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Die Umwelt ist kontinuierlich einem Wandel unterworfen. Expositionen im Arbeitsumfeld und damit verbunden die Bedeutung von beruflichen Typ-I- und Typ-IV-Allergenen konnen sich andern. Die wichtigsten Berufsallergene betreffenden Trends, neue arbeitsplatzbezogene Allergene/Allergenexpositionen, das diagnostische Vorgehen zum Nachweis neuer Allergene in der Praxis und regulatorische Entwicklungen werden dargestellt. Aufbauend auf bekannten, berufsdermatologisch relevanten Allergenexpositionen werden publizierte Trends aus klinischen Kohorten ausgewertet, und erganzend wird eine systematische Literaturrecherche (PubMed 2016–2021) nach neuen Berufsallergenen durchgefuhrt. Zu den Berufen mit der hochsten Inzidenz von arbeitsbedingter allergischer Kontakturtikaria und/oder Proteinkontaktdermatitis gehoren Backer, Landwirte und Landarbeiter, veterinarmedizinisch-technische Assistenten, Tierarzte, Koche, Molkerei- und Viehzuchtarbeiter, Gartner und Friseure. Das hochste Risiko, ein berufliches Kontaktekzem zu entwickeln, besteht im Gesundheitswesen, in der Landwirtschaft, in metallverarbeitenden Berufen und bei Maschinenfuhrern, im Nahrungsmittelsektor, im Dienstleistungsgewerbe und in Bauberufen. Die Suchstrategie „new occupational allerg*“ ergab 603 Hits, „novel occupational allerg*“ 158 Hits; 25 Arbeiten beinhalteten fur die Fragestellung relevante Ergebnisse und werden aufbereitet. Neue berufsdermatologisch relevante proteinbasierte Soforttypallergene wie auch Kontaktallergene werden dargestellt. Es sind aktuelle Trends zu bekannten Berufsallergenen und neue Berufsallergene im Zeitraum 2016 bis 2021 festzustellen. Nur eine eingehende individuelle Arbeitsplatzanamnese und Testung patienteneigener Materialien konnen neue Allergene in der Berufsdermatologie identifizieren.

Die Berufsdermatologie hat sich, insbesondere in den letzten Jahren, zu einem lebendigen und interessanten Spezialgebiet mit interdisziplinarem Charakter entwickelt. Sie umfasst mehr als Handekzeme. Insbesondere in den letzten Jahren hat die immer starker ansteigende Pravalenz der atopischen Dermatitis (AD) auch zu einer Zunahme von atopischen Handekzemen gefuhrt, die beruflich verschlimmert sein konnen. Auch kann anhand von neueren Systemtherapien das Handekzem deutlich besser behandelt werden. Die aktuelle Leitlinie zum Handekzem umfasst eine Palette von verschiedenen topischen und systemischen Therapien. Dennoch zeigen sich in der taglichen berufsdermatologischen Praxis immer noch sehr hartnackige Falle, insbesondere bei den vesikularen Handekzemen. Letztgenannte konnen des Ofteren keiner eindeutigen Ursache zugeordnet werden, was haufig fur die Betroffenen ein groses Problem darstellt. Zudem sollten auch Kofaktoren, wie z. B. chronische Infektionsgeschehen und psychische Erkrankungen, besonders berucksichtigt werden. In diesem Beitrag werden anhand mehrerer berufsdermatologischer Falle besondere Herausforderungen der Berufsdermatologie dargestellt.

Es ist der Aufbau einer berufsdermatologischen Kohorte am Universitatsklinikum Heidelberg vorgesehen. In einer 3‑jahrigen prospektiven multizentrischen Kohortenstudie wird ein neues Diagnostikum, der sog. molekulare Klassifikator, bei mindestens 262 berufsdermatologischen Patienten eingesetzt, um Psoriasis und Ekzem zu differenzieren. Als Kontrollgruppe dient eine Kohorte von 282 berufsdermatologischen Patienten, bei denen die gleiche Verdachtsdiagnose gestellt, aber nicht der molekulare Klassifikator eingesetzt worden war. In 5 Nachbefragungen uber 3 Jahre werden insbesondere Daten zu Diagnosen, Krankheitsverlauf und -schwere, Zeiten der Arbeitsunfahigkeit, Berufsverbleib und Lebensqualitat erhoben. Es soll gezeigt werden, dass eine fruhzeitige Diagnosestellung insbesondere die Auswahl der Therapie, den Krankheitsverlauf, die Anzahl der Fehltage beeinflusst. Die Studie wird von der Deutschen Gesetzlichen Unfallversicherung (DGUV) gefordert.

