Rehabilitation, dermatological

• Benefits for dermatological REHA can be granted according to § 9 SGB VI if the earning capacity of the insured person is considerably endangered or reduced due to a dermatological disease and a reduction of the earning capacity ( MdE) of the insured person can be averted by the benefits in the case of considerable endangerment of the earning capacity or in the case of reduced earning capacity this can be considerably improved or restored by the benefits or their considerable deterioration can be averted (§ 10 para. 1 SGB VI; so-called personal requirements).
• Dermatological REHA continues to be indicated in accordance with the applicable rehabilitation guidelines and the "Guidelines on the need for rehabilitation for skin diseases" if there is a need for rehabilitation. This exists if the impending or already manifest impairment of participation due to health reasons, a comprehensive curative treatment by the dermatology/venereology physician required for the individual rehabilitant is not sufficient, the extension of a skin disease over a larger body surface and/or localisation in the visible body area is present, a severe form of skin disease is present in a temporal connection after hospital treatment, for which there is a special need for rehabilitation, an optimal therapeutic effect can only be achieved through the holistic, interdisciplinary concept of REHA, and a positive rehabilitation prognosis exists (e.g.long-term recurrence-free interval).
• In particular, the severity of the clinical manifestations, recurrence frequency of the chronic skin disease despite adequate therapy (e.g. multiple exacerbations requiring in-patient treatment) and the presence of risk factors must be taken into account. Services for dermatological REHA will not be provided by the REHA funding agency before four years have elapsed since the performance of such or similar services for REHA. This does not apply, however, if premature services are urgently required for health reasons (§ 12 para. 2 SGB VI). The indication for rehabilitation is given, for example, for the following dermatological/allergological diseases:
  • Allergic rhinoconjunctivitis
  • Allergic bronchial asthma
  • Follow-up treatment (AHB) for malignant skin tumours (e.g. malignant melanoma, spinocellular carcinoma, basal cell carcinoma, etc.) and malignant systemic diseases of the skin (e.g. T-cell lymphomas, mycosis fungoides, etc.)
  • Autoimmunological blistering diseases (e.g. pemphigus vulgaris, pemphigoid, bullous)
  • chronically itching dermatoses (e.g. diseases of the prurigo group)
  • Chronic diseases of the lymphatic system ( lymphedema)
  • Chronic contact eczema
  • Chronic urticaria
  • chronic wounds
  • Dematoses that are characterised by particular resistance to therapy and have been treated unsuccessfully for a long time
  • Dermatological manifestations in chronic venous insufficiency (CVI), arterial occlusive disease (AVK)
  • Erythroderma
  • genetically caused extensive skin diseases ( e.g. epidermolysis bullosa group, ichthyosis).
  • extensive scars, e.g. as a result of burns or operations
  • psoriasis vulgaris
  • Tuberculosis cutis
  • Collagenoses
  • Steroid withdrawal
  • lichen planus
  • lichen simplex chronicus
  • Cutaneous T-/B-cell lymphomas
  • Parapsoriasis
  • Prevention of allergies.

