Washington Cosmetology License Exam — All Questions

The outermost layer of the skin, the one estheticians and cosmetologists work on most directly, is the:

• a.Epidermis✓
• b.Dermis
• c.Subcutaneous (adipose) layer
• d.Stratum papillare

The skin has three main layers. The epidermis is the thin outermost layer (its surface is the stratum corneum) and is where most surface skin-care and exfoliation work occurs. Beneath it is the dermis, the thicker living layer containing blood vessels, nerves, hair follicles, and sweat and oil glands. Deepest is the subcutaneous (adipose) layer of fatty tissue that provides insulation and contour.

A comedo (plural comedones), commonly seen in acne-prone skin, is best described as:

• a.A contagious viral growth on the skin surface
• b.A raised sac filled with clear fluid
• c.A follicle plugged with sebum and dead skin cells✓
• d.An area of increased pigmentation from sun exposure

A comedo is a follicle that has become plugged with sebum (oil) and dead keratinized cells. When the plug is exposed to air at the surface it oxidizes and darkens, forming an open comedo, or blackhead. When it is covered by skin it stays light and forms a closed comedo, or whitehead. Comedones are a hallmark of acne and are a disorder of the sebaceous (oil) glands, not an infection or a pigmentation change.

During a basic facial, why is a cleansing step performed before applying treatment products or a mask?

• a.To immediately close the pores so nothing can penetrate
• b.To remove makeup, oil, and surface debris✓
• c.Because treatment products work better on unwashed skin
• d.To strip away the skin's acid mantle before treatment

Cleansing is the foundational first step of a facial. Removing makeup, excess oil, sweat, and environmental debris leaves a clean surface so that subsequent steps — exfoliation, massage, treatment products, and masks — can perform as intended and penetrate more effectively. Cleansing does not permanently strip the skin's protective acid mantle; a well-formulated cleanser respects it.

Which layer of the epidermis is made of tightly packed, fully keratinized dead cells that are continually shed from the surface?

• a.The stratum granulosum, where the cells develop granules and begin to die
• b.The stratum corneum, the outermost layer that is shed and replaced continually✓
• c.The stratum spinosum, where the cells are held together by spiny desmosome attachments
• d.The stratum germinativum, the deepest layer, where new cells are produced

The stratum corneum is the outermost layer of the epidermis; its cells are dead, flattened, and full of keratin, and they shed constantly as new cells push up from below. The granular layer sits deeper, where cells develop keratin granules and start to die, and the spiny layer is deeper still. The germinativum (basal) layer is the deepest epidermal layer, where cell division happens. Nearly all surface skin care and exfoliation work is done on the corneum.

New epidermal cells are produced by cell division in which layer, which is also where the melanocytes are found?

• a.The stratum corneum, the flat surface layer of dead keratinized cells
• b.The stratum lucidum, a clear layer found only in the thickest skin
• c.The papillary layer of the dermis, which lies just under the epidermis
• d.The stratum germinativum (basale), the deepest layer of the epidermis✓

The stratum germinativum, also called the basal layer, is the deepest layer of the epidermis. It is where mitosis produces the new cells that migrate upward, and it is where melanocytes sit and manufacture melanin. The corneum is the dead surface layer and the lucidum is a thin clear layer above the granular layer in thick skin; neither produces new cells. The papillary layer belongs to the dermis, not the epidermis.

The stratum lucidum is a thin, clear layer of the epidermis found only in certain areas of the body. Where is it found?

• a.In the thick skin of the palms of the hands and the soles of the feet✓
• b.On the eyelids and in the thinnest skin of the face and the neck
• c.Only in the scalp, where the hair follicles are most densely packed
• d.Everywhere a sebaceous gland opens into a hair follicle on the body

The stratum lucidum is a translucent layer of clear, flattened cells present only in the thick, hairless skin of the palms and soles. It is absent from thin skin such as the eyelids, which have the thinnest skin on the body. Its presence is why the epidermis is sometimes described as having five layers in thick skin and four elsewhere. It has nothing to do with follicle or gland density.

