[Rehabilitation after work related skin diseases]. / Rehabilitation von berufsbedingten Hauterkrankungen.

The high incidence rates of occupational contact dermatitis, its poor prognosis, and the high social and economic impact of the disease for the affected individuals as well as for the medical insurance companies indicates a need to strive for the target of "rehabilitation instead of retirement". Here, we highlight the need and effectiveness of rehabilitation measures in individuals with work related skin diseases (mainly contact dermatitis and hand eczema). We discuss the measures for secondary individual prevention as well as tertiary prevention, which have been established in our department together with the state medical insurance companies, mainly the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BWG: Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Service). The results of the multicentre study "Optimisation and Quality Assessment of Tertiary Prevention of Occupational Dermatoses" are presented and discussed. Both, the secondary as well as tertiary prevention measures have been successful, which has resulted in a decrease in the total annual rehabilitation costs to the BGW. A reason for this success story is the fact that in Germany these organisations are, in contrast to the health insurance companies, responsible for both acute treatment and the rehabilitation.

[Secondary individual prevention and rehabilitation in female hairdressers suffering from skin diseases]. / Sekundäre Individualprävention bei FriseurInnen.

The risk of contracting occupational skin diseases is highest in hairdressers. A job-specific secondary prevention programme was created to enable hairdressers to stay on the job despite their skin problems. The effect of this prevention programme on both, the severity of skin disorders and the hairdressers' behaviour regarding skin protection are evaluated in this paper. Between 1997 and 2002 a total of 2437 hairdressers participated in the programme. Complete data for the evaluation are available for 635 hairdressers (26 %). This selection is partly due to the fact that the evaluation is restricted to certain regions in Germany. The percentage of hairdressers with severe skin symptoms dropped from 49 % at the start of the rehabilitation programme to 11 % after completion of the programme. The proportion of hairdressers using gloves and applying skin care doubled. Therefore the rehabilitation programme appears to be successful regarding the ability of hairdressers to cope with skin problems.

[Quality of life of patients with occupationally-induced hand eczema]. / Lebensqualität bei Patienten mit berufsbedingten Handekzemen.

In recent years quality of life has been studied in a growing number of different dermatological diseases. Internationally validated questionnaires such the RAND-36 (identical to the SF-36) do not contain enough questions which are relevant for skin diseases. There is no publication on quality of life issues in occupational skin diseases, and only one short report gives data on quality of life in hand eczema. The widely used skin specific instrument DLQI has only 2 questions that indirectly refer to employment issues. A quality of life questionnaire on occupational skin diseases (mostly hand eczema) should ideally include questions on work-related impairment of both physical functioning and interaction with colleagues.

Contact dermatitis and quality of life: a structured review of the literature.

Quality of life (QoL) assessment has rapidly become an important outcome variable in dermatology research. Even though the importance of the patient's personal morbidity is generally accepted as being important by dermatologists, scepticism and confusion remain about the usefulness of QoL in dermatological research and how it should be measured. QoL assessments in individuals with contact dermatitis are few. A structured review of the literature is presented. All studies reviewed found that contact dermatitis is associated with impaired health-related QoL. Hand eczema appears to be as equally impairing as generalized eczema and an early, confirmed diagnosis is associated with improved QoL. Disease duration, atopic dermatitis, age and gender do not seem to have a major impact on QoL, although contradictory findings exist. Assessment of QoL in contact dermatitis is required for future clinical research and may be a valuable tool to the clinician to evaluate new treatments. A combination of dermatology-specific (e.g. Dermatology Life Quality Index) and generic questionnaires (e.g. the Short Form-36) is supported.

Contact dermatitis: prognosis, risk factors, and rehabilitation.

This article reviews the prognosis for irritant and allergic contact dermatitis and occupational and nonoccupational contact dermatitis. Factors adversely affecting prognosis are discussed. Rehabilitation of the patient with disabling contact dermatitis is considered. The importance of the various risk factors for contact dermatitis are reviewed.

Disability due to occupational contact dermatitis.

In 1977 skin disease accounted for 65% of industrial disease claims, and work-related contact dermatitis accounted for the bulk of these. Such cases pose a significant problem to all concerned: compensation authorities, occupational physicians, dermatologists, industry, unions, and affected workers and their families. The physician must create reasonable expectations in the mind of the patient in order to avoid predicting rapid resolution of the dermatitis.

[Ergo-therapy as a dermatological rehabilitation measure in eczematics--aim and first clinical experiences (author's transl)]. / Arbeitstherapie (Ergotherapie) als dermatologische Rehabilitationsmassnahme bei Ekzematikern. Zielsetzung und erste klinische Erfahrungen.

A new kind of clinical rehabilitation therapy of chronic eczematous patients is reported. It consists of a standardized, work-like activity of the hands increasing in time and intensity. This ergotherapy is coordinated with the clinical treatment. Until now our experiences have shown that the clinical healing as well as the functional reconstruction of the horny layer (alkali resistance, permeability) are not delayed by the work-like skin stress. The instruction and guidance concerning cleaning and skin protective measures are of particular importance. The observation of the course of 77 subjects suggests a positive influence on patients suffering from degenerative eczema whereas the results in patients with multiple allergies do not confirm previous expectations.

Industrial rehabilitation of dermatitis patients.

Industrial rehabilitation is identified as an integral part of the process of patient resettlement. The organization of the Government-sponsored Employment Rehabilitation Service is described. The low incidence of dermatitis as seen by medical advisers in that Service is explained. Ways in which employment medical advisers can provide complementary support to consultant dermatologists is suggested.