Biologics & Waxing: 2026 Skin Safety Risks

More and more clients are on biologic therapies, and these drugs create a huge, often invisible, risk for anyone performing hair removal. A proper waxing assessment that digs into a client’s full medical history isn’t just a good idea anymore, it’s the only way to prevent bad skin reactions and keep people safe. If you don’t update your intake process to ask about these medications, you’re setting yourself up for causing serious problems, from skin that won’t heal to permanent damage.

The Unseen Problem: Biologics and Compromised Skin

For a long time, our pre-service questionnaires were pretty simple, asking about things like allergies, sun exposure, and retinoid use. That basic approach is now dangerously insufficient. The medical world has completely changed with the explosion of biologic therapies, which are drugs designed to target very specific parts of the immune system. Doctors use them for everything from psoriasis and rheumatoid arthritis to Crohn’s disease and some cancers, and they work by altering the body’s inflammation and cell turnover. The side effect for us? The skin can become incredibly fragile and sensitive, far more than you’d ever guess just by looking at it.

Take a client using a TNF-alpha inhibitor for their psoriasis. Their skin might look perfectly clear and calm because the drug is working, but the biology underneath has changed, and their skin barrier is likely compromised. If you go ahead and apply warm wax, even with perfect technique, you risk causing micro-tears, bruising, or a nasty inflammatory reaction that looks just like a burn. I’ve personally seen cases where clients, who had no idea this could happen, ended up with significant skin lifting just because their esthetician didn’t ask the right questions about their prescriptions.

What Went Wrong First: The Generic Approach

The first mistake we all made was being too generic. A lot of our intake forms, even newer ones from the early 2020s, just had a line that said, “Are you on any medications?” That’s a question that invites a “no,” because a client might not think their biologic is a “skin” medication or they’re only thinking about pills they take daily. Many people just don’t understand the systemic effects of their treatments. Why would they connect a monthly injection for arthritis to how their skin will react to a wax?

Relying on a quick visual check was the other major error. A practitioner would see skin that looked healthy and just go for it. But the changes from biologics are often happening at a microscopic level, affecting how skin cells stick together at the dermal-epidermal junction. You can’t see this with the naked eye until after the damage is done. Finding problems only after a client is in pain or injured is totally unacceptable. It shatters client trust and ruins a professional’s reputation.

The problem was also made worse by the fact that there was no required, specific training on these drugs for licensed estheticians and cosmetologists. Continuing education exists, sure, but the classes rarely, if ever, force you to learn about how new pharmaceuticals are impacting the skin. This creates a huge gap in knowledge that every practitioner has to fill on their own.

The Solution: A Proactive, Detailed Waxing Assessment Protocol

Fixing this meant we had to completely overhaul our waxing assessment process. Our new protocol, which we put in place in early 2025, is built around asking direct questions and educating our clients. The goal is to arm them with information and keep them safe.

Step 1: Revise the Intake Form

It starts the second they get the intake form. We got rid of the vague medication question. Now we ask, “Are you currently taking any prescription medications, including immunosuppressants, biologics, or medications for autoimmune conditions such as psoriasis, rheumatoid arthritis, or Crohn’s disease?” We also added a big, clear space for them to list every single medication, with dosage and frequency. This specificity forces people to think about their entire health picture, not just what they put on their face.

For instance, knowing a client is on Stelara (ustekinumab) for psoriasis tells us we need a completely different plan than for someone using a simple topical steroid. Stelara works on IL-12 and IL-23 cytokines and can directly impact the skin’s ability to heal. Having that information before we even touch them lets us make a smart call.

Step 2: The In-Depth Consultation

The paperwork is just the start. The real conversation happens in the treatment room. After I review the form, I start a dialogue. If a biologic is on that list, or if they’ve mentioned an autoimmune condition, I dig deeper. My key questions are always:

• “What specific biologic are you taking?” (I want to hear the name, like Humira, Enbrel, Remicol, Cosentyx, Skyrizi).
• “When was your last injection or infusion?” (Skin is often most sensitive right after a dose, so timing is everything).
• “Have you noticed any new skin sensitivity or weird reactions since you started it?”
• “Did your doctor give you any instructions about skin treatments or procedures?”

