Medico-legal evaluation of occupational skin diseases and occupational skin cancer.

The medico-legal evaluation of occupational skin diseases is one of the core competencies of dermatology. As a neutral medical expert, the dermatologist has a different role to that of a treating physician. In Germany, the so-called Bamberg Recommendation (Bamberger Empfehlung) provides a scientifically based assessment basis to ensure equal treatment of all persons undergoing medico-legal evaluation. In addition to dermatological expertise, knowledge of insurance law and legal terminology is essential for the medical expert. Dermatologists provide legal and administrative decisions of social courts and social insurance institutions with their qualified expert opinions. In this way, dermatology makes an important contribution to social security.

[Sustainability in occupational dermatology : Starting points, challenges, and potentials for sustainable care of work-related skin diseases]. / Nachhaltigkeit in der Berufsdermatologie : Ansatzpunkte, Herausforderungen und Potenziale für eine nachhaltige(re) Versorgung beruflich Hauterkrankter.

Sustainability is becoming increasingly important in healthcare and has moved into focus at various levels. This article aims to provide an overview of guiding principles, concepts, and target systems of sustainability and to transfer these to occupational dermatology. Current and future starting points are outlined for various levels, e.g., politics, research, industry, and patient care, in order to link sustainability and occupational dermatology in a structured and systematic way and to transform the structures of patient care in occupational dermatology care towards sustainability. Using the specific example of protective gloves, which is a pivotal personal protective measure to prevent work-related hand eczema, starting points, potentials, and challenges are analyzed and specific possibilities and perspectives for more ecologically sustainable action are presented.

Severely compromised supply of patch test allergens in Europe hampers adequate diagnosis of occupational and non-occupational contact allergy. A European Society of Contact Dermatitis (ESCD), European Academy of Allergy and Clinical Immunology (EAACI), European Academy of Dermatology and Venereology (EADV) task forces 'Contact Dermatitis' and 'Occupational Skin Disease' position paper.

Patch testing is the only clinically applicable diagnostic method for Type IV allergy. The availability of Type IV patch test (PT) allergens in Europe, however, is currently scarce. This severely compromises adequate diagnostics of contact allergy, leading to serious consequences for the affected patients. Against this background, the European Society of Contact Dermatitis (ESCD) has created a task force (TF) (i) to explore the current availability of PT substances in different member states, (ii) to highlight some of the unique characteristics of Type IV vs. other allergens and (iii) to suggest ways forward to promote and ensure availability of high-quality patch testing substances for the diagnosis of Type IV allergies throughout Europe. The suggestions of the TF on how to improve the availability of PT allergens are supported by the ESCD, the European Academy of Allergy and Clinical Immunology, and the European Academy of Dermatology and Venereology and intend to provide potential means to resolve the present medical crisis.

Associations between tobacco smoking status and patch test results-A cross-sectional pilot study from the Information Network of Departments of Dermatology (IVDK).

BACKGROUND: Earlier studies suggested a potential association between tobacco smoking and nickel sensitization, but little is known about other contact allergens. OBJECTIVES: To investigate the association of smoking status and contact sensitizations as well as subtypes of dermatitis, and to analyse the sensitization profiles of tobacco smokers. PATIENTS AND METHODS: Within the Information Network of Departments of Dermatology (IVDK), we performed a cross-sectional multicentre pilot study comprising 1091 patch-tested patients from 9 departments, comparing 541 patients with a history of cigarette smoking (281 current and 260 former smokers) with 550 never-smokers. RESULTS: We could not confirm the previously reported association between nickel sensitization and tobacco smoking. Moreover, sensitizations to other allergens, including colophony, fragrance mix I, Myroxylon pereirae and formaldehyde, were not increased in cigarette smokers compared with never smokers. Hand dermatitis (50.6% vs. 33.6%) and occupational cause (36.2% vs. 22.5%) were significantly more frequent among cigarette smokers compared with never-smokers as shown by non-overlapping 95% confidence intervals. CONCLUSIONS: Although our study does not allow a firm conclusion on whether smoking status contributes to certain contact sensitizations, it confirms an association of smoking with hand dermatitis and occupational cause.