Keratinization is best described as the process in which:

• a.melanocytes transfer their pigment granules into the surrounding skin cells
• b.sebaceous glands convert stored fat into the oil that reaches the surface
• c.cells made in the deepest epidermal layer move up, fill with keratin, and die✓
• d.the dermis builds new collagen and elastin fibers to replace damaged ones

Keratinization describes the life cycle of an epidermal cell: it is produced by division in the basal layer, is pushed upward through the spiny and granular layers while filling with the protein keratin, loses its nucleus and dies, and finally becomes part of the flat, protective surface layer that sheds. Pigment transfer from melanocytes is a separate process, as is the dermis rebuilding collagen and elastin. Sebaceous glands secrete sebum but play no part in keratinizing the cells.

Which structure is located in the papillary layer, the upper portion of the dermis?

• a.The adipose cells that insulate the body and give the face its contour
• b.The dense bands of collagen that give skin most of its tensile strength
• c.The dermal papillae, which hold nerve endings and small capillary loops✓
• d.The flattened dead cells that form the protective surface of the skin

The papillary layer is the thin upper portion of the dermis, named for the dermal papillae, the small cone-shaped projections that reach toward the epidermis and contain looped capillaries and nerve endings. The heavier bundles of collagen and elastin belong to the reticular layer beneath it. Fat cells are found in the subcutaneous tissue below the dermis, and the flat dead cells are the epidermis surface.

The reticular layer, the deeper portion of the dermis, contains:

• a.blood vessels, nerves, follicles, oil and sweat glands, collagen, and elastin✓
• b.keratinized dead cells, melanin granules, and the openings of the pores at the surface
• c.only fat cells, which cushion the bones and give the face its contour
• d.the clear cells of the stratum lucidum and the granular layer of the epidermis above

The reticular layer is the thicker, deeper part of the dermis. It supplies the skin with oxygen and nutrients and houses blood vessels, nerves, hair follicles, sudoriferous and sebaceous glands, and the collagen and elastin fibers that give skin its strength and elasticity. Keratinized cells and the layers named lucidum and granulosum are epidermal, not dermal. Fat cells make up the subcutaneous tissue below the dermis.

What is the primary role of the subcutaneous (adipose) tissue that lies beneath the dermis?

• a.It produces the keratin that hardens the cells at the skin's surface
• b.It holds the melanocytes that determine the skin's natural color
• c.It forms the acid mantle that keeps the skin's surface slightly acidic
• d.It stores fat that insulates the body, absorbs shock, and gives contour✓

The subcutaneous or adipose layer is the deepest of the three skin layers. Its fatty tissue insulates the body against heat loss, acts as a shock absorber protecting the structures beneath, and provides the contours of the face and body. Keratin is produced in the epidermis, melanocytes sit in the basal layer of the epidermis, and the acid mantle is a surface film of sebum and perspiration.

Which statement about the skin as an organ is accurate?

• a.It is the body's smallest organ and is uniform in thickness everywhere
• b.It is the body's largest organ, and it is thickest on the palms and soles✓
• c.It is thickest on the eyelids, where it must protect the eye from injury
• d.It is one layer of living cells that cannot regenerate after an injury

The skin is the largest organ of the body by surface area and weight. Its thickness varies by location: it is thickest on the palms of the hands and the soles of the feet, which take the most friction and pressure, and thinnest on the eyelids. It is made of three layers, not one, and the epidermis renews itself continuously as basal cells divide and keratinize.

Two clients have very different natural skin colors. That difference is due mainly to:

• a.the amount and the type of melanin that their melanocytes produce✓
• b.the number of separate layers in each client's epidermis and dermis
• c.how much sebum each client's sebaceous glands secrete in a day
• d.the thickness of the subcutaneous fat layer beneath each client's skin

Melanocytes in the basal layer of the epidermis produce melanin, and it is the quantity and the type of melanin they make and distribute that determine natural skin color. The number of epidermal and dermal layers is essentially the same from person to person. Oil production is a matter of skin type, and subcutaneous fat affects contour, not color. Melanin production also increases with ultraviolet exposure, which is what tanning is.

The sudoriferous glands contribute most directly to which functions of the skin?

