A returning client books a peel. Her file says Fitzpatrick III, no medications, no known allergies, and it was completed in March 2024.
Since then she has finished a course of doxycycline, started tretinoin ordered from an online pharmacy, been on a GLP-1 for seven months, and had one laser session at a clinic near her office that left a patch of pigment she has stopped mentioning. None of that is in the file. Nobody asked again, and the form was never built to be asked again.
We’ve written about the intake form as a document and about the consultation as a conversation. This one is about the part that sits between them and quietly rots: the skin history itself. What belongs in it, which fields are least trustworthy, and how to keep it current without making a client re-type her life story every time she comes in for a facial.
The only part of the file that keeps moving
Contact details change occasionally. Date of birth never does. Skin history changes constantly, and it changes in exactly the ways that matter to what you’re about to do.
Which is why treating it as an intake field doesn’t work. Intake happens once, at the start, when you know less about this person than you ever will again and they’re filling out a form in your waiting room holding a coffee. Everything clinically useful about their skin accumulates after that: what you did, how it responded, what they started using at home, what their dermatologist put them on, what happened at the place they tried in June.
So a skin history has two halves, and most forms only have the first. There’s the baseline you take at the start, and there’s the running record you build afterwards. If the second half doesn’t exist, the first half is a snapshot of a stranger from two years ago, and you’re making treatment decisions against it.
Your Fitzpatrick box is probably wrong
Almost every skin consultation form in the country has a Fitzpatrick box, and it’s usually self-reported. That’s a problem, and there’s good evidence for how big a problem.
Researchers at Northwestern ran 270 participants stratified across all six phototypes and four self-identified ethnic groups, asked them the standard burning and tanning questions, and compared the results to a dermatologist’s assessment and to spectrophotometry. Forty-two percent of responses couldn’t be classified into a Fitzpatrick type at all using the standard definitions. Answers about burning tracked the dermatologist’s assessment reasonably well. Answers about tanning had essentially no correlation with it, a Spearman coefficient of 0.089. And self-report failed to distinguish type IV from type V, which is precisely the boundary where your settings should change.
The tanning question is the culprit. “Do you tan easily?” is a question built around a phenotype it assumes you have, and a client with type V skin has no useful way to answer it. Ask her instead whether her skin gets darker after irritation, whether a scratch leaves a mark that lingers for months, whether a spot from a breakdown last year is still visible. All three get at pigment response to injury, which is what you wanted the number for, and anyone can answer them.
Keep the Fitzpatrick field. It’s the input for most published protocols and it’s what our chemical peel calculator and laser hair removal calculator key off. Just record who assigned it and when. A number the client picked from a diagram on her phone and a number you assigned after looking at her in daylight are different pieces of evidence, and your form should be able to tell them apart later.
That matters because post-inflammatory hyperpigmentation gets under-anticipated in exactly the types self-report misclassifies. It shows up in somewhere between 1 and 32 percent of patients treated with fractional ablative lasers depending on device, settings and skin type, and in more than 37 percent of dark-skinned patients after fully ablative CO2. Get the type wrong on the low side and you’ve picked settings for someone who isn’t in the chair. Our piece on sequencing microneedling, peels and retinoids covers where the type changes the protocol rather than just the consent conversation.
The medication section fails in one specific direction
Every form asks about medications. The answers are worse than most practitioners assume, and they’re wrong in a predictable way.
An emergency department study of 502 patients compared what people said they were taking against what the record held. The record was accurate in 21.9 percent of cases. Prescription drugs were over-represented, meaning the file listed things the patient had already stopped. Everything else was missing: 76 percent of non-prescription medications, 73 percent of vitamins, 89 percent of supplements and 67 percent of herbals were absent from the record even though the patient reported using them.
People don’t count what they didn’t get from a pharmacy. St John’s wort isn’t a medication in most clients’ minds, and it’s on the highest-risk list for laser and IPL work alongside the tetracyclines. Neither is the doxycycline from a two-week course that ended a fortnight ago, because it’s finished. Neither is the hydrochlorothiazide, because it’s for blood pressure and this is a facial.
Two things fix most of this and neither costs anything. Split the question instead of asking one open one: prescription medications, over-the-counter medications, vitamins and supplements, herbal products, topical prescriptions, and topical actives you buy yourself. Six narrow prompts get more back than one wide one, and the wide one is what most templates use.
Then ask the completion question, which almost no form has: anything you finished in the last six months. A course of isotretinoin that ended in February is invisible to a form written in the present tense, and it’s the single answer most likely to change what you do. We covered the current thinking on isotretinoin timing in the intake form guide; the point here is narrower, which is that “are you taking” and “have you taken” are different questions and your form probably only asks one.