[Prevention and health promotion in dermatology]. / Prävention und Gesundheitsförderung in der Dermatologie.

The term prevention includes measures that are used to avoid illnesses or damage to health as well as to reduce the risk of illness or to delay its occurrence. Preventive measures can be classified based on various criteria: temporal differentiation (primary, secondary, and tertiary prevention), context (behavioral and relational prevention), and recipient (general and individual prevention). Health promotion is used when appropriate measures are intended to strengthen and increase human health potential and resources. This includes, among other things, measures to develop health-promoting behavior (empowerment) and measures regarding the planning and implementation of health-promoting behavior (participation). One goal of these measures is generally to increase health literacy. This article describes examples of prevention and health promotion measures for occupational skin cancer (counseling approach for individual sun protection for outdoor workers; "individuelle Lichtschutzberatung" [ILB]) as well as occupational hand eczema within the meaning of German occupational disease number 5101 (outpatient and inpatient individual prevention measures). These are supplemented by the example of outpatient age-adapted small group trainings for patients with atopic dermatitis according to the multicenter evaluated concept of AGNES e. V. ("Arbeitsgemeinschaft Neurodermitisschulung") and ARNE ("Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter"). These examples also address aspects of sustainability and digitalization (eHealth, eLearning) in the areas of prevention and health promotion.

Quality of patch testing patient's own material in patients with suspected occupational skin diseases throughout Germany: Interim results of the German Social Accident Insurance (DGUV) research project FB 317b.

BACKGROUND: Due to limited availability of commercial test preparations, patch testing patient's own material (POM) is of great importance to diagnose occupational allergic contact dermatitis. OBJECTIVES: To assess the quality of performance and documentation of patch testing with POM in patients with suspected occupational skin diseases (OSD) in Germany. METHODS: Retrospective-prospective analysis of protocols of patch tests with POM was conducted between 2013 and 2021 in patients with suspected OSD and submitted to statutory accident insurance institutions. Assessments were done by predefined criteria. RESULTS: Three thousand and four patch tests with POM from 460 patients were included. A full description of the POM was provided in 73.3% of all tests. The test concentration, test vehicle and pH value were documented in 74.3%, 70.5% and 42.2% of tests, for which the respective parameters were considered relevant. One hundred and sixty-one positive reactions to POM were documented. In 72%, sufficient patch testing with commercial test substances was conducted to investigate the positive reaction. In 30.4%, consecutive patch testing of all ingredients of the POM was done. CONCLUSIONS: The results not only show considerable shortcomings mainly in documentation but also to some extent performance of patch tests with POM in patients with suspected OSD in Germany.

Diagnosis and treatment of Hymenoptera venom allergy: S2k Guideline of the German Society of Allergology and Clinical Immunology (DGAKI) in collaboration with the Arbeitsgemeinschaft für Berufs- und Umweltdermatologie e.V. (ABD), the Medical Association of German Allergologists (AeDA), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNOKC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Allergy and Environmental Medicine (GPA), German Respiratory Society (DGP), and the Austrian Society for Allergy and Immunology (ÖGAI).

