Occupational dermatosesL25.9

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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DefinitionThis section has been translated automatically.

Skin disease which is exclusively or partly due to workplace influences (occupational disease). The assessment of an occupational dermatosis always has to be made individually under consideration of the workplace conditions. An occupational dermatosis has to be distinguished from an occupational skin disease (e.g. occupational disease according to BK 5101) or an accident at work (§ 8 SGB VII).

ClassificationThis section has been translated automatically.

The predominant number of occupational dermatoses (> 95%) is formed by the eczema group. The following classification is accepted:

General therapyThis section has been translated automatically.

  • According to § 3 BeKV (Ordinance on Occupational Diseases), a patient with an occupational dermatosis, if its aggravation, recurrence or the concrete danger of the development of an occupational disease of the skin is threatening, the development of an occupational disease must be treated "with all suitable means" at the expense of the statutory accident insurance institution (usually professional association) preventively ( prevention).
  • The treatment includes therapeutic as well as skin protection and skin care measures. At the expense of the accident insurance carrier, e.g. skin-friendly cleansing preparations (syndets), bath oils, skin-caring external preparations with and without active substances as well as skin protection preparations may be prescribed. Measures at the expense of the accident insurance carrier may only be taken after its approval. This is requested by the treating dermatologist with the dermatologist's report.
  • The prescriptions are only made on a prescription form from the health insurance company, stating the name of the accident insurance company and the file number. The prescription fees are waived for the patient ("free of charge" check the box!). As the prescribed preparations are not paid for by the statutory health insurance companies, they are not charged to the drug budget.
  • Preventive skin protection measures at the workplace include:
    • Technical and organisational measures at the workplace, e.g. encapsulation of a lathe, replacement of cooling lubricants, chromium-free tanned work shoes, protective gloves and general skin protection measures (cost absorption: employer).
    • Although leather tanning with chromate (IV-valent chromium) is prohibited in Germany, foot eczema with proven chromate sensitisation is still frequently found. Tanning with chrome III-containing chrome alum is permitted. It is disputed whether an oxidation of chromium III ions into chromium IV ions is possible. The allergenicity of chromium III is low, cross-allergenicity to chromate IV is rarely described. The discrepancy can be explained by the fact that, due to the incomprehensible interrelationships in the shoe industry, chromate-tanned shoes are still occasionally coming onto the market. The review of the regulation is only carried out on a random basis. Chromium-free can only be assumed with 100% certainty for those manufacturers who expressly use leather that is free of chromate, i.e. leather that has been tanned using vegetable dyes. In some occupational groups, such as bricklayers or miners, chromate sensitization can be triggered by cement penetrating into the work shoes.
    • Personal protective measures: Individual skin protection preparations, in exceptional cases protective gloves, supporting measures for gentle cleaning and regeneration of the skin, hardening measures (UVA/PUVA). Cost absorption: Statutory accident insurance carrier (according to § 3).
    • Medical treatment, outpatient inpatient therapy, cures. Cost absorption: Statutory accident insurance institution (according to § 3). Only when all means of prevention have been exhausted should a change of job be made.
      As a rule, occupational dermatoses are hand eczema.
    • Cumulative sub-toxic hand eczema, toxic hand eczema: Most frequent form of occupational hand eczema, especially in housewives, hairdressing, machining, cleaning and care staff, butchers, bricklayers, bakers. Only if it is not possible to carry out preventive measures (e.g. wearing protective gloves as a baker) is the abandonment of the workplace unavoidable.
    • Toxic hand eczema: Toxic contact dermatitis heals rapidly after avoiding the noxious agent. If the noxious agent is handled properly, no further skin problems will normally occur. The patient can remain at the workplace.
    • Hand eczema, atopic: The onset of atopic hand eczema is a multifactorial process which does not depend exclusively on the action of the external noxious agent. In humid professions, however, there is often an exogenous triggering of hand eczema by irritant noxae. In case of substantial partial cause or trend-setting aggravation by the occupational activity (congruence of work), the atopical hand eczema also becomes an occupational dermatosis or an occupational disease of the skin.
    • Allergic contact eczema: usually type IV sensitization (see below allergy). Usually heals quickly after allergen elimination. If contact cannot be avoided by specific protective measures (e.g. gloves), a change of job is often unavoidable.
      The special skin protection measures depend on the quality of the noxious agent causing the contact. In the case of contact allergies, the focus is on avoiding (replacing) the allergen. If this is not possible, it may be possible to remain at the workplace with suitable protective gloves (see Table 2). For non-specific noxious agents (cumulative toxicity), protective gloves are the first priority. Skin protection preparations are of secondary importance. Accompanying cleaning and moisturizing of the skin.
    • Gloves: Best protection against external noxious agents. However, rubber gloves contain potent allergens (vulcanisation accelerators, antioxidants, etc.) and therefore also represent a potential danger. Vinyl gloves can be used if rubber ingredients such as latex, mercaptobenzothiazole, thiurams, carbamates etc. are incompatible. Vinyl gloves are generally preferable to rubber gloves (no additives!).
    • Skin protection products
      :Basic principle: The noxious agent should not be soluble in the product to make penetration into the skin more difficult. Skin protection against water soluble substances is therefore achieved by W/O bases, skin protection against water insoluble substances by O/W bases.