Add a line for topicals sourced outside a Canadian pharmacy while you’re in there. Prescription-strength tretinoin bought online is common enough now that “are you using any prescription creams” reliably returns a no from people who are using one.
Hormones are a skin history question
Pregnancy status is on every form because of contraindications. The rest of the hormonal picture usually isn’t, and it explains a good share of what walks through the door with a pigment complaint.
Melasma commonly starts or worsens with pregnancy, oral contraceptives or hormone replacement, and it disproportionately affects Fitzpatrick types III to V. A client with facial pigment who started a combined pill four months ago is a different case from one with the same distribution and twenty years of sun behind it, and both the plan and what you promise her should change accordingly. If the form never asked about contraception, you work that out in month three, when the pigment comes back.
GLP-1 agonists are the newer one, and they’ve become common enough to deserve their own line instead of hiding in the general medication field. Rapid weight loss changes the face faster than skin remodels, and the demand has already moved. In a December 2025 survey, 67 percent of aesthetic clinicians reported more patients seeking treatment for changes tied to rapid weight loss, up 45 percent on the year before. You’re not going to treat volume loss with a facial. The reason it belongs on the form is that a client on month seven of semaglutide who books a series because her skin “looks tired” is describing something a facial won’t fix, and you want to know that before you sell her a course of six.
Reaction history is the field almost nobody keeps
Ask most estheticians what happened the last time a client reacted to something and they’ll remember it. Ask them to find it in the file six months later and they’ll scroll.
If you change one field this year, change this one. It’s usually missing, because a reaction is vivid at the time and vivid things don’t feel like they need writing down. They do, because you won’t always be the one reading the file. The moment you hire or cover a shift, everything living in your head stops being part of the record.
A reaction entry needs five things: the date, the product or modality, what the skin did, how long it took to settle, and what you did about it. “Client reacted to the enzyme” is not a record. “Sept 12, papaya enzyme 10 min, erythema past 48h with two small vesicles at the jaw, settled day 5 with hydrocortisone, avoid enzymes, tolerate lactic 20%” is a record, and the next person to open that file won’t repeat it.
It happens more than it feels like it does. The North American Contact Dermatitis Group patch tested 10,061 patients over seven years and found 23.8 percent of women and 17.8 percent of men reacted to a cosmetic product, with fragrances and preservatives the two most clinically relevant categories. Those are patch-test patients, so the rate in a general clientele is lower, but the ingredients responsible are the ones in your back bar.
Patch test results deserve a field of their own for the same reason, with a date and an outcome, rather than a line buried in a paragraph. A patch test is worthless if nobody can find the result, and the result has a shelf life, since a negative from 2023 says nothing about a product you reformulated last spring.
What happened somewhere else is still your problem
Clients move around. They get injectables at one place, laser at another, facials with you, and each of those files contains a third of the picture.
The skin history needs a treatments-elsewhere section, and it has to be specific enough to be worth having: what was done, roughly when, what device or product if they know it, and what the result was. Most clients won’t know the device. They’ll know “laser for my face at a place downtown in the spring,” which is enough to change your timing and enough to prompt a follow-up question.
Injectables are the entry I’d chase hardest. Filler and neurotoxin change what’s safe at the surface and when, and the timing is what governs it; our notes on injectable documentation cover the detail that belongs in that record. Energy-based work comes next, partly because it’s the likeliest source of an insult the skin hasn’t finished recovering from, and partly because nobody volunteers it. A client who doesn’t think a laser session counts as something you’d care about won’t mention it.
Photos are the last piece. If you take before-and-afters, the images are the only part of the skin history that doesn’t depend on somebody’s recall, and they’re the part with the most consent complexity attached. Clinical documentation and marketing use are separate permissions and belong in separate fields, which we’ve worked through in consent forms and before/after photos.
Put the facts in fields and the story in the note
Everything above is about what you ask. This part is about where the answer ends up.
Roughly 80 percent of what sits in a health record is unstructured text. For narrative that’s correct, because a paragraph carries nuance a dropdown never will. For skin history it’s a trap, because the questions you ask a skin history are queries. Which clients are on a photosensitiser before I run a laser day. Who has a documented reaction to fragrance. Who’s due for a patch test. Which of my type IV and V clients had pigment after a peel last year.
You can’t ask a paragraph those questions. You can ask a field.
This is the same failure we described in charting assessment scores, where a clinician does the assessment properly and then loses the item-level detail into a sentence. The fix is the same one: the structured version of the fact lives in a field, and the paragraph carries the story around it. Fitzpatrick as a value with a source and a date, photosensitisers as a flag, reactions and patch tests as dated entries with results. Then write the note like a person, because the note is still where the actual thinking goes.