Hymenoptera venom (HV) is injected into the skin during a sting by Hymenoptera such as bees or wasps. Some components of HV are potential allergens and can cause large local and/or systemic allergic reactions (SAR) in sensitized individuals. During their lifetime, ~ 3% of the general population will develop SAR following a Hymenoptera sting. This guideline presents the diagnostic and therapeutic approach to SAR following Hymenoptera stings. Symptomatic therapy is usually required after a severe local reaction, but specific diagnosis or allergen immunotherapy (AIT) with HV (VIT) is not necessary. When taking a patient's medical history after SAR, clinicians should discuss possible risk factors for more frequent stings and more severe anaphylactic reactions. The most important risk factors for more severe SAR are mast cell disease and, especially in children, uncontrolled asthma. Therefore, if the SAR extends beyond the skin (according to the Ring and Messmer classification: grade > I), the baseline serum tryptase concentration shall be measured and the skin shall be examined for possible mastocytosis. The medical history should also include questions specific to asthma symptoms. To demonstrate sensitization to HV, allergists shall determine concentrations of specific IgE antibodies (sIgE) to bee and/or vespid venoms, their constituents and other venoms as appropriate. If the results are negative less than 2 weeks after the sting, the tests shall be repeated (at least 4 - 6 weeks after the sting). If only sIgE to the total venom extracts have been determined, if there is double sensitization, or if the results are implausible, allergists shall determine sIgE to the different venom components. Skin testing may be omitted if in-vitro methods have provided a definitive diagnosis. If neither laboratory diagnosis nor skin testing has led to conclusive results, additional cellular testing can be performed. Therapy for HV allergy includes prophylaxis of reexposure, patient self treatment measures (including use of rescue medication) in the event of re-stings, and VIT. Following a grade I SAR and in the absence of other risk factors for repeated sting exposure or more severe anaphylaxis, it is not necessary to prescribe an adrenaline auto-injector (AAI) or to administer VIT. Under certain conditions, VIT can be administered even in the presence of previous grade I anaphylaxis, e.g., if there are additional risk factors or if quality of life would be reduced without VIT. Physicians should be aware of the contraindications to VIT, although they can be overridden in justified individual cases after weighing benefits and risks. The use of ß-blockers and ACE inhibitors is not a contraindication to VIT. Patients should be informed about possible interactions. For VIT, the venom extract shall be used that, according to the patient's history and the results of the allergy diagnostics, was the trigger of the disease. If, in the case of double sensitization and an unclear history regarding the trigger, it is not possible to determine the culprit venom even with additional diagnostic procedures, VIT shall be performed with both venom extracts. The standard maintenance dose of VIT is 100 µg HV. In adult patients with bee venom allergy and an increased risk of sting exposure or particularly severe anaphylaxis, a maintenance dose of 200 µg can be considered from the start of VIT. Administration of a non-sedating H1-blocking antihistamine can be considered to reduce side effects. The maintenance dose should be given at 4-weekly intervals during the first year and, following the manufacturer's instructions, every 5 - 6 weeks from the second year, depending on the preparation used; if a depot preparation is used, the interval can be extended to 8 weeks from the third year onwards. If significant recurrent systemic reactions occur during VIT, clinicians shall identify and as possible eliminate co-factors that promote these reactions. If this is not possible or if there are no such co-factors, if prophylactic administration of an H1-blocking antihistamine is not effective, and if a higher dose of VIT has not led to tolerability of VIT, physicians should should consider additional treatment with an anti IgE antibody such as omalizumab as off lable use. For practical reasons, only a small number of patients are able to undergo sting challenge tests to check the success of the therapy, which requires in-hospital monitoring and emergency standby. To perform such a provocation test, patients must have tolerated VIT at the planned maintenance dose. In the event of treatment failure while on treatment with an ACE inhibitor, physicians should consider discontinuing the ACE inhibitor. In the absence of tolerance induction, physicians shall increase the maintenance dose (200 µg to a maximum of 400 µg in adults, maximum of 200 µg HV in children). If increasing the maintenance dose does not provide adequate protection and there are risk factors for a severe anaphylactic reaction, physicians should consider a co-medication based on an anti-IgE antibody (omalizumab; off-label use) during the insect flight season. In patients without specific risk factors, VIT can be discontinued after 3 - 5 years if maintenance therapy has been tolerated without recurrent anaphylactic events. Prolonged or permanent VIT can be considered in patients with mastocytosis, a history of cardiovascular or respiratory arrest due to Hymenoptera sting (severity grade IV), or other specific constellations associated with an increased individual risk of recurrent and/or severe SAR (e.g., hereditary α-tryptasemia). In cases of strongly increased, unavoidable insect exposure, adults may receive VIT until the end of intense contact. The prescription of an AAI can be omitted in patients with a history of SAR grade I and II when the maintenance dose of VIT has been reached and tolerated, provided that there are no additional risk factors. The same holds true once the VIT has been terminated after the regular treatment period. Patients with a history of SAR grade ≥ III reaction, or grade II reaction combined with additional factors that increase the risk of non response or repeated severe sting reactions, should carry an emergency kit, including an AAI, during VIT and after regular termination of the VIT.