• a.Lubrication of the hair and the skin, by producing an oily protective film
• b.Sensation, by carrying nerve impulses from the surface back to the brain
• c.Pigmentation, by releasing the granules that darken the skin after ultraviolet exposure
• d.Heat regulation and excretion, by producing sweat that evaporates off the skin✓

Sudoriferous glands are the sweat glands. They excrete perspiration, which is largely water with a small amount of salts and waste, through pores onto the surface; as it evaporates, it cools the body. Lubrication comes from sebum produced by the sebaceous glands. Sensation is carried by nerve endings in the dermis, and pigment comes from melanocytes in the epidermis.

Sebaceous glands are appendages of the skin that:

• a.open onto the palms and soles to cool the body as their fluid evaporates
• b.secrete sebum, usually into a hair follicle, to lubricate the skin and hair✓
• c.produce the salty fluid that carries waste products out through the pores
• d.generate the pigment that shields the deeper layers from ultraviolet light

Sebaceous glands are the oil glands. They are attached to hair follicles and secrete sebum, an oily substance that lubricates the skin and hair and helps keep the surface from drying out. Sweat glands, not oil glands, produce the salty fluid that cools the body, and the palms and soles have sweat glands but no sebaceous glands because they have no hair follicles. Pigment is produced by melanocytes.

The acid mantle on the surface of healthy skin is best described as:

• a.a layer of dead surface cells that must be stripped away before any facial service
• b.a coating of pure sebum that contains no water or perspiration at all
• c.a slightly acidic film of sebum and sweat that helps protect against microbes✓
• d.an alkaline film that holds the surface of the skin well above a neutral pH of 7

Sebum from the oil glands mixes with perspiration from the sweat glands to form a thin, slightly acidic film over the skin known as the acid mantle. That acidity discourages the growth of many bacteria and other microorganisms and helps the barrier retain moisture. It is not alkaline, and it is not simply the dead surface cells. Harsh, highly alkaline cleansers can disturb the mantle temporarily, which is one reason pH-balanced products are preferred.

A client asks what her skin actually does for her body. Which answer correctly names the functions of the skin?

• a.Protection, sensation, heat regulation, excretion, secretion, and absorption✓
• b.Circulation, digestion, respiration, reproduction, and absorption of nutrients
• c.Protection, digestion, pigmentation, respiration, and the storage of vitamins
• d.Sensation, circulation, keratinization, perspiration, and hormone production

The six functions of the skin are usually listed as protection (a barrier against injury and microorganisms), sensation (nerve endings for heat, cold, touch, pressure, and pain), heat regulation (perspiration and blood flow), excretion (waste carried out in perspiration), secretion (sebum from the oil glands), and absorption (a limited amount of material passing into the skin). Digestion, circulation, and reproduction are functions of other body systems, and keratinization is a cellular process rather than a function of the organ.

Which of the following is a SECONDARY skin lesion?

• a.A macule, a flat spot of discoloration level with the surrounding skin
• b.A wheal, an itchy raised area such as a hive or an insect bite reaction
• c.A vesicle, a small raised blister that is filled with a clear fluid
• d.A crust, the dried serum and dead cells left over a healing area✓

Primary lesions are the changes that appear first, in the early stage of a condition, and include macules, papules, tubercles, vesicles, pustules, wheals, cysts, and nodules. Secondary lesions develop later, once the condition has progressed or begun to heal, and include crusts (scabs), scales, excoriations, fissures, scars, keloids, and ulcers. A crust is the dried accumulation of serum and dead cells over a healing lesion, which makes it secondary.

A small, raised, solid pimple on a client's chin contains no fluid. This lesion is called a:

• a.macule, a flat discolored spot that is level with the surrounding skin
• b.papule, a primary lesion that may or may not develop into a pustule✓
• c.pustule, a raised lesion holding pus inside an inflamed hair follicle
• d.fissure, a crack in the skin that extends down into the dermis

A papule is a small, solid, elevated lesion with no fluid inside it; inflamed acne often begins as a papule that then fills with pus and becomes a pustule. A macule is flat rather than raised, such as a freckle. A fissure is a crack in the skin, like a chapped lip or a split heel, and it is a secondary lesion rather than a primary one.

