Contraindications are conditions that make a treatment unsafe — absolute (never treat, e.g. Accutane, active cold sore) or relative (modify or get clearance, e.g. pregnancy, recent procedures). A documented intake screens for them, and the professional move is to delay and get medical clearance when in doubt.
The most important treatment decision an esthetician makes is sometimes not to treat. Knowing the contraindications — the conditions that make a treatment unsafe — protects the client, protects the practitioner, and is a hallmark of professional judgment. This is where good training separates itself from a weekend certificate.
Absolute vs. relative contraindications
An absolute contraindication means do not perform the treatment, period. A relative contraindication means proceed only with modification, medical clearance, or extra caution. Sorting which is which, in real time, is the skill.
Contraindications every esthetician should know
| Condition | Concern | Typical status |
|---|---|---|
| Isotretinoin (Accutane) | Impaired healing, scarring | Absolute for peels/resurfacing (commonly 6+ months after) |
| Pregnancy/breastfeeding | Ingredient safety (retinoids, some acids) | Relative — modify |
| Active cold sore/herpes | Spreads, worsens | Absolute until healed |
| Active infection/open lesions | Spread, poor healing | Absolute in the area |
| Recent cosmetic procedures/injectables | Interaction, bruising | Relative — space out |
| Uncontrolled diabetes/immunosuppression | Impaired healing | Relative — clearance |
| Certain photosensitizing medications | Burn risk with light | Relative — assess |
| Known product allergies | Reaction | Modify/avoid |
Why documentation matters
A thorough intake form and consultation aren't bureaucracy — they're the record that a contraindication was screened for. Documenting what was asked, what the client disclosed, and why a treatment was modified or declined is both good care and professional protection. When in doubt, the safe answer is to delay and get medical clearance.
When to refer or delay
Refer or delay whenever you encounter an absolute contraindication, anything undiagnosed, or a client who can't clearly answer health-history questions. Declining a treatment for the right reason builds trust, not resentment. This judgment is trained throughout MSI's Facial Specialist program and reinforced in the Advanced Clinical Aesthetician track.
FAQ
Can you get a facial or peel while on Accutane?
No — isotretinoin (Accutane) impairs skin healing, so peels, waxing, and resurfacing are contraindicated, commonly for at least six months after stopping the medication. Always confirm with the prescribing physician.
What treatments are contraindicated during pregnancy?
Pregnancy is a relative contraindication: retinoids and some strong acids are typically avoided, and treatments are modified. Many gentle facials are fine, but the client's OB should guide anything uncertain.
Can you treat a client with an active cold sore?
No. An active herpes/cold sore is an absolute contraindication in the area — treatment can spread the infection and worsen the outbreak. Wait until it is fully healed.
Why is documenting contraindications important?
A documented intake and consultation records that health risks were screened, which protects the client's safety and the practitioner. It shows why a treatment was modified or declined if a question ever arises.
Written by Dr. Tali Arviv, MD, Co-Founder and Medical Director of MedSpa Institute. Credentials verifiable through the Florida Department of Health.
- Absolute contraindications mean don't treat; relative ones mean modify or get clearance.
- Accutane, active herpes, and active infection are common absolute contraindications.
- Pregnancy and recent procedures are relative — modify and space out.
- A documented intake protects both client and practitioner; when in doubt, delay.