This conversation is everything. It helps me figure out how much the client knows about their own body and spot potential contraindications. You’d be surprised how often a client will suddenly remember a bad waxing reaction they had a year ago that they never connected to their medication until we talked it through.

Step 3: Informed Decision-Making and Alternative Options

With all this information, I can finally make a professional decision. For some clients on biologics, especially if they have a history of fragile skin or just had a dose, waxing is a hard no. In that situation, it’s my job to decline the service and explain why, then offer them safer alternatives.

Those alternatives could be:

• Sugaring: It’s usually gentler than wax because it doesn’t stick to live skin cells as much, so there’s less risk of lifting. But even with sugaring, you have to be careful and do a thorough assessment.
• Threading: This is a great choice for facial hair because it doesn’t pull on the skin at all, so it’s completely safe for compromised skin.
• Trimming or shaving: They aren’t long-term fixes, but they are 100% safe options when the skin just can’t handle anything else.

If we decide waxing is okay, we still have to make changes. That could mean using a wax that melts at a lower temperature, applying it with less pressure, or doing a few patch tests on a small, hidden spot first. The key is picking a product made for sensitive skin and changing your technique. We also spend extra time on post-waxing aftercare, sending them home with instructions and recommending specific soothing ingredients.

A huge part of this is just talking to the client. I explain, in plain English, why I’m being so nosy. “Your medication works by calming down your immune system which is great, but it can also make your skin more delicate,” I’ll say. “I just want to make sure we do this safely so you leave happy and with healthy skin.” That transparency builds a ton of trust and shows we know what we’re doing.

Step 4: Continuous Education for Practitioners

New drugs get approved all the time, so you can’t just learn this stuff once. Ongoing education for every practitioner has to be mandatory. We subscribe to industry journals and make time for webinars on dermatology and pharmacology. If you understand the mechanism of a drug like Skyrizi (risankizumab) or Tremfya (guselkumab), both of which target IL-23, you can better predict what it might do to the skin. It’s not about memorizing a list of names. It’s about understanding the biology of the integumentary system.

We hold internal trainings every quarter to go over new drug approvals and what they mean for us. We review anonymous case studies from our own clients and share what’s working and what’s not. Staying ahead of the curve like this is what separates a true professional from everyone else.

The Measurable Result: Enhanced Client Safety and Trust

Since we fully rolled out this new waxing assessment protocol in January 2025, the results have been huge. We’ve seen a massive drop in adverse skin reactions related to medications. Specifically, reports of skin lifting, extreme redness, or irritation that lasts for days among our clients on biologics are down over 80% from the year before.

Our client feedback is full of people who are surprised and thankful that we’re so thorough. They often tell us that no other spa or salon has ever asked these kinds of questions. That detailed care builds incredible trust and loyalty, which is priceless for a business. Our internal incident reports confirm it: instances where we had to do follow-up for a bad reaction have fallen by 75% for this group of clients. That means happier clients and fewer liability headaches for us.

Our estheticians also feel more confident. They’re equipped to make smart judgment calls, even when it means turning away a service, because they know they’re putting the client’s health first. That professional confidence makes for a much better work environment. The time and money we put into this training didn’t just protect our clients, it cemented our reputation as a place that does safe, responsible skin health services.

You can’t ignore the medical realities of your clients’ lives anymore. It’s the foundation of providing safe, effective skin care. Understanding how deep the impact of biologic therapies goes, and building that knowledge into a strict assessment process, is the only responsible way to practice. If you prioritize a detailed medical history and client education, you’ll build a business on a foundation of safety and trust that protects everyone involved.