Nickel and cobalt release from beauty tools: A field study in the German cosmetics trade.

BACKGROUND: Relevant nickel and cobalt release from hairdressing tools has recently been evidenced. Comparable data are not available for tools used in beauty salons. OBJECTIVES: Screening of beauty tools for nickel and cobalt release. METHODS/MATERIALS: Three hundred eight beauty tools were tested in seven beauty salons located in two North-German states. A nickel spot test and a cobalt spot test were used to test the tools for nickel release and cobalt release, respectively. RESULTS: One hundred forty-three of 308 beauty tools overall (46.4%; 95% confidence interval [CI]: 40.8%-52.2%) released nickel and 18 of 308 beauty tools overall (5.8%; 95%CI: 3.5%-9.1%) released cobalt. Nickel release was found in 22 of 99 metal tools (22.2%; 95%CI: 14.5%-31.7%) and 121 of 209 tools with metallic parts (57.9%; 95%CI: 50.9%-64.7%); cobalt release was detected in 3 of 99 metal tools (3.0%; 95%CI: 0.63%-8.6%) and 15 of 209 tools with metallic parts (7.2%; 95%CI: 4.1%-11.6%). CONCLUSIONS: Nickel and cobalt are emitted at allergologically relevant levels by a wide range of beauty tools (i.e., metal tools and tools with metallic parts) utilized in the German cosmetics trade. Beauty tools should thus be considered occupational sources of nickel and cobalt exposure.

Nickel and cobalt: Underestimated contact allergens in hairdressers?

INTRODUCTION: Nickel and cobalt were not regarded as pertinent contact allergens in the hairdressing trade for the last decades. It was even stated that the relevance of nickel allergy in the hairdressing trade has been overestimated for several years. Recently, nickel and cobalt release from a multitude of metal tools in the German hairdressing trade was documented in two field studies. METHODS: Review of two field studies. RESULTS: In 2019, nickel release from 9.2% of 229 tested metallic hairdressing tools was evidenced, and in 2021, nickel release from 27.6% as well as cobalt release from 2.1% of 475 tested tools was detected in overall 30 North German hairdressing salons. Tweezers, sectioning clips, hair clips, and straight razors were identified as nickel as well as cobalt releasing tools. Crochet hooks and tail combs were identified as only nickel releasing tools. DISCUSSION: A variety of metallic tools - which are used daily by hairdressers - release nickel and/or cobalt in allergologically relevant amounts. This circumstance has to be considered problematic with regard to the development of work-related allergic contact dermatitis. Thus, nickel and cobalt should possibly receive greater attention as potential contact allergens in the hairdressing trade. CONCLUSION: The proven nickel and cobalt release from metallic hairdressing tools might entail legal ramifications in terms of insurance law. In case of nickel and cobalt allergies within the occupational group of hairdressers, metal tools might be considered as feasible sources for nickel and cobalt exposure.

Treatment with alitretinoin in patients taking part in a tertiary individual prevention program for work-related skin diseases.

