Usually yes for low-risk treatments — but never for anything that breaks the skin without GP clearance in writing.
Immunosuppressants and biologics are common now: methotrexate, azathioprine and ciclosporin for autoimmune conditions, and injectable biologics like adalimumab, etanercept or ustekinumab for psoriasis, rheumatoid arthritis and Crohn's. Clients often don't volunteer them because they think of them as "just my arthritis injection", not as medication that changes what's safe. Ask the question directly on your consultation form.
What actually changes:
- Infection risk is the headline. A suppressed immune system turns a minor bacterial introduction into a serious one. Microneedling, dermaplaning, medium or deep peels, electrolysis, and anything that draws blood need written GP or specialist consent before you proceed.
- Healing is slower. Waxing, threading and mechanical exfoliation can lift skin that would normally hold. Test a small area and wait a full week before a full treatment.
- Skin fragility on long-term steroids. Many of these clients are also on oral prednisolone. See our note on steroid creams and oral steroids — thin skin tears under wax strips.
- Photosensitivity. Methotrexate and azathioprine can both increase sun and light sensitivity. Treat laser, IPL and LED as needing specialist sign-off, not a standard patch test.
- Live-vaccine timing is not your call. If a client mentions a recent immunisation alongside a biologic, that is a GP conversation, not a reason for you to improvise a waiting period.
Where you're generally fine: manicures and pedicures on intact skin, blow-dries, non-invasive facials with gentle products, gentle Swedish massage. Sterilise as if it mattered more than usual, because it does.
Under the Equality Act 2010 you cannot refuse a client simply because they have an autoimmune condition. You can — and should — decline a specific treatment that is clinically unsafe, offer an alternative, and record why.
Two practical habits: re-patch-test at every visit rather than relying on a result from six months ago, and write the medication name and the date of GP clearance into the client's record. Health data is special category data under UK GDPR Article 9, so store it in your client system with explicit consent, not in a notebook by the till.
Every client, remembered — safely.
SAY-OS keeps each client's contraindications, allergies and history in one place, and flags them at booking — so the right call happens before they're in the chair.
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