Psoriasis palmaris et plantaris, occupational dermatological aspects L40.3

Psoriasis palmaris et plantaris , occupational dermatological aspects

The association between trauma and psoriasis was first described by Heinrich Köbner and is called the Köbner phenomenon. The stimuli that occur can also be of occupational nature and therefore have occupational dermatological relevance.

Evidence of occupational causation (varies according to Angelovska):

• Initial manifestation of palmoplantar psoriasis during occupational activity
• Localization of palmoplantar psoriasis at the body region whose work-related stress exceeds an opportunity cause.
• Detectable work-related stress (mechanical and/or chemical, rarely microtrsumrn or contact sensitization)
• Improvement/healing with reduction of occupational exposure (vacation/interruption of work)
• In case of renewed occupational exposure Deterioration/relapse in close temporal relation to re-exposure
• Medically documented occupational exposure-congruent course of disease.

Evidence of occupational aggravation (varies according to Angelovska):

• The psoriasis disease was already present when starting work
• Psoriasis increases in intensity in a work-related heavily loaded localization while exercising the professional activity objectifiable (deterioration of psoriasis on the palms of the hands)
• There is a detectable work-related stress (mechanical and/or irritative, rarely microtrauma or contact sensitisation)
• Improvement of palmoplantar psoriasis with reduction of occupational exposure
• worsening of palmoplantar psoriasis in close temporal relation to occupational exposure
• Medically documented occupational exposure-congruent course of disease.

Since psoriasis palmaris et plantaris is a congenital disease, the insured person is "protected in the condition in which he was at the beginning of the damaging activity" (analogous to atopic eczema). This protection includes all predispositions, disease dispositions and constitutional weaknesses, i.e. also the genetic disposition for psoriasis. The causal factor "disposition" is to be evaluated (as part of the cause) like any other factor.

In general, a distinction must be made between occupationally caused and occupationally aggravated psoriasis palmoplantaris. In the first case, the total damage must be compensated. In the second case, only the amount of damage that the damaging effect has added to the existing damage, i.e. the underlying disease.

Within the framework of an assessment, it must be clarified whether the occupational activity is a significant partial cause or only an occasional cause in addition to "other non-occupational trigger factors". An indication for " an essential partial cause " is the documented work-related deterioration of the course of the disease on the palms of the hands (as areas of skin that are particularly stressed at work) as well as an improvement after a longer period of not working. In principle, it must be clarified and recorded by expert opinion whether the extent and type of extra-occupational stress does not even exceed the actual occupational stress and thus represents "the essential cause". If the occupational activity represents at least one significant partial cause (among other equivalent causes) for the triggering or maintenance of palmoplantar psoriasis, a BK 5101 in the sense of occupational causation must be recognised, provided the other requirements of the BK 5101 are fulfilled.

1. Angelovska I et al. (2014) Palmoplantar Psoriasis in Working Life: A Case Series from the Practice in Consideration of the S1 Guideline for Occupational Dermatological Assessment of Psoriasis.JDDG 12:697-706
2. Erlenkämper A (1998) Social law for physicians, Thieme Verlag , 206-231
3. Schmidt A (1994) Atopy and expert opinion. Allergology 17: 94-96