Occupational dermatoses L25.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Occupational skin diseases

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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).

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

General therapy
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  • 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 has to be treated "with all appropriate 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 ingredients 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 subtoxic 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.


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.

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


Gum ingredients, pesticides, medicines


Chromate, rubber ingredients

Nursing professions

gum ingredients, disinfectants, pharmaceuticals, cosmetic ingredients


Flowers (primroses, composite plants), pesticides


Chromate, rubber ingredients

Machining professions

Preservatives, oil additives

Cleaning professions

Disinfectants, rubber ingredients

Food Professions

disinfectants, food, preservatives


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

Dental Technician

Acrylates, metals

Body mechanic

Epoxy resins, oil additives, cooling lubricants


Developers (P-phenylenediamine derivatives), rubber ingredients


Wood, varnishes, resins, adhesives


Chromate, epoxy resins, acrylates


cooling lubricants, rubber ingredients

Protective gloves in different professions





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 machining 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



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


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


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


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


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


Physioderm cream, Stefatop lotion

List with possible dermatological diseases

Occupational disease number



Diseases caused by chemical agents


Metals and metalloids


diseases caused by lead or its compounds


Diseases caused by mercury or its compounds


diseases caused by chromium or its compounds


diseases caused by cadmium or its compounds


diseases caused by manganese or its compounds


diseases caused by thallium or its compounds


diseases caused by vanadium or its compounds


diseases caused by arsenic or its compounds


diseases caused by phosphorus or its inorganic compounds


diseases caused by beryllium or its compounds


Asphyxiant gases


Diseases caused by carbon monoxide


Diseases caused by hydrogen sulphide


Solvents, pesticides and other chemical substances


Diseases caused by hydrogen halides


Diseases caused by benzene, its homologues or by styrene


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


Diseases caused by carbon disulphide


Diseases caused by methyl alcohol (methanol)


Diseases caused by organic phosphorus compounds


diseases caused by fluorine or its compounds


Diseases caused by nitric acid esters


Diseases caused by halogenated alkyl, aryl or alkylaryl oxides


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.


Diseases caused by ionising radiation


diseases caused by infectious agents or parasites and tropical diseases


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


Diseases transmissible from animals to humans


Tropical diseases, typhus


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

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  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


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020