A client has small, firm white bumps just under the surface of the skin around her eyes. These are most likely:

• a.milia, small epidermal cysts of keratin trapped just beneath the surface✓
• b.open comedones, in which the trapped plug has oxidized and turned dark
• c.wheals, raised itchy areas produced by an allergic reaction or an insect bite
• d.lentigines, flat pigmented spots produced by repeated exposure to the sun

Milia are small, firm, whitish epidermal cysts formed when keratin becomes trapped beneath the surface of the skin; they are common around the eyes and on the cheeks and have no visible opening. An open comedo, or blackhead, has an opening to the air and looks dark rather than white. Wheals are raised and itchy, and lentigines are flat pigmented spots, so neither matches a firm white bump under the surface.

Acne vulgaris develops when:

• a.the skin is repeatedly stripped of its sebum, leaving the follicles empty
• b.melanin pigment builds up inside the follicle wall and seals off the opening to the surface
• c.a follicle plugged with sebum and dead cells is colonized by bacteria and inflames✓
• d.the sudoriferous glands stop producing sweat and the pores then fuse closed

Acne vulgaris is a disorder of the sebaceous glands. Excess sebum and retained dead keratinized cells plug the follicle, forming a comedo; bacteria that normally live in the follicle multiply in that environment, and the resulting inflammation produces papules and pustules. It is not caused by an absence of oil, by pigment, or by the sweat glands shutting down. A cosmetologist may work on non-inflamed skin cosmetically, but severe or cystic acne should be referred to a physician.

A client shows persistent redness with visible tiny blood vessels across the cheeks and nose, sometimes with small papules. This chronic condition is most likely:

• a.psoriasis, which forms silvery scales over red patches, often on elbows and knees
• b.contact dermatitis, an inflammation caused by contact with an irritant or allergen
• c.vitiligo, in which patches of skin lose pigment and turn much lighter than normal
• d.rosacea, a chronic condition for which the client should be referred to a physician✓

Rosacea is a chronic condition marked by persistent flushing and redness, dilated surface capillaries, and sometimes papules and pustules across the central face. Because it is a medical condition, the cosmetologist should avoid heat, strong stimulation, and harsh exfoliation, and should refer the client to a physician rather than attempt to diagnose or treat it. Psoriasis produces scaly plaques, contact dermatitis follows exposure to a specific irritant, and vitiligo is a loss of pigment rather than redness.

Which term describes the larger mask-like patches of darker pigment that can appear on the face, often with hormonal changes?

• a.Lentigines, the small flat pigmented spots produced by repeated sun exposure
• b.Melasma (chloasma), larger patches of increased pigment across the face✓
• c.Albinism, an inherited absence of melanin in the skin, the hair, and the eyes
• d.Leukoderma, a general term for light patches where the pigment is absent

Melasma, also called chloasma and sometimes the mask of pregnancy, is hyperpigmentation that appears as larger irregular patches, typically on the forehead, cheeks, and upper lip, and is associated with hormonal changes and sun exposure. Lentigines are the small, discrete flat spots often called sun or age spots. Albinism and leukoderma are the opposite problem, a lack of pigment. Sun protection is essential in managing any hyperpigmentation.

Vitiligo and albinism are both examples of:

• a.hypopigmentation, an absence of melanin pigment in the affected skin✓
• b.hyperpigmentation, an overproduction of melanin in the affected skin
• c.secondary lesions, which form only after an injury has begun to heal
• d.contagious conditions, which must never be serviced anywhere in a salon

Hypopigmentation means too little melanin. In vitiligo, patches of skin lose their pigment and appear as light areas with defined borders; in albinism, an inherited condition, melanin is absent from the skin, hair, and eyes from birth. Neither is contagious, and neither is a secondary lesion. Both conditions leave the skin with little natural protection against ultraviolet light, so diligent use of a broad-spectrum sunscreen matters.

A client arrives for a facial with an open, oozing, honey-colored crusted sore near her mouth. The professional should:

• a.perform the facial but simply avoid touching that area with any product
• b.extract the area first and then continue with the scheduled facial service
• c.decline the service and refer the client to a physician for evaluation✓
• d.cover the sore with a bandage and shorten the service to a few minutes

Open, weeping, or crusted sores around the mouth may be impetigo, a highly contagious bacterial infection, or a herpes simplex outbreak, which is viral and also contagious. Either one contraindicates the service: the professional should politely decline, explain that the skin needs medical attention, and refer the client to a physician. A cosmetologist must never diagnose the condition or attempt to treat it, and working around it does not prevent the spread of the organism on hands, linens, and implements.