Caution!

The wrong foundation can improve the penetration of the noxious agent into the skin and increase skin damage! A skin protection plan should be drawn up for every activity that is harmful to the skin. This includes skin cleansing, skin protection and skin care adapted to the noxious agent, see also Table 3, 4.Industrially manufactured preparations always contain preservatives and usually also fragrances which may have a sensitising effect. The preservatives used vary from preparation to preparation. If the sensitization is known, the ingredients have to be clarified in advance.

TablesThis section has been translated automatically.

Profession

Noxae

Hairdressers

P-phenylenediamine (colouring agent), glycerol monothioglycolate (perm), ammonium persulphate (bleaching agent), gum ingredients, perfumes

Farmers

Gum ingredients, pesticides, medicines

Bricklayer

Chromate, rubber ingredients

Nursing professions

gum ingredients, disinfectants, pharmaceuticals, cosmetic ingredients

Florists

Flowers (primroses, composite plants), pesticides

Miners

Chromate, rubber ingredients

Machining professions

Preservatives, oil additives

Cleaning professions

Disinfectants, rubber ingredients

Food Professions

disinfectants, food, preservatives

Locksmith

Oil additives (preservatives etc.), rubber ingredients, cooling lubricants

Dental Technician

Acrylates, metals

Body mechanic

Epoxy resins, oil additives, cooling lubricants

Photographer

Developers (P-phenylenediamine derivatives), rubber ingredients

Joiner

Wood, varnishes, resins, adhesives

Tilers

Chromate, epoxy resins, acrylates

Printer

cooling lubricants, rubber ingredients


Protective gloves in different professions

Profession

Activity

Glove

Remarks

Hairdressing trade

Hair Washing

Wash glove (e.g. Ansell Edmont, Eislingen Wash glove art. no. 79-200)

Wearing and provision of suitable gloves is mandatory (TRGS 530 Hairdressing Trade)!

Dyeing, bleaching, for perms

Vinyl-HS (e.g. Marygold Industrial long "Suretech" Company London, Mönchengladbach), Nitrillatex-HS (e.g. from Ansell Edmond "Touch'N Tuff")

"Industrial long" has extended gauntlet

Mechanical engineering industry

in particular for metal cutting professions

Cotton-HS dipped in plastic or rubber

Wearing HS often not allowed for safety reasons

Construction industry

Rubber dipped cotton-HS

Food industry

PVC (vinyl) HS or rubber dipped cotton HS

Butcher

Sale

Vinyl-HS (e.g. Industrial long "Suretech" from London)

"Industrial long" has extended gauntlet

Slaughter and boning

Rubber dipped cotton HS under chain HS

Cleaning professions

Vinyl-HS (e.g. household HS Fa. Ansell Edmont Art. No. 79-100), rubber dipped cotton-HS

Public Health

Non-sterile activity

Vinyl-HS

Powder Free

Sterile activity

Non-powdered latex HS (e.g. Ansell, Manex powder-free)

For latex allergy: sterile neoprene HS (e.g. Dermaprene from Ansell, Neoderme from Manex)

model making technician, dental technician

Treatment and processing of acrylates

4-h-gloves (e.g. from GIA GmbH Bochum) protect for 4 hours also as finger cots or polyethylene HS

With acrylate sensitization, a change of activity is often unavoidable


Skin protection with different noxious agents

Examples of harmful noxious agents

Sample preparations from selected suppliers

Stockhausen Krefeld

Reinol Lever-Sutter/Mannheim

Basotherm (Biberach/Riss)

