Christoph Skudlik

Multicentre study ‘rehabilitation of occupational skin diseases –optimization and quality assurance of inpatient management (ROQ)’–results from 12‐month follow‐up

Background. Occupational skin disease (OSD) is common, and imposes a considerable personal and public burden. To tackle OSD, the German stepwise procedure of handling OSD was set up. It contains an interdisciplinary, integrated inpatient rehabilitation measure [tertiary individual prevention (TIP)] [dermatological treatment and diagnostic procedures, and patient education (health and psychological)]. The primary aims of the TIP are reduction of the severity of OSD, reduction in the use of corticosteroids, facilitation of return to work, decreased absence from work, and enhanced quality of life (QoL). It was positively evaluated for a period of 4 weeks after return to work.

First results from the multicentre study rehabilitation of occupational skin diseases--optimization and quality assurance of inpatient management (ROQ).

Background and objectives. The German stepwise procedure of handling occupational skin diseases (OSDs) offers interdisciplinary integrated (inpatient/outpatient) rehabilitation measures [tertiary individual prevention (TIP)] for severe OSD. In 2005, a prospective cohort multicentre study was started in order to evaluate TIP.

Osnabrueck hand eczema severity index--a study of the interobserver reliability of a scoring system assessing skin diseases of the hands.

An easy‐to‐use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index (OHSI) was developed for this purpose and the interobserver reliability investigated. The clinical severity was evaluated on the basis of the extension or clinical characteristics of six morphological characteristics. For the validation of the OHSI, hand eczema in 28 patients was investigated independently by one dermatologist and 2 occupational physicians. The agreement between the observers was determined by using kappa values, Kendalls coefficient of concordance, the intraclass correlation coefficient (ICC) and the 95% limits of agreement. The ICC for the total OHSI was 0.80 and the estimated limits of agreement (−3.6 and 3.0) were sufficiently small to expect that ratings according to OHSI performed by independent observers of different medical specialities should produce similar results. It could be demonstrated that the use of the OHSI is simple and practicable. The interobserver reliability for the summary score is good. OHSI seems a reliable tool for assessing the severity of occupational hand eczema.

Optimierte Versorgung von Patienten mit berufsbedingten Handekzemen

ZusammenfassungBerufsbedingte Hauterkrankungen manifestieren sich in mehr als 90% der Fälle in Form von Handekzemen und nehmen seit Jahren mit mehr als ein Viertel aller gemeldeten Berufskrankheitenverdachtsfälle die Spitzenposition im Berufskrankheitengeschehen in Deutschland ein. Zur Optimierung der Versorgung von Patienten mit berufsbedingten Handekzemen wurde ab 2005 innerhalb der gesetzlichen Unfallversicherung das „Stufenverfahren Haut“ eingeführt. Dieses stellt sicher, dass Betroffene mit berufsbedingten Hauterkrankungen den jeweils indizierten verschiedenen Präventionsangeboten rasch und stadienadaptiert zugeführt werden können. Voraussetzung hierfür ist, dass die Erkrankungsfälle den zuständigen Trägern der gesetzlichen Unfallversicherung möglichst frühzeitig gemeldet werden. Diese zentrale Aufgabe kommt dem Hautarzt zu, dem hierfür der 2006 eingeführte optimierte Hautarztbericht zur Verfügung steht. Mit dem optimierten Hautarztbericht wurde eine Plattform geschaffen, die eine frühzeitige ambulante interdisziplinäre Prävention und einen Informationsfluss zwischen den beteiligten Akteuren ermöglicht. Der optimierte Hautarztbericht ist komplementär zu den im Stufenverfahren Haut vorgesehenen Präventionsmöglichkeiten aufgebaut und berücksichtigt somit insbesondere die in den letzten Jahren weiterentwickelten und vernetzten interdisziplinären (ambulanten und stationären) Versorgungsstrukturen der sekundären und tertiären Individualprävention in der Berufsdermatologie.AbstractOccupational dermatoses (OD) have been at the top of all occupational diseases in Germany for years (>25% of all occupational diseases officially reported annually to the public statutory employers’ liability insurance bodies). More than 90% of OD-cases are hand eczema. Several pilot initiatives to improve prevention of occupational skin diseases have been developed and funded since 2005 by the statutory employers’ liability insurance schemes. The concept underpinning these initiatives is a nationwide multi-step intervention approach recently implemented by the public statutory insurance system administration (“step- wise procedure”) which aims at offering quick and specific preventive help at all levels of severity of OD. The dermatologist has a pivotal function in this concept; for early secondary prevention, the so-called dermatologist’s procedure was recently updated in order to provide more rapid and concise dermatological consultations and care. Additionally, combined outpatient dermatological and educational intervention seminars (“secondary individual prevention”, SIP) and interdisciplinary inpatient prevention measures have been developed (“tertiary individual prevention”, [TIP]) and are currently being further evaluated in multicenter studies.