In the ABCDE guide used to evaluate a mole, the letter E stands for:

• a.Elevation, meaning that any mole raised above the surface is dangerous
• b.Evolving, meaning the mole is changing in size, in shape, or in color✓
• c.Exfoliation, meaning the mole flakes whenever the area is cleansed
• d.Erythema, meaning redness has appeared in the skin around the mole

The ABCDE warning signs for melanoma are asymmetry, an irregular border, more than one color, a diameter larger than a pencil eraser, and evolving, meaning the lesion is changing over time in size, shape, color, or symptoms. A cosmetologist who notices these signs should never diagnose or name the condition to the client; the correct action is to suggest, tactfully, that a physician examine the area. Many raised moles are ordinary, so elevation alone is not one of the warning signs.

A client's skin feels tight and looks dull, yet her T-zone still produces oil. This is best described as:

• a.a dry skin type, meaning her sebaceous glands produce very little sebum
• b.a sensitive skin type, which reacts with redness to most products applied
• c.an oily skin type, meaning the follicles are enlarged over the whole face
• d.a dehydrated condition, meaning her skin lacks water rather than oil✓

Skin type is largely genetic and describes how much oil the skin produces: dry, oily, combination, or normal. A condition is something the skin is experiencing at the moment and can change with environment, products, and habits; dehydration is a lack of water in the skin, and it can occur on oily skin as easily as on dry skin. Tightness and dullness alongside a working T-zone point to dehydration rather than a dry type. Sensitivity is a separate condition marked by reactivity and easy flushing.

The Fitzpatrick scale classifies skin according to:

• a.the amount of sebum that the skin produces over the course of a day
• b.the number of primary and secondary lesions present at the consultation
• c.how readily the skin burns or tans when it is exposed to sunlight✓
• d.how much water the stratum corneum is able to hold after it is cleansed

The Fitzpatrick scale sorts skin into types based on how it reacts to ultraviolet exposure, ranging from skin that always burns and never tans to deeply pigmented skin that rarely burns. It is used to anticipate how a client will respond to sun exposure and to services such as exfoliation and light-based treatments, and to gauge the risk of post-inflammatory pigment changes. Oiliness, hydration, and lesion counts are assessed separately during skin analysis.

Which statement about ultraviolet radiation and the skin is accurate?

• a.UVA rays penetrate more deeply and contribute strongly to premature aging✓
• b.UVB rays penetrate more deeply than UVA and are the main cause of wrinkling
• c.UVA rays are blocked entirely by window glass, while UVB rays pass through it
• d.Only UVB rays reach the skin, and only on cloudless days in the summer

UVA rays have a longer wavelength and reach farther into the dermis, where they damage collagen and elastin, which is why they are strongly associated with photoaging; they also pass through window glass and are present throughout the day and the year. UVB rays are shorter, act mainly on the epidermis, and are the primary cause of sunburn. Both contribute to skin cancer risk, so daily broad-spectrum protection is recommended regardless of the season.

When a sunscreen label says the product is broad spectrum, it means the product:

• a.carries an SPF high enough to allow unlimited time in direct sunlight
• b.protects against both UVA and UVB radiation rather than UVB alone✓
• c.was tested on all six Fitzpatrick skin types before it went on the market
• d.blocks every ultraviolet ray, so it never has to be reapplied during the day

Broad spectrum means the sunscreen has been shown to protect against UVA as well as UVB. The SPF number by itself describes protection against the burning rays, mostly UVB, which is why a high SPF alone does not guarantee UVA coverage. No sunscreen blocks all ultraviolet light or lasts indefinitely; reapplication is needed after swimming, sweating, or a period of sun exposure. Broad spectrum is a performance claim, not a statement about which skin types were studied.

A client's intake form shows that she is currently taking isotretinoin, a prescription acne medication. The professional should:

• a.proceed with a strong chemical exfoliation in order to speed up her results
• b.perform vigorous extractions, because the medication softens the plugs first
• c.wax the brows first, since the medication has no effect on hair removal
• d.postpone exfoliating and waxing services and refer her to her physician✓

Isotretinoin and similar medications thin and fragilize the skin, and waxing or aggressive exfoliation can lift skin and cause tearing, irritation, and scarring. The correct response is to document what the client reported, postpone those services, and refer the client to the prescribing physician for guidance on when services may resume. Recent chemical peels, active infection, open lesions, and sunburn are contraindications for the same reason. The consultation and intake form exist precisely to catch this before a service begins.