Skin protection against water soluble substances

Washing water, water-miscible cooling lubricant, concrete, acids, alkalis, salts, pickling agents, lime, food, cleaning agents

Taktosan-HSS Taktosan emulsion Stoko emulsion (food sector), Taktodor (moisture retention)

Reinol-B-HSC, Reinol-Aquagard

Saniwip-HSC,

Skin protection against water insoluble substances

Oils, greases, drilling oils, cutting oils, paints, varnishes, lacquer thinners, adhesives, petrol, petroleum, organic solvents, synthetic resins, metal dust

Travabon-HSS Travabon L (with silicon dioxide)

Reinol F-HSC, Reinol-Drygard

Sansibal-HSC

Imprint free skin protection products

Sineprint (imprint free)


Skin cleansing and skin care

Skin cleansing

Light soiling

Neopol Cream, Frapantol Soap

Reinol Soap Lotion

Saniklin Wash Liquid, Stephalen Wash Gel

Medium pollution

Solopol Paste

Reinol-K HWP, Reinolen (food)

Saniscrub scrub cream

Coarse soiling

Cresto Paste

Reinol-HWP

Saniscrub scrub cream

Special soiling

(varnishes, oil paints, adhesives, etc.)

Cupran liquid, Slig liquid, Slig special, Reduran, Reduran special

Lacosan (lacquers), pure oil liquid, Sumanol powder soap

Contra Color (paints, varnishes)

Skin Care

Stokolan Cream, Stokolan Lotion

Reinol-Dermasoft

Physioderm cream, Stefatop lotion


List with possible dermatological diseases

Occupational disease number

Diseases

1

Diseases caused by chemical agents

11

Metals and metalloids

1101

diseases caused by lead or its compounds

1102

Diseases caused by mercury or its compounds

1103

diseases caused by chromium or its compounds

1104

diseases caused by cadmium or its compounds

1105

diseases caused by manganese or its compounds

1106

diseases caused by thallium or its compounds

1107

diseases caused by vanadium or its compounds

1108

diseases caused by arsenic or its compounds

1109

diseases caused by phosphorus or its inorganic compounds

1110

diseases caused by beryllium or its compounds

12

Asphyxiant gases

1201

Diseases caused by carbon monoxide

1202

Diseases caused by hydrogen sulphide

13

Solvents, pesticides and other chemical substances

1302

Diseases caused by hydrogen halides

1303

Diseases caused by benzene, its homologues or by styrene

1304

diseases caused by nitro or amino compounds of benzene or its homologues or their derivatives

1305

Diseases caused by carbon disulphide

1306

Diseases caused by methyl alcohol (methanol)

1307

Diseases caused by organic phosphorus compounds

1308

diseases caused by fluorine or its compounds

1309

Diseases caused by nitric acid esters

1310

Diseases caused by halogenated alkyl, aryl or alkylaryl oxides

1315

Diseases caused by isocyanates

For numbers 1101 to 1110, 1201 and 1202, 1303 to 1309 and 1315: Skin diseases are excluded. These are considered diseases within the meaning of this Annex only in so far as they are manifestations of a general disease caused by the absorption of the harmful substances into the body, or in so far as they must be compensated in accordance with item 5101.

2402

Diseases caused by ionising radiation

3

diseases caused by infectious agents or parasites and tropical diseases

3101

infectious diseases, if the insured person worked in the health service, in welfare work or in a laboratory or was particularly exposed to the risk of infection to a similar extent through another activity

3102

Diseases transmissible from animals to humans

3104

Tropical diseases, typhus

5102

Skin cancer or skin changes that tend to form cancer due to soot, paraffin wax, tar, pitch, anthracene or similar substances

Note(s)This section has been translated automatically.

LiteratureThis section has been translated automatically.

  1. John SM et al (2007) Certificate: "Occupational Dermatology (ABD)". New curriculum 2006 of the CME-seminars of the Task Force of Occupational and Environmental Dermatology. German Dermatol Ges 5: 135-144
  2. Schwanitz HJ (2003) Preventive measures. In: Schwanitz HJ, Wehrmann W, Brandenburg S, John SM (Hrsg) Expert Opinion Dermatology Steinkopf Verlag, Darmstadt, pp. 17-31

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Last updated on: 29.10.2020