Guideline on the management of hand eczema ICD-10 Code: L20. L23. L24. L25. L30.

© Dt. Dermatologische Gesellschaft u. a. • Journal compilation

Prevention of occupational skin disease: a workplace intervention study in geriatric nurses.

Background  Health care workers have an increased risk of occupational dermatosis.

[Optimal care of patients with occupational hand dermatitis: considerations of German occupational health insurance].

ZusammenfassungBerufsbedingte Hauterkrankungen manifestieren sich in mehr als 90% der Fälle in Form von Handekzemen und nehmen seit Jahren mit mehr als ein Viertel aller gemeldeten Berufskrankheitenverdachtsfälle die Spitzenposition im Berufskrankheitengeschehen in Deutschland ein. Zur Optimierung der Versorgung von Patienten mit berufsbedingten Handekzemen wurde ab 2005 innerhalb der gesetzlichen Unfallversicherung das „Stufenverfahren Haut“ eingeführt. Dieses stellt sicher, dass Betroffene mit berufsbedingten Hauterkrankungen den jeweils indizierten verschiedenen Präventionsangeboten rasch und stadienadaptiert zugeführt werden können. Voraussetzung hierfür ist, dass die Erkrankungsfälle den zuständigen Trägern der gesetzlichen Unfallversicherung möglichst frühzeitig gemeldet werden. Diese zentrale Aufgabe kommt dem Hautarzt zu, dem hierfür der 2006 eingeführte optimierte Hautarztbericht zur Verfügung steht. Mit dem optimierten Hautarztbericht wurde eine Plattform geschaffen, die eine frühzeitige ambulante interdisziplinäre Prävention und einen Informationsfluss zwischen den beteiligten Akteuren ermöglicht. Der optimierte Hautarztbericht ist komplementär zu den im Stufenverfahren Haut vorgesehenen Präventionsmöglichkeiten aufgebaut und berücksichtigt somit insbesondere die in den letzten Jahren weiterentwickelten und vernetzten interdisziplinären (ambulanten und stationären) Versorgungsstrukturen der sekundären und tertiären Individualprävention in der Berufsdermatologie.AbstractOccupational dermatoses (OD) have been at the top of all occupational diseases in Germany for years (>25% of all occupational diseases officially reported annually to the public statutory employers’ liability insurance bodies). More than 90% of OD-cases are hand eczema. Several pilot initiatives to improve prevention of occupational skin diseases have been developed and funded since 2005 by the statutory employers’ liability insurance schemes. The concept underpinning these initiatives is a nationwide multi-step intervention approach recently implemented by the public statutory insurance system administration (“step- wise procedure”) which aims at offering quick and specific preventive help at all levels of severity of OD. The dermatologist has a pivotal function in this concept; for early secondary prevention, the so-called dermatologist’s procedure was recently updated in order to provide more rapid and concise dermatological consultations and care. Additionally, combined outpatient dermatological and educational intervention seminars (“secondary individual prevention”, SIP) and interdisciplinary inpatient prevention measures have been developed (“tertiary individual prevention”, [TIP]) and are currently being further evaluated in multicenter studies.

Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy

Background  Filaggrin loss‐of‐function mutations and atopy may alter the clinical course of irritant contact dermatitis (ICD).

Tacrolimus ointment in the treatment of occupationally induced chronic hand dermatitis

Background:  Occupational hand dermatitis (OHD) is a common and often chronic condition. Usage of topical corticosteroids is limited in long‐term therapy because of potential side‐effects. New treatment options are highly appreciated.

Prevention of Hand Eczema: Gloves, Barrier Creams and Workers’ Education

To date, there is fair-quality evidence from a large number of countries, where preventive initiatives for occupational contact dermatitis (OCD) in selected settings and professions have proven significantly effective and successful; in this context, early dermatological intervention as well as specific teaching of affected individuals has been demonstrated as pivotal. Undoubtedly, awareness to OCD, its pathogenesis and prevention by those at risk have, as yet, to be improved in all countries. Thus, it is an imminent future task to improve on workers’ education, multi-disciplinary approaches being advisable. Prevention may increasingly become a stronghold for dermatology: by their specific knowledge and competence – in close cooperation with other disciplines – dermatologists can save their patients’ health and jobs, and thus also save expenses for tax-payers and insurance systems. Of course, preventive intervention needs to be accompanied by common regulatory efforts including evidence-based standards for adequate manufacturing and use of gloves, protective creams and after-work skin care to limit exposure to hazardous substances.