OBJECTIVES: This study aimed to assess whether the occurrence of skin problems in 2006 (baseline) was associated with response frequency, quitting a job due to health problems, and change in occupational skin exposures in 2009. METHODS: We conducted a three-year prospective study of the general working population of Norway. Associations between baseline indicators (sex, age, education, occupation), and occurrence of skin problems with response frequency at follow-up were assessed with Chi-square test and unconditional logistic regression. Associations between the occurrence of skin problems at baseline with quitting a job due to health problems and skin exposure at follow-up were also assessed with unconditional logistic regression. RESULTS: We found no evidence of an association between the occurrence of skin problems at baseline and a lower response frequency at follow-up. Age, sex, education, and occupation were the most important predictors for response at follow-up. Skin problems at baseline consistently predicted quitting a job due to health problems at follow-up. No evidence of change in the patterns of occupational skin exposures at follow up in 2009 was found for workers reporting skin problems in 2006. CONCLUSION: While skin problems at baseline were not related to a lower response frequency at follow-up, our results suggest that workers reporting skin problems may quit their jobs due to health problems. Preventive efforts are still needed to reduce hazardous occupational skin exposures among workers reporting skin problems.

ObjectivesTo explore the association between N95 respirator wearing and device-related pressure injury (DRPI) and to provide a basis for protecting medical staff from skin injuries.DesignA cross-sectional, multicentre study.Setting and participantsMedical staff of 60 hospitals were selected from 145 designated medical institutions located in the epidemic area where the patients with COVID-19 were treated in China.ResultsIn total, 1761 respondents wore N95 respirators (use alone 20.8%; combination use 79.2%), and the prevalence of DRPI was 59.2% (95% CI 56.93 to 61.53). A daily wearing time of >4 hours (OR 1.62, 95% CI 1.11 to 2.35), wearing a N95 respirator in combination with goggles both with the presence of sweating (OR 13.40, 95% CI 7.34 to 23.16) and without the presence of sweating (OR 0.80, 95% CI 0.56 to 1.14) and wearing only a N95 respirator with the presence of sweating (OR 9.60, 95% CI 7.00 to 13.16) were associated with DRPI. A correspondence analysis indicated that if there was no sweating, regardless of whether the N95 respirator was worn by itself or in combination with goggles, single-site DRPI mainly occurred on the nose bridge, cheek and auricle. If there was sweating present, regardless of whether the N95 was worn by itself or in combination with goggles, multiple DRPI sites occurred more often on the face.ConclusionsThe prevalence of DRPI among medical staff caused by N95 respirators was very high, which was mainly associated with a longer daily wearing time and interaction with sweating. The nasal bridge, cheeks and auricles were the primary protection locations found.

Fish, crustaceans, and mollusks are among the most potent allergenic foods of animal origin and are thus important triggers of work-related immediate-food allergies. In Germany, work-related seafood allergies are of great importance in the fishing and processing industries as well as in the areas of food preparation, food control, and food sales. There is no causal therapy of seafood allergy, only the strict and lifelong avoidance of allergens remains. The following recommendations serve to assess the impact of a seafood allergy with regard to the work opportunities ended by it for the assessment of the reduction of earning capacity (MdE (German for Minderung der Erwerbsfähigkeit)) in the context of the occupational disease number 5101 of the Annex to the German regulation for occupational diseases. As a special feature of work-related seafood allergy with regard to insurance law aspects, it must be taken into account that there is a potential risk of systemic reaction with subsequent multi-organ involvement. For the estimation of MdE in the general labor market, the impact of a seafood allergy can therefore be assessed, depending on its clinical severity, as generally “mild” to “severe” in justified individual cases.

Videogame controller–induced knuckle pads may present in a strikingly unique distribution. Successful paring without recurrence can be achieved when combined with removal of the original insult.

Chronic exposure to trauma, friction, or extreme conditions can generate cutaneous or ungual lesions in sports and certain occupations. Although some of these dermatologic conditions are diagnosed with a naked-eye examination, there are cases in which the provision of the underlying anatomic alterations can be helpful for the diagnosis and management. In comparison with computed tomography or magnetic resonance imaging, ultrasound has the highest axial resolution, which is critical for the observation of anatomic changes in the skin and nail. We review the ultrasound characteristics of frequent cutaneous and ungual lesions related to sports and occupations with a clinical correlation. The ultrasound features in some particular conditions such as "biker's and surfer's panniculitis," "fiddler's neck," piezogenic papules, and lipoatrophy semicircularis, among others, are discussed.

SummaryBackground Recent animal tests have indicated cross-reactivity between methylisothiazolinone (MI), octylisothiazolinone (OIT), and benzisothiazolinone (BIT). Objectives To retrospectively analyse concomitant reactions to different isothiazolinones in patients in an occupational dermatology clinic during the ongoing MI contact allergy epidemic. Methods We searched patch test files (January 2012 to February 2017) for patients with allergic reactions to OIT, BIT, and MI, and analysed their patch test results, occupations, exposure, and diagnoses. Results We found 61 (9.4%) allergic reactions to MI, 19 (2.9%) reactions to OIT and nine (1.4%) reactions to BIT in a total of 647 consecutively tested patients. Seventeen (89%) of the OIT-positive patients had concomitant reactions to MI, whereas only 3 (33%) BIT-positive patients had allergic reactions to MI. The MI reactions in OIT-positive patients were almost exclusively extreme reactions (+++). Exposure to OIT was identified in 26% of the OIT-positive patients, and 56% of the BIT-positive patients had been exposed to BIT. Conclusions Allergic reactions to OIT were strongly associated with extreme reactions to MI, which suggests cross-sensitization. However, BIT reactions were mostly independent.