BACKGROUND: Patients taking part in a tertiary individual prevention program (TIP) for work-related skin diseases frequently have chronic hand eczema (HE) for which alitretinoin is a treatment option. OBJECTIVE: To investigate treatment with alitretinoin before and during the TIP and related factors. METHODS: Data of 1614 patients taking part in the TIP between January 2015 and December 2019 were analyzed retrospectively. RESULTS: Three hundred forty-eight patients (21.6%) reported treatment with alitretinoin prior to the TIP showing an increase over time, particularly in men. In 45 patients (2.8%), alitretinoin treatment was initiated during the TIP. Treatment with alitretinoin was significantly less common among female than male patients, both prior to (P < .001) and during the TIP (P = .015). Female patients who had received alitretinoin in the past were significantly older than the other female patients (P < .001). Among patients treated with alitretinoin prior to the TIP, women had a significantly higher disease severity at admission than men (P = .007). CONCLUSIONS: About twenty percent of patients reported treatment with alitretinoin prior to the TIP. The data indicate that treatment of female TIP patients with alitretinoin is less frequent than among male patients and depends on age and disease severity.

Effectiveness of secondary prevention in metalworkers with work-related skin diseases and comparison with participants of a tertiary prevention program: A prospective cohort study.

BACKGROUND: In Germany, a multistep approach has been established to prevent work-related skin diseases (WRSDs). OBJECTIVES: To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP). PATIENTS AND METHODS: In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow-up 8-12 weeks after the SIP or at dismissal from the TIP (3-4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome-wide association study (GWAS). RESULTS: Ninety-three SIP patients (81.6%) attended the follow-up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS. CONCLUSIONS: The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP.

Economic evaluation of a tertiary prevention program for occupational skin diseases in Germany.

BACKGROUND: Occupational skin diseases (OSDs) are the most common work-related diseases in Germany and responsible for a large individual and financial burden. Therefore, a tertiary individual prevention program (TIP) is offered to patients with severe OSD who are at increased risk of abandoning their profession. OBJECTIVES: To define cost of illness (COI) of OSD in Germany and to economically evaluate the TIP from a societal perspective. METHODS: In this study, data on patients taking part in the TIP (September 2005 to December 2009) were collected. Sociodemographic and medical data, costs, disease severity (Osnabrueck Hand Eczema Severity Index), and quality of life (QoL; Dermatology Life Quality Index) were assessed. COI and cost-effectiveness analyses were performed with a simulated control group. RESULTS: In the analysis, 1041 patients were included. Intervention costs per person were €15 009 with decreasing COI over time. The incremental cost-effectiveness ratio revealed expenses per patient of €8942 for a reduction in severity level and €9093 for an improvement in QoL in the base case. Considering costs for retraining, the break-even point is reached if the TIP prevents retraining in approximately 64% of participants. CONCLUSIONS: The decreased COI in this long-term evaluation indicates that the TIP is cost-effective in patients with severe OSD.

Tertiary prevention of occupational skin diseases: Prevalence of allergic contact dermatitis and pattern of patch test results.

BACKGROUND: Allergic contact dermatitis (ACD) is one of the most common occupational skin diseases (OSDs). Its prevalence and the causative allergens differ between occupations. OBJECTIVES: To evaluate the prevalence of ACD and the pattern of patch test results of patients taking part in a tertiary individual prevention programme (TIP) for OSD in Germany. PATIENTS AND METHODS: In a retrospective cohort study, the data of 3411 TIP patients patch tested between 2007 and 2016 were analysed. RESULTS: In 2687 (78.8%) patients, work-related skin disease was diagnosed, mostly hand dermatitis. The highest proportion of face dermatitis was seen in painters (8.1%). ACD was most common in painters (56.8%), hairdressers (45.8%), construction workers (31.5%), gardeners/florists (26.7%), and metalworkers (26.5%). On average, hairdressers had the youngest age (31.4 ± 12.6 years, P < 0.0001) and the shortest time in the profession prior to the TIP (mean 13.7 years). The pattern of patch test reactivity showed occupation-specific differences related to work exposures. CONCLUSIONS: Identification of occupational groups at risk for ACD and relevant allergens may help in the development and implementation of targeted prevention strategies. Our data suggest that there should be a particular focus on hairdressers and painters.