One test. Can you produce a list of every client with a documented pigment reaction in under a minute? If the answer is that you’d have to open files one at a time, the information exists but the record doesn’t.
Updating it without re-taking it
Skin histories go stale because updating one costs about what creating it did, so nobody does it between the first visit and the incident.
Make the update cheap and it happens. Send the existing answers back to the client before the appointment and ask what’s changed, rather than sending a blank form. Two minutes on a phone in a parking lot beats twelve on a clipboard, and you’ll get far more of them back.
Then set triggers rather than relying on an interval alone. A fixed six-to-twelve month review is a reasonable floor. On top of it, re-ask whenever a client books a service category she hasn’t had before, whenever more than nine months has passed, and whenever anything happened last time that you wrote down as a reaction. A client cleared for facials in January is not cleared for her first peel in September on the strength of that same form.
Keep the old answers. This is the one that gets missed most often, because the obvious way to build an update is to overwrite the previous response. Don’t. If a client says no to a medication question in March and yes in September, both answers matter, and what you need on file is the pair with dates, not the current state. Overwrite it and the record can no longer show what you knew when you made the call, which is the thing it exists to show.
How long you’re keeping this
Two separate clocks, and most studios only know about one.
Public health has a floor. In Ontario, O. Reg. 136/18 requires the operator to collect the client’s name and contact information before providing a personal service, with the exception of straight hairdressing and barbering, and records kept on site for a year and then somewhere secure for a further two. That’s three years, and it’s about outbreak traceability rather than clinical care. Other provinces run their own personal service settings rules through their health units.
The liability clock is much longer. Ontario’s Limitations Act runs two years from when a claim is discovered, not from when the treatment happened, under a fifteen-year ultimate limitation period. Discoverability is the part that matters: a pigment change a client attributes to something else for three years starts her clock when she connects it, not when you treated her. Regulated health professionals in Canada generally work to ten years from the last entry, sixteen in British Columbia, and for minors ten years from the age of majority. Estheticians aren’t held to a college’s retention standard, but the exposure is shaped the same way, and three years is not a defensible amount of history to be holding.
Set against that, PIPEDA is built on data minimisation and expects you to have a retention schedule rather than keeping everything forever by default. That’s not really a conflict. Write a retention period down, apply it the same way every time, and set it against the limitation window rather than the inspection one.
It’s worth knowing what the litigation record in this category looks like. Jalian and Avram’s work on cutaneous laser surgery found that cases involving non-physician operators rose from 36 percent of the total in 2008 to 78 percent in 2012, and that 77 percent of those cases arose outside traditional medical settings, in salons and med spas. Burns, scars and pigmentation problems were the three most-alleged injuries. In the 2012 to 2020 update the pattern held. Set aside the merits of any individual claim. What defends every one of them is a record of what was asked and what was decided, and that record is the skin history.
The short version
- Treat skin history as a running record with a baseline, not a field you fill once at intake.
- Keep the Fitzpatrick box but record who assigned the type and when. Self-report couldn’t be classified at all for 42 percent of people, and the tanning question carries almost no signal.
- Ask about pigment response to injury instead of tanning. It’s the thing you actually want to know and every client can answer it.
- Split the medication question six ways. Supplements and herbals are missing from records far more often than prescriptions, and they include real photosensitisers.
- Ask what they finished in the last six months, not just what they’re taking now.
- Give contraception, HRT and GLP-1 use their own lines. All three change the skin and none reliably surface from a general medication prompt.
- Write reactions down with a date, the product, the response, the settling time and what you did. It’s the field you’ll want when somebody else is reading the file.
- Capture treatments done elsewhere, especially injectables and anything energy-based, with rough timing.
- Put the facts in fields and the story in the note. If you can’t list every client with a documented pigment reaction in a minute, the record isn’t doing its job.
- Update by sending back last time’s answers, keep the old versions with their dates, and re-ask on new service categories rather than only on a calendar.
- Retain against the limitation window, not the three-year public health floor.
The awkward part is that the studios with the weakest skin histories tend to be the ones with the strongest relationships. When you’ve treated somebody forty times you stop asking, because you know her skin, and you do know her skin. You just don’t know what her doctor changed in April.
If you’re rebuilding the paperwork from scratch, start with the intake form guide for the document and the consultation questions for the conversation that fills it. The business layer underneath both, pricing, retention and the rest, is in our guide to running a profitable esthetics business in Canada. And if the honest blocker is that your current system can’t hold any of this, we’ve compared what’s available in the best software for estheticians in Canada.