Occupational dermatosesL25.9

Skin disease which is exclusively or partly due to workplace influences (occupational disease). The assessment of an occupational dermatosis always has to be made individually under consideration of the workplace conditions. An occupational dermatosis has to be distinguished from an occupational skin disease (e.g. occupational disease according to BK 5101) or an accident at work (§ 8 SGB VII).

The predominant number of occupational dermatoses (> 95%) is formed by the eczema group. The following classification is accepted:

• Common diseases (see below occupational skin disease):
  • Atopic hand eczema, congenital, work-related exacerbation
  • Cumulative toxic eczema
  • Allergic contact eczema
  • Psoriasis palmaris et plantaris, congenital, work-related aggravation
  • Physical urticaria.
• Rarer diseases (see Tab. 1 BK list of possible dermatological diseases):
  • Professional acne
  • Dermatomycoses
  • Bacterial diseases (e.g. mycobacterioses)
  • Virus dermatoses ( cowpox, milking knots, ornithoses)
  • Dermatozoonoses
  • Dermatoses caused by ultraviolet, thermal or ionising radiation
  • Dermatoses due to inclusions of foreign materials ( beryllium, aniline, asbestos)
  • Dermatoses due to chronic intoxications ( arsenic, uranium).

• According to § 3 BeKV (Ordinance on Occupational Diseases), a patient with an occupational dermatosis, if its aggravation, recurrence or the concrete danger of the development of an occupational disease of the skin is threatening, the development of an occupational disease must be treated "with all suitable means" at the expense of the statutory accident insurance institution (usually professional association) preventively ( prevention).
• The treatment includes therapeutic as well as skin protection and skin care measures. At the expense of the accident insurance carrier, e.g. skin-friendly cleansing preparations (syndets), bath oils, skin-caring external preparations with and without active substances as well as skin protection preparations may be prescribed. Measures at the expense of the accident insurance carrier may only be taken after its approval. This is requested by the treating dermatologist with the dermatologist's report.
• The prescriptions are only made on a prescription form from the health insurance company, stating the name of the accident insurance company and the file number. The prescription fees are waived for the patient ("free of charge" check the box!). As the prescribed preparations are not paid for by the statutory health insurance companies, they are not charged to the drug budget.
• Preventive skin protection measures at the workplace include:
  • Technical and organisational measures at the workplace, e.g. encapsulation of a lathe, replacement of cooling lubricants, chromium-free tanned work shoes, protective gloves and general skin protection measures (cost absorption: employer).
  • Although leather tanning with chromate (IV-valent chromium) is prohibited in Germany, foot eczema with proven chromate sensitisation is still frequently found. Tanning with chrome III-containing chrome alum is permitted. It is disputed whether an oxidation of chromium III ions into chromium IV ions is possible. The allergenicity of chromium III is low, cross-allergenicity to chromate IV is rarely described. The discrepancy can be explained by the fact that, due to the incomprehensible interrelationships in the shoe industry, chromate-tanned shoes are still occasionally coming onto the market. The review of the regulation is only carried out on a random basis. Chromium-free can only be assumed with 100% certainty for those manufacturers who expressly use leather that is free of chromate, i.e. leather that has been tanned using vegetable dyes. In some occupational groups, such as bricklayers or miners, chromate sensitization can be triggered by cement penetrating into the work shoes.
  • Personal protective measures: Individual skin protection preparations, in exceptional cases protective gloves, supporting measures for gentle cleaning and regeneration of the skin, hardening measures (UVA/PUVA). Cost absorption: Statutory accident insurance carrier (according to § 3).
  • Medical treatment, outpatient inpatient therapy, cures. Cost absorption: Statutory accident insurance institution (according to § 3). Only when all means of prevention have been exhausted should a change of job be made.
    As a rule, occupational dermatoses are hand eczema.
  • Cumulative sub-toxic hand eczema, toxic hand eczema: Most frequent form of occupational hand eczema, especially in housewives, hairdressing, machining, cleaning and care staff, butchers, bricklayers, bakers. Only if it is not possible to carry out preventive measures (e.g. wearing protective gloves as a baker) is the abandonment of the workplace unavoidable.
  • Toxic hand eczema: Toxic contact dermatitis heals rapidly after avoiding the noxious agent. If the noxious agent is handled properly, no further skin problems will normally occur. The patient can remain at the workplace.
  • Hand eczema, atopic: The onset of atopic hand eczema is a multifactorial process which does not depend exclusively on the action of the external noxious agent. In humid professions, however, there is often an exogenous triggering of hand eczema by irritant noxae. In case of substantial partial cause or trend-setting aggravation by the occupational activity (congruence of work), the atopical hand eczema also becomes an occupational dermatosis or an occupational disease of the skin.
  • Allergic contact eczema: usually type IV sensitization (see below allergy). Usually heals quickly after allergen elimination. If contact cannot be avoided by specific protective measures (e.g. gloves), a change of job is often unavoidable.
    The special skin protection measures depend on the quality of the noxious agent causing the contact. In the case of contact allergies, the focus is on avoiding (replacing) the allergen. If this is not possible, it may be possible to remain at the workplace with suitable protective gloves (see Table 2). For non-specific noxious agents (cumulative toxicity), protective gloves are the first priority. Skin protection preparations are of secondary importance. Accompanying cleaning and moisturizing of the skin.
  • Gloves: Best protection against external noxious agents. However, rubber gloves contain potent allergens (vulcanisation accelerators, antioxidants, etc.) and therefore also represent a potential danger. Vinyl gloves can be used if rubber ingredients such as latex, mercaptobenzothiazole, thiurams, carbamates etc. are incompatible. Vinyl gloves are generally preferable to rubber gloves (no additives!).
  • Skin protection products
    :Basic principle: The noxious agent should not be soluble in the product to make penetration into the skin more difficult. Skin protection against water soluble substances is therefore achieved by W/O bases, skin protection against water insoluble substances by O/W bases.

Caution!

Protective gloves in different professions

Skin protection with different noxious agents

Skin cleansing and skin care

List with possible dermatological diseases

1. John SM et al (2007) Certificate: "Occupational Dermatology (ABD)". New curriculum 2006 of the CME-seminars of the Task Force of Occupational and Environmental Dermatology. German Dermatol Ges 5: 135-144
2. Schwanitz HJ (2003) Preventive measures. In: Schwanitz HJ, Wehrmann W, Brandenburg S, John SM (Hrsg) Expert Opinion Dermatology Steinkopf Verlag, Darmstadt, pp. 17-31