• Due to the complexity of the problem of the "chronically skin diseased" a very differentiated and individualized REHA concept is required. The dermatological rehabilitation carried out on an outpatient basis as well as the inpatient form is based on a holistic rehabilitation concept including the socio-medical assessment and includes a comprehensive, rehabilitation-specific, interdisciplinary therapy offer. This consists of physical, individually tailored physical measures such as ointment therapy, UV radiation, therapeutic baths, etc., disease-centred drug therapy, psychological, ecotrophological, social and educational components.
• The decision as to whether a rehabilitated person should be given inpatient or outpatient dermatological REHA depends on:
• extent of the damage
• Impairment of activities
• (imminent) impairment of participation
• Extent of the medical risk
• social environment and the justified wishes of the person undergoing rehabilitation (consideration of personal/family and religious/ideological needs and circumstances) as well as the existence of an outpatient or inpatient facility that meets the quality criteria.
• Indication/medical conditions/activities: the above-mentioned injuries and their effects may lead to impairment of activities:
• in the behaviour during personal and social activities (e.g. acceptance of the disease, self-image, problems of stigmatisation, skills in dealing with the disease, compensation strategies, self-endangerment, role in the family, motivation and drive at work)
• self-sufficiency (e.g. household, cleaning, shopping, nutrition, personal hygiene, clothing) locomotion, mobility and dexterity (e.g. manual skills, walking for long periods, climbing stairs, walking fast, use of public transport, travelling)
• situation-related (e.g. physical resilience at work, in leisure time and in everyday life with regard to weight, endurance, certain body positions such as standing for long periods, humid environment, extreme cold/heat, sunlight, environmental noxae)
• Participation: As a result of the above-mentioned damages and impairments of activities, impairments of participation can occur in the following different areas:
• physical independence (e.g. need for aids
• Adaptation of the environment
• Need for help from other people
• personal assistance or care
• Dependence on external aid
• limited independence or self-sufficiency in everyday life
• Mobility (e.g. restrictions on movement in the personal environment, in the neighbourhood, in the community, at a distance, when travelling)
• Employment in the occupational sector with regard to the route to and from work, workplace conditions (e.g. occupational exposure to skin allergens and noxious agents), work organisation, qualifications (education, training and further training)
• free time housekeeping
• mental resilience
• social integration/reintegration (e.g. establishing and maintaining social relations)
• economic independence.
• Context factors: The so-called context factors represent the entire life background of a person. They include all environmental and personal factors that are relevant to a person's health. The context factors interact with all components of the ICF (body functions and structures, activities and participation). Context factors can have a positive, promoting influence (facilitating factors) on all components of functional health and thus on the rehabilitation process. It is therefore important to identify them as early as possible and to use their rehabilitation-promoting effect (resource concept of rehabilitation).
• Rehabilitation goals: The goals of medical rehabilitation are to avert, eliminate, reduce, prevent aggravation or mitigate the threatening or already manifest impairments of participation in working life and in life in society by early initiation of the necessary rehabilitation measures. The aim of rehabilitation is to (re)enable the rehabilitee to pursue a gainful occupation and/or certain activities of daily life as far as possible in the way and to the extent that these are considered "normal" (typical for the individual's personal life context).
• Objectives in this sense for working life are e.g. restoring and maintaining the ability to work Planning of job adaptation Maintenance of the job Planning and initiation of measures for (further) participation in working life.
• Objectives for the activities of daily life: e.g. shaping the home environment, adaptation of living space, help in finding coping strategies, guidance on health-conscious nutrition and motivation to change lifestyle, including reduction of negative contextual factors, initiation of adaptation to sports and leisure activities.
• Rehabilitation goals related to bodily functions and body structures: The goals are to avert, eliminate, reduce, prevent aggravation or mitigate the consequences of damage to the entire skin organ, taking into account the diagnoses, particularly with regard to clinical appearance, itching, infections, movement restrictions and contractures. The focus is on the long-term improvement or stabilisation of the skin condition and, if necessary, other manifestations.
• Rehabilitation goals related to activities: Goals are the avoidance, elimination, reduction, prevention of aggravation or mitigation of the consequences of an increase in the impairment of activities, especially in behavior (e.g. in the family, at work, in leisure time, in motivation and in crises) in self-care (e.g.e.g. reduction of anxiety and depression, management of chronic pain, itching and stress, promotion of compliance, optimisation of coping (Coping).
• Rehabilitation goals related to participation: The goals are to prevent, eliminate, reduce, prevent the increase in or mitigate the consequences of impending or already manifest impairments to participation, particularly in physical independence (in terms of self-sufficiency), mobility (moving around the neighbourhood), employment (training, work, housekeeping, leisure time), mental stability, social integration and economic independence (in terms of earning a living). Rehabilitation goals related to contextual factors The nature and extent of functional problems can be increased or decreased by contextual factors (environmental and personal factors), so that these must be taken into account when determining rehabilitation goals. This may require, among other things, workplace inspections, visits to the home and discussions with the employer or reference persons with the aim of adapting the environmental conditions to remaining impairments of the rehabilitee's activities (adaptation).

Applications for initiation of rehabilitation benefits are made by completing Form 60 (available from health insurance companies).

Further information on dermatological rehabilitation can be obtained from the website of the"Arbeitsgemeinschaft Rehabilitation in der Dermatologie".

1. Elsner J, Weyergraf A (2007) Indication and application for dermatological rehabilitation. JDDG 5 (Suppl2) 52
2. Framework recommendations for outpatient dermatological rehabilitation, of 22 January 2004, Federal Working Group for Rehabilitation II, special part.