Multicentre cohort study 'Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assurance of Inpatient Management (ROQ)': results from a 3-year follow-up.

BACKGROUND: A tertiary individual prevention programme (TIP) is offered to patients with severe occupational skin disease (OSD) in Germany. Previously, it was shown that the burden of OSDs is considerably reduced in patients up to 1 year after the TIP. OBJECTIVES: To evaluate the long-term effects of the TIP. PATIENTS AND METHODS: In a prospective multicentre cohort study, the clinical and patient-reported outcome data 3 years after the TIP were evaluated. RESULTS: Of the 1788 patients initially included in the study, 1410 were available for the 3-year follow-up analysis. The severity of OSD, the use of topical corticosteroids and days of absence from work were significantly reduced 3 years after the TIP, and the quality of life and skin protective behaviour were significantly improved. Of the patients, 96.9% were able to resume work. One thousand one hundred and sixty-six patients (82.7%) were still working 3 years after the TIP, 874 of them (75.0%) in the same occupational field. Hairdressers had the lowest rate of remaining in their original profession (41.3%). CONCLUSIONS: The follow-up during 3 years of this unique cohort of patients with OSDs shows that the TIP is associated with sustained improvements in terms of disease severity, ability to work, quality of life, and prognosis.

[Current trends in occupational dermatology]. / Aktuelle Trends in der Berufsdermatologie.

In clinical practice occupational skin diseases usually present as hand dermatitis. Occupationally acquired contact allergies are of eminent relevance in many work place products e.g. skin care products, dyes and paints, epoxy resins or protective gloves. However, not infrequently, a range of other dermatoses of different etiology and localization can be occupationally induced and, at least in Germany, thus be medically treated and--if necessary--compensated for with full coverage by the statutory employers' liability insurance. Examples regarding non-eczematous skin diseases triggered by external factors are psoriatic lesions, cutaneous type-1-allergies, occupationally acquired infections, and dermatoses in other localizations which are occupationally exposed to irritant influences (e.g. feet in workers wearing occlusive safety boots). Moreover, outdoor workers deserve specific attention by the dermatologist if squamous cell carcinomas including precursor lesions like actinic keratoses or Bowen disease have occurred. In Germany, recently the scientific advisory committee to the Ministry of Labor has recommended including these skin cancers caused by occupational solar UV exposure in the national list of occupational diseases. The framework for dermatological preventive care of occupationally-induced inflammatory dermatoses has been continuously improved in the last years. The aim is to reach a similar level of care and preventive measures for patients with occupational skin cancer, including primary preventive workers' education.

Secondary prevention of occupational dermatoses: first systematic evaluation of optimized dermatologist's procedure and hierarchical multi-step intervention.

BACKGROUND: In 2011, 25,056 notifications of suspected occupational dermatitis (OD) were submitted to the statutory accident insurance (UVT), predominant by dermatologist's reports. Parallel to the introduction of the improved dermatologist's procedure, the hierarchical multi-step intervention approach to OD was launched within the UVT. It is aimed at ensuring that patients with OD can be allocated to preventive dermatological interventions quickly and appropriately according to the severity of their OD. From 2007-2010, the quality of dermatological interventions as well as the corresponding administrative procedures were evaluated in a unique research project supported by the German Social Accident Insurance. PATIENTS AND METHODS: About 10 % (n = 1 600) of notified cases with suspected OD in 2007 in Germany were analyzed in a random quota sample by occupational dermatologists and administrations. Follow-up was 12 months. If a dermatologist's procedure was initiated after the initial notification, patients' and dermatologists' opinions were obtained by questionnaires. RESULTS: More than 85 % of the OD notifications were submitted by dermatologists and only 1.6 % by occupational physicians. In 88 %, the dermatologist's report was used. Yet, there is room for optimizing procedures: e.g., the clinical and/or occupational relevance of type IV allergies was assessed only in 36.5 % of patients. Job loss due to OD occurred less often if suitable preventive and/or therapeutic strategies (e.g., skin protection seminars) were implemented by the UVT (p = 0.001). Preventive and therapeutic strategies were initiated more often when the dermatologist's report was conclusive, a central element is the outpatient care by a dermatologist. CONCLUSIONS: The research project shows that the quality of dermatological intervention, as well as administrative procedures, can be optimized. Early intervention with suitable preventive and therapeutic strategies in patients with OD should be aimed at, as this is crucial for the outcome of OD.