SummaryBackground Allergic reactions to resol-type phenol formaldehyde resin [phenol formaldehyde resin 2 (PFR2)] are relatively common. It has been suggested that PFR2 should be included in baseline series. However, a recent international study found clinical relevance in only 25% of patients. Objectives To report the results of screening with PFR2 over a 5-year period (2012–2016), and to study the clinical relevance of allergic reactions to PFR2 over a 15-year period (2002–2016). Methods At the Finnish Institute of Occupational Health, PFR2 was added to the baseline series in 2012. We had previously tested PFR2 in the plastic and glue series. We searched the patch test files for patients with allergic reactions to PFR2, and analysed their patch test results, occupation, exposure, and diagnosis. Results During the screening period of 5 years, a total of 10 (1.6%) patients reacted positively to PFR2. Seven of these had occupational allergic contact dermatitis caused by phenol formaldehyde resin (PFR). In 3 patients, we found no exposure to PFR. Over the preceding 10 years, the clinical relevance of 10 additional allergic reactions to PFR2 was similarly high. Conclusions In an occupational dermatology clinic, 70% of PFR2 reactions were clinically relevant. Further studies in general dermatology clinics are needed.

Occupational skin diseases according to BK No. 5101 - "severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease" - is the most commonly reported notifiable occupational diseases in Germany. Following the optimization of measures of primary, secondary, and tertiary prevention, today most individuals affected are able to continue their profession. With the revision of the German ordinance on occupational diseases (BKV) in January 2015, skin cancer caused by UV irradiation was added to the list of occupational diseases. The new occupational disease (BK) 5103 is defined as "squamous cell carcinoma or multiple actinic keratoses of the skin caused by natural UV irradiation". In this context, "multiple" signifies the occurrence of either more than five individual actinic keratosis lesions over the course of 12 months or the presence of field cancerization of > 4 cm(2) . In the following review, important aspects of this new occupational disease will be highlighted and discussed.

Objectives . We investigate the impact of occupational skin disease consultations among outpatients at the Dermatological Department, University Hospital, Northern Norway. Study design . From 1997 until 2004, 386 patients with occupational skin disease were examined and given advice on skin care, skin disease treatment, skin protection in further work, and on the legal rights of patients with this disease. Ten to fifteen years later, we wanted to look at these patients in terms of their work situation, the current status of their disease, the help they received from the labour offices, and their subjective quality of life. Material and methods . In the autumn of 2011 until the spring of 2012, a number of the patients examined in the period from 1997 to 2004 were selected and sent a questionnaire, which they were asked to answer and return, regarding their work situation and the progress and current status of their occupational disease. Results . A total of 153 (77%) patients answered the questionnaire; 71% of these patients were still in work, and further 15% had old-age retired, 13% were working until then; 16% had retired early because of disability; 54% had changed jobs because of their occupational skin disease; 86% of the patients indicated that the skin disease had improved since our previous investigation. Conclusions . Our investigation into patients with occupational skin disease documented that the majority of patients who had received professional dermatological consultation and intervention offers were still in the labour market and had good control of their skin disease 10–15 years later. We discovered that 71% of the patients were still employed. 13% had remained in work until they became old age pensioners. Only 16% dropped out of work because of disability. These high percentages may indicate that our intervention has contributed positively to patients’ work conditions and the course of their skin disease. Keywords: dermatitis; occupational; dermatitis; contact; hand eczema; quality of life; sick leave/working disability; education; professional; retraining (Published: 10 May 2016) Citation: Int J Circumpolar Health 2016, 75: 30100 - http://dx.doi.org/10.3402/ijch.v75.30100

Die zunehmende Anerkennung UV-Licht-induzierter Hautkarzinome als Berufsdermatose in entsprechend exponierten beruflichen Tatigkeiten stellt auch neue Herausforderungen fur die Pravention dar. Seit nahezu 100 Jahren wird ein aktiver Sonnenschutz durch Verwendung von UV-Licht-filternden topischen Praparaten entwickelt. Daruber hinaus wird angestrebt, durch Anwendung verschiedener antioxidativer Prinzipien wie Vitamin E, Vitamin C und pflanzlichen Antioxidantien eine zusatzliche Schutzwirkung zu erzielen. Die Evidenz fur diese Praparate in ihrer zur Anwendung kommenden Formulierung ist aber sehr unterschiedlich wie auch die Verwendung von Tabletten zum Sonnenschutz. Die aktuellen Anderungen der berufsdermatologischen Einordnung von UV-Licht-bedingten Hauttumoren werden verstarkt auch derartige praventive Strategien fordern und in angemessenen klinischen Studien zu belegen sein.

Background One of the greatest challenges in occupational dermatology is the identification of chemical substances used by patients in their work in order to determine their allergenic potential. Numerous techniques have been described for the