Tertiary individual Prevention (TIP) of occupational skin diseases in Germany
C. Skudlik*, H. Allmers, B. Wulfhorst, S.M. John
University of Osnabrueck, Dermatology, Environmental Medicine and Health Theory, Osnabrueck, Germany
Background
If employees are threatened to loose their job due to a severe allergic and/or irritant dermatosis, intensive interdisciplinary measures of tertiary individual prevention (TIP) of occupational skin diseases are required. In a previous 1-year-follow up study, we could demonstrate that 2/3 of patients undergoing TIP could remain in their job.
Methods
TIP comprises 2-3 weeks in-patient treatment and health-pedagogic counseling, and consecutive 3 weeks out-patient treatment by the local dermatologist. The patient will stay off work for a total of 6 weeks to allow full barrier-recovery. Corticosteroids are omitted from treatment, due to their negative effects on barrier homeostasis. All TIP-patients in our institution in the year 2002 were analyzed with respect to occupational groups, diagnoses, spectrum of sensitization and medical intervention prior, during and by the end of the in-patient period.
Results
In 91% of 296 cases contact dermatitis of the hands was diagnosed: 75% primary irritant contact dermatitis (37% chronic irritant contact dermatitis, 38% irritant-induced atopic hand eczema), and 16% allergic contact dermatitis. 68% of all patients showed type-IV-sensitizations; however, these proved to be clinically and occupationally relevant only in 42% of cases. In most cases, type-IV-sensitization followed irritant contact dermatitis. In more than 83% of cases a (nearly) complete remission of hand eczema could be achieved. Clinically relevant type-IV-sensitizations were most frequent in hairdressers (66%). Cleaning personnel most frequently had used corticosteroids on a regular basis (60%) and often displayed steroid withdrawal symptoms (53%) and marked skin-atrophy of the hands (23%).
Conclusion
The obtained data from TIP reveal specific risk factors for the development of occupational skin diseases in the investigated high-risk professions and thus allow to design strategies for the improvement of medical intervention. Different outcomes in the various hazardous professions studied underline the necessity for diversified interdisciplinary approaches of prevention.
Content last modified: 22 May 2005