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. OBJECTIVES: To investigate whether the observed short-term effects remain significant and meaningful over a period of 12 months after discharge from the TIP. METHODS: A prospective design was used to compare clinical and patient-reported outcome data between admission to a 3-week inpatient TIP and 12 months after discharge (12-month follow-up). RESULTS: Of 1788 individuals admitted to the TIP, data from 1617 individuals were available for analysis. We observed a significant reduction in the severity of OSD, the use of topical corticosteroids, and days of absence from work because of OSD. QoL was significantly improved, and 87.4% were able to return to work and remain in the workforce. CONCLUSIONS: A randomized controlled trial would have been desirable, but was not possible, for legal and other reasons. However, the long-term 12-month follow-up shows that the TIP is associated with sustained improvements in terms of ability to work, QoL, and prognosis, and reductions in days of absence from work because of skin conditions and topical corticosteroid application. These results indicate that the TIP provided a reduction in the personal and public burden of OSD.

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

UNLABELLED: 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. METHODS: One thousand seven hundred and eighty-eight patients with severe OSD were treated and educated in five clinics with follow-up before and 4 weeks after return to work. RESULTS: During the inpatient phase, there was a significant improvement in the severity of OSD (Osnabrueck Hand Eczema Severity Index, p < 0.001) and in the quality of life (Dermatology Life Quality Index, p < 0.001). These effects were largely sustained during the outpatient follow-up phase and in the 4 weeks after return to work. Among all patients, 89.4% used topical steroids before TIP, including 52.5% using high-grade topical steroids; 93.2% of the patients were able to refrain from using topical steroids before returning to work. As a result of TIP, return to work was possible for 1587 patients (88.8%). CONCLUSIONS: The primary objectives of TIP (return to work, improvement of OSD, enhancement of quality of life, and reduction in the use of topical steroids) were successfully met. The long-term follow-up (1 and 3 years after TIP) will examine whether these favourable outcomes can be sustained.

Work-related accidents and occupational diseases in veterinarians and their staff.

OBJECTIVES: We assessed the occupational hazards in veterinary practice by analysing accident insurance data in order to stimulate strategies to prevent occupational accidents and diseases in veterinarians and their staff. METHODS: Approximately 10,000 veterinary practices comprising about 27,500 veterinarians and their staff are covered by the Institution of Statutory Accident Insurance of the Health and Welfare Service (BGW). Each year about 2,000 accident and occupational disease claims are filed by these veterinarians and their staff. The claims for the 5-year period from 1998 to 2002 are analysed in this paper. RESULTS: For 2002, the incidence rate for accidents in the workplace was 105.4 per 1,000 full-time workers, a rate 2.9-times higher than for general practitioners of human medicine. When only severe accidents resulting in a loss of work time of more than 3 days were analysed, the relative risk increased to 9.2. Approximately 66% of the reported accidents are due to scratches, bites, or kicks from animals. Claims of occupational disease are filed 2.7-times more often by veterinarians and their staff than by general practitioners and their staff. The occupational diseases filed most often concern the skin (39%), followed by allergic respiratory diseases (30.5%), and infectious diseases (19.1%). CONCLUSIONS: Prevention strategies for veterinarians should focus on accidents caused by animals. The prevention of occupational diseases should focus on skin diseases, respiratory disease, and infections.