Occupational skin disease according to BK 5101 L25.9

Occupational skin disease that meets all the requirements of one of the following numbers;

According to BK No. 5101 of Annex 1 to the Ordinance on Occupational Diseases, the statutory accident insurance institutions (= employers' liability insurance associations) must provide compensation as an occupational disease:

"Severe or repeatedly recurring skin diseases that have forced the person to refrain from all activities that were or may be the cause of the development, aggravation or recurrence of the disease". This includes all diseases of the skin or skin appendages, including the conjunctiva, with the exception of skin cancer (skin cancer is listed under its own BK number/BK no.5103 ).

This means:

1. The causal occupational connection must be sufficiently probable, the mere possibility or reasonable suspicion is not sufficient. A special situation is given for congenital skin diseases (see e.g. under Psoriasis palmaris et plantaris, occupational dermatological aspects)
2. The disease must be severe (clinical picture, course, duration > 6 months) or (!) recurrent (at least three similar episodes).
3. There must have been an objective compulsion to give up the above-mentioned activities.

• Definition of the "severity of a skin disease":
  • Clinical picture and symptoms: vesicle attacks, erosions, excoriations, impetiginization, rhagades, infiltrations, swellings, pruritus, pain, restricted mobility.
  • Extent and localization of infestation: scattering phenomena extending beyond the contact area, extensive or generalized infestation.
  • Course: Resistance to therapy, poor healing tendency, partial hospitalization or inpatient treatment, systemic treatment with glucocorticoids or antibiotics.
  • Duration: Longer-term need for treatment, e.g. longer than six months, with mild skin symptoms.
  • Allergy: The clinical effect of occupational sensitization shows a high tendency to relapse with foreseeable worsening of the disease, avoidance of the triggering allergen is not possible. The allergen must have led to the development of the clinical equivalent of allergic contact dermatitis and must not be avoidable by technical and organizational measures, e.g. replacement, or individual preventive measures (protective gloves, protective clothing).
• Definition of "repeated recurrence":
  • At least three episodes of illness, e.g. initial illness followed by two relapses. Relapse presupposes extensive improvement or healing of the previous episode. The insured person must not be in need of treatment or unable to work between relapses, as otherwise there is no relapse but merely an exacerbation or intermittent course.
• Definition of "objective compulsion to give up the harmful activity":
  • Until 2021, recognition required the objectifiable medical necessity of the task. Termination due to the skin disease was not sufficient as a recognition criterion. At the beginning of 2021, the obligation to cease and desist, which was previously a prerequisite for recognition of BK 5101 (also for other BKs), was abolished. It is to be expected that this will also have consequences for various aspects of social insurance law relating to occupational skin diseases (Elsner P 2021).
• For application in expert practice, a case-related assessment has proven to be effective as follows (according to Wehrmann):
  • Was the harmful noxious agent not sufficiently avoidable?
  • Were reasonable and suitable individual preventive measures exhausted?
  • Did the medical treatment measures fail to bring about any improvement?
  • If these three assessment questions can be answered with "yes", it can generally be assumed that the occupational activity is compulsory.
• The hazard may be caused by:
  • Exposure to chemical substances: e.g. chromates, alkalis, solvents(turpentine, paint thinner), technical greases and oils (drilling oils, see below acne, occupational acne), plastics, dyes.
  • Physical factors: e.g. microtraumas caused by metal or glass particles, glass wool, asbestos, cut hair, actinic and possibly thermal stimuli (heat, cold).
  • Skin pathogenic germs and possibly plant substances.
  • Complicating mucosal reactions (see case report)
  • According to No. 1108, skin cancer changes caused by arsenic or its compounds must be taken into account
  • According to No. 5102 of the same regulation, "skin cancer or skin lesions with a tendency to form cancer caused by soot, crude kerosene, tar, anthracene, pix or similar substances" must also be taken into account.
  • No. 5103: With the amendment of the Occupational Diseases Ordinance, BK 5103 "Squamous cell carcinoma or multiple actinic keratoses of the skin caused by natural UV radiation" was added to the list of occupational diseases on January 1, 2015.
• Other diseases relevant to dermatological assessment are represented by the following numbers:
  • BK No. 2402: Diseases caused by ionizing radiation (e.g. X-ray ulcer).
  • BK No. 3101: Infectious diseases if the insured person worked in the health service, in charity care or in a laboratory or was particularly exposed to a similar degree to the risk of infection through another activity (e.g. varicella, zoster, molluscum contagiosum, syphilis, tuberculosis, HIV infection).
  • BK No. 3102: Diseases transmissible from animals to humans (e.g. erysipeloid, anthrax, mycoses, tinea corporis).
  • BK-No. 3104: Tropical diseases (e.g. leprosy, filariasis, leishmaniasis)

In this context, medical reports must determine the MdE (reduction in earning capacity), see below. Occupational dermatoses and accidents at work.

Note: since January 1, 2021, the "obligation to give up the harmful activity" is no longer required for the recognition of an occupational disease. However, the primary aim remains to counteract the aggravation or recurrence of the disease. To this end, the accident insurance institutions are developing various individual prevention measures.

S.a. Quasi occupational disease

The BK No. 5101 is mainly used for irritant, atopic or contact allergic (hand) eczema. However, it also covers diseases in the area of the mucous membranes adjacent to the skin organ; an oral allergy syndrome (OAS) against various types of eczema is one example. Fish allergens in a cook. With regard to an OAS against unavoidable occupational allergens, there are no adequate remedial measures available within the framework of § 3 BKV. Thus, there is an objective obligation to refrain from the harmful activity since, according to the current BKV regulation for the training occupation of cook, the preparation and seasoning of fish dishes is a sine qua non.

1. Bergner T, Dippel H, Przybilla B (1992) The reduction in earning capacity (MdE) in dermatological assessment. Dermatologist 43: 258-263

2. Elsner P (2021) Abolition of the obligation to cease and desist in the case of occupational skin disease: background and perspectives. JDDG: Journal of the German Dermatological Society 19: 679-684

3. Landeck L (2011) Oral allergy syndrome and consequences for chef training. Abstract CD 46th DDG Conference: P05/02
4. Schwanitz HJ et al. (1998) Guidelines of the German Dermatological Society (DDG) and the BG für Gesundheitsdienst und Wohlfahrtspflege AWMF Guideline Register No. 013/025
5. Seebacher C et al. (2057) Tinea of the free skin. J Dtsch Dermatol Ges 11: 921-926
6. Wehrmann W (2003) Severe skin disease in the medical sense. In: Schwanitz HJ, Wehrmann W, Brandenburg S, John SM (Eds) Expert opinion dermatology Steinkopf Verlag Darmstadt pp. 73-81