Occupational skin disease according to bk 5101 L25.9

Occupational skin disease which meets all the requirements of one of the following numbers. According to No. 5101 of Annex 1 to the Occupational Diseases Ordinance, the statutory accident insurance institutions (= Berufsgenossenschaften) are to compensate as an occupational disease: "Severe or repeated relapsing skin diseases which have forced the omission of all activities which were or may be causative for the development, aggravation or resurgence of the disease". This means:

The causal occupational connection must exist with sufficient probability, the mere possibility or reasonable suspicion is not sufficient. A special situation is given for the constitutional skin diseases (see e.g. under Psoriasis palmaris et plantaris, occupational dermatological aspects).

The disease must be severe (clinical picture, course, duration > 6 months) or (!) repeatedly relapsed (at least three similar episodes).

There must have been an objective compulsion to give up the above-mentioned activities.

Definition of the "severity of a skin disease":

• Clinical picture and symptoms: vesicular eruptions, erosions, excoriations, impetiginisation, rhagades, infiltrations, swellings, pruritus, pain, limitation of movement.
• Extension and localization: scattered phenomena beyond the area of contact, extensive or generalized infestation.
• Course: Resistance to therapy, poor healing tendency, partial or inpatient treatment, systemic treatment with glucocorticoids or antibiotics.
• Duration: Longer-term need for treatment, e.g. longer than six months, with mild skin manifestations.
• Allergy: The clinical effect of occupational sensitisation shows a high tendency to relapse with foreseeable worsening of the disease, avoidance of the triggering allergen is not possible. The allergen must have led to the clinical equivalent of allergic contact dermatitis and must not be avoidable by technical-organisational measures, e.g. replacement, or individual preventive measures (protective gloves, protective clothing).

Definition of "repeated relapses":

• At least three episodes of illness, e.g. initial illness followed by two relapses. Relapse requires extensive improvement or healing of the previous episode. Between the relapses, the insured person must be neither in need of treatment nor unable to work, otherwise there is no relapse, but merely an exacerbation or intermittent course.

Definition "Objective compulsion to abandon the harmful activity":

• Recognition requires the objectifiable medical necessity of the abandonment. A termination because of the skin disease is not sufficient as a recognition criterion. For the criterion of "abandonment of all activities" it is decisive that the abandoned activities were the cause for the development of the disease or its aggravation. According to a ruling of the BSG, however, an exception is given (B2U5/03 R of 9.12.03) if new occupational safety measures (e.g. through the replacement of an allergen) now make it possible to remain at the workplace, but an MdE of at least 10% already existed before they took effect.

For the application in expert practice, a case-related evaluation has proven itself as follows (according to Wehrmann):

• Was the harmful noxious agent not sufficiently avoidable?
• Were reasonable and suitable individual preventive measures exhausted?
• Were the medical treatment measures without directional improvement?
• If these three assessment questions can be answered with "yes", it can generally be assumed that the occupational activity is compulsory.

The danger can be given by:

• Exposure to chemical substances: e.g. chromates, alkalis, solvents(turpentine, paint thinner), technical fats and oils (drilling oils, see below acne, occupational acne), plastics, dyes.
• Physical factors: E.g. microtrauma by metal or glass particles, glass wool, asbestos, cut hairs, actinic and possibly thermal stimuli (heat, cold).
• Skin pathogenic germs and possibly plant substances.
• Complicating mucosal reactions (see case report).
• According to No. 1108, skin cancer lesions caused by arsenic or its compounds have to be taken into account.
• According to No. 5102 of the same regulation, "skin cancer or skin lesions tending to cancer caused by carbon black, crude paraffin, tar, anthracene, pix or similar substances" must also be taken into account.
• No. 5103: With the amendment of the Occupational Diseases Ordinance, BK 5103 "Squamous cell carcinoma or multiple actinic keratoses of the skin caused by natural UV radiation" was added to the list of occupational diseases on 1.1.2015.

Other diseases relevant to dermatological assessment are represented by the following numbers:

• No. 2402: Diseases caused by ionizing radiation (e.g. X-ray ulcer).
• No. 3101: Infectious diseases if the insured person has worked in the health service, in charity care or in a laboratory or has been particularly exposed to the risk of infection to a similar extent through another activity (e.g. varicella, zoster, molluscum contagiosum, syphilis, tuberculosis, HIV infection).
• No. 3102: Diseases transmissible from animals to man (e.g. erysipeloid, anthrax, mycoses, tinea corporis).
• No 3104: Tropical diseases (e.g. leprosy, filariasis, leishmaniasis).

In this context, medical reports have to determine the MdE (reduction of earning capacity), see below. Occupational dermatoses and occupational accident.

S.a. Quasi occupational disease

The BK No. 5101 is mainly used for irritant, atopic or contact allergic (hand) eczema. However, it also covers diseases in the area of the mucous membranes adjacent to the skin organ; an oral allergy syndrome (OAS) against various types of eczema is one example. Fish allergens in a cook. With regard to an OAS against unavoidable occupational allergens, there are no adequate remedial measures available within the framework of § 3 BKV. Thus, there is an objective obligation to refrain from the harmful activity since, according to the current BKV regulation for the training occupation of cook, the preparation and seasoning of fish dishes is a sine qua non.

1. Bergner T, Dippel H, Przybilla B (1992) The reduction of earning capacity (MdE) in dermatological assessment. Dermatologist 43: 258-263
2. Landeck L (2011) Oral allergy syndrome and consequences for the training as a cook. Abstract CD 46th DDG-Conference: P05/02
3. Schwanitz HJ et al (1998) Guidelines of the German Dermatological Society (DDG) and the BG for Health Service and Welfare Work AWMF Guidelines Register No. 013/025
4. Seebacher C et al (2057) Tinea of the free skin. J Dtsch Dermatol Ges 11: 921-926
5. Wehrmann W (2003) Severe skin disease in the medical sense. In: Schwanitz HJ, Wehrmann W, Brandenburg S, John SM (Hrsg) Expert Opinion Dermatology Steinkopf Verlag Darmstadt pp. 73-81