Which sequence reflects the standard order of a basic facial?

• a.Cleanse, analyze the skin, exfoliate, extract, apply a mask, tone, moisturize✓
• b.Exfoliate, cleanse, moisturize, analyze the skin, extract, tone, apply a mask
• c.Apply a mask, extract, cleanse, tone, analyze the skin, exfoliate, moisturize
• d.Moisturize, tone, cleanse, apply a mask, exfoliate, analyze the skin, extract

A basic facial begins with cleansing so the surface is clear, followed by analysis under magnification to determine skin type and conditions and to confirm there are no contraindications. Exfoliation loosens dead cells and softens follicle plugs so that any extraction is easier, and massage and a treatment mask follow. Toner removes residue and rebalances the surface, and a moisturizer, with sun protection for daytime, finishes the service.

The main purpose of applying a toner after cleansing is to:

• a.dissolve the plugs inside the follicles so that extraction becomes unnecessary
• b.remove any remaining residue and help restore the skin's normal surface pH✓
• c.seal moisture into the skin in place of a moisturizer or a sunscreen
• d.lift dead cells off the surface in the way a mechanical exfoliant does

A toner (also called freshener or astringent, depending on strength) is applied after cleansing to remove any leftover cleanser and residue and to help return the surface of the skin to its normal, slightly acidic pH. Toners do not dissolve follicle plugs, replace a moisturizer or sunscreen, or exfoliate the way a scrub or an acid does. Stronger astringents are chosen for oilier skin and gentler fresheners for dry or sensitive skin.

A client with oily, congested skin is receiving a facial. Which mask is generally most appropriate?

• a.A cream mask, which is rich in emollients and helps soften very dry skin
• b.A gel mask, which is soothing and hydrating for sensitive or dehydrated skin
• c.A clay mask, which draws out oil and has a tightening, absorbing effect✓
• d.A heavy occlusive oil mask, applied to trap as much moisture as possible

Clay-based masks absorb excess sebum and surface debris and have a tightening effect as they dry, which suits oily and congested skin. Cream masks are emollient and are chosen for dry or mature skin, while gel masks are light, hydrating, and soothing, making them a good fit for sensitive or dehydrated skin. Heavy occlusive products would trap oil against skin that is already congested.

How does chemical exfoliation differ from mechanical exfoliation?

• a.Chemical exfoliation uses agents such as AHAs or BHAs to loosen the cell bonds✓
• b.Chemical exfoliation scrubs with granules, while acids only add water to skin
• c.Chemical exfoliation is done with a brush machine and a gritty cleansing cream
• d.Chemical exfoliation removes the entire epidermis, unlike mechanical methods

Mechanical exfoliation removes dead surface cells physically, by scrubs, brushing machines, or microdermabrasion. Chemical exfoliation uses ingredients, most commonly enzymes and hydroxy acids, that loosen the bonds holding dead cells together so they release. Alpha hydroxy acids such as glycolic and lactic acid are water soluble and work mainly at the surface, while the beta hydroxy acid salicylic acid is oil soluble and can work inside an oily follicle. Neither method should ever remove the whole epidermis, and stronger peels belong to the medical setting.

During a leg waxing service, after spreading wax on the client with a spatula, the professional should:

• a.return that same spatula to the wax pot to pick up wax for the next area
• b.wipe the spatula clean on a fresh towel and then dip it into the pot again
• c.test the temperature of the wax by applying it directly to the client's face
• d.use a new applicator every time more wax is taken out of the pot✓

Double-dipping, returning a used applicator to the container, carries skin cells and bacteria into the product and contaminates the whole pot for every client afterward, so a fresh applicator is used for each pass. Wiping a spatula does not decontaminate it. Wax temperature is tested on the professional's own inner wrist or forearm, and a small test patch is applied to the client's skin, never on the face as a temperature check. Waxing is a form of epilation, removing hair from the follicle, while shaving and depilatories are depilation, removing hair only at the surface.