Mde

MdE = acronym for "reduction in earning capacity".

Restriction of work opportunities on the general labour market, taking into account the entire knowledge and physical and mental abilities of the person concerned throughout his or her working life. In the case of skin diseases, the MdE usually lies in a range between 0-30%. The two MdE tables of the Bamberg information sheet provide assistance in estimating the amount of MdE to be applied for occupational diseases according to No. 5101 and No. 5102 of the Annex to the Ordinance on Occupational Diseases.

Occupational disease No. 5101 is defined as "serious or recurrent recurrent skin diseases which have forced to refrain from all activities which were or could be the cause of the development, aggravation or resurgence of the disease".

Occupational disease No 5102 is defined as ³skin cancer or skin changes prone to carcinogenesis caused by soot, crude paraffin wax, tar, anthracene, pitch or similar substances³.

Occupational disease No 5103 is defined as "squamous cell carcinoma or multiple actinic keratoses of the skin caused by natural UV radiation".

1. Geier J et al. (2010) Impact of occupational sensitization to p-tert-butylphenol-formaldehyde resin (PTBP-F-R) in BK 5101. Dermatol Occupational Environment 58:190-192.
2. Becker D et al. (2010) Evaluation of the effect of occupational sensitization by ammonium persulfate in the context of the determination of a reduction in gainful activity according to No. 5101 of Annex 1 to the Occupational Diseases Ordinance (BeKV). Dermatol Occupational Environment 58:185-189
3. Diepgen TL et al. (2009) Bamberger Merkblatt: Assessment recommendations for the assessment of skin and skin cancer diseases. Part II: skin cancer diseases. Dermatol Occupational Environment 57: 3-17
4. Diepgen TL et al. (2008) Bamberger Merkblatt: appraisal recommendations for the appraisal of skin and skin cancer diseases. Part I: Skin diseases. Dermatol Occupational Environment 56:132-150
5. Diepgen TL et al. (2005) Evidence-based assessment of the impact of type IV allergies in reducing earning capacity - appraisal of occupational skin diseases. Dermatologist 56: 207-223
6. Diepgen TL et al. (2002) Assessment of the effect of allergies in the reduction of earning capacity in the context of BK 5101. Part I: Acrylates/methacrylates, epoxy resin systems, formaldehyde, dichromate, rosin, latex, nickel, p-phenylenediamine. Dermatol Occupational Environment 50: 139-154
7. Elsner P (2015) Expert MDE assessment in BK 5103 ("squamous cell carcinomas" or multiple actinic keratoses of the skin caused by natural UV radiation"): Multiple actinic keratoses. Dermatology in Occupation and Environment 63: 13-15

Bamberg leaflet

• Slight skin symptoms:

  • Pathological skin changes that occur up to three times a year and heal quickly with adequate dermatological therapy and the patient's cooperation and/or

  • low lichenified or low atrophic skin as a consequence of prolonged occupational eczema or after corticosteroid treatment, and/or

  • documented pathological skin changes after intensive (irritative, toxic etc.) skin exposure.

• Moderate skin symptoms:

  • Pathological skin changes that occur more than three times a year and persist for several weeks despite adequate dermatological therapy and patient involvement and/or lichenified or thin, slightly vulnerable skin as a consequence of a prolonged occupational eczema or after corticosteroid treatment and/or

  • documented pathological skin changes after moderate (irritative, toxic etc.) skin exposure.

• Severe skin symptoms:

  • Extensive permanent or chronically recurrent skin lesions of considerable disease value with e.g. deep rhagades, pronounced lichenification and infiltration and

  • documented pathological skin changes even after slight skin exposure.

• Minor effect of an allergy:

  • Single occupational substance, not very common in the general labour market.

• Moderate effect of an allergy:

  • Single occupational substance, widespread, or several occupational substances, little widespread in the general labour market or individual occupational substance little widespread, with clinically particularly intensive sensitization.

• Serious effect of an allergy:

  • Several occupational substances, widespread, single occupational substance, very widespread in the general labour market, also taking into account possible cross-allergies and/or where sensitization is clinically particularly intense.

Allergen and effect on MDE

• No/low disease activity:

  • No new formation of a basal cell carcinoma within the last 2 years and no new formation of a squamous cell carcinoma within the last 4 years; possible presence of slight, non malignant skin changes, such as single actinic keratoses or low expression of a chronic light-damaged skin.

• Moderate disease activity:

  • New formation of several actinic keratoses or pronounced chronic light-damaged skin.

• High degree of disease activity:

  • in case of first diagnosis of basal cell carcinoma or squamous cell carcinoma for the first 2 years after diagnosis

  • Development of malignant skin tumours at short intervals (< 2 years) or development of numerous actinic keratoses or comparable changes (e.g. Bowen's disease).