with eczema when exposed to the herpes virus. And what it looks like it's these fluid filled blisters on the skin. It's crazy painful, and it's often present where the eczema is. So what kind of cards did you draw that you got eczema, and on top of that, these itchy, ouchy eczema?

0:17:30.4 MS: So double whammy.

0:17:32.3 EC: If you're healthy, shouldn't be a problem, but it's most likely to appear in immunocompromised individuals. So I'm gonna go back again to consultation. Understanding the clinical side of somebody is super important, even when we're offering facials, because it's not like we're just asking these questions 'cause we're nosy, we're asking these questions because we wanna make sure we're treating or addressing our clients in a holistic way, meaning their whole selves and not causing, you know, a problem.

0:18:02.8 MS: Yeah, you said it. And I think the important thing to note too, is that the consultation and that paperwork is being done every time your client comes in, because things change. And if we're talking about herpes here specifically, one day they could have an outbreak and the next day they could not. So documenting this and educating our clients and making sure they're understanding, like you said, why we're doing these consultations, why we're documenting, why we're asking these questions, and if we have to turn them away, it's simply just for their safety. Just like with any other virus or skin condition, the best thing we can do as estheticians is to show empathy, use gentle care and recognize when a client may need medical advice. Now, listeners, we want to hear from you. Share with us on social media, through Instagram, Facebook or by emailing getconnected@ascpskincare.com. Thank you for listening to ASCP Esty Talk. And as always, for more information on this episode or for ways to connect with Ella and myself, or to learn more about ASCP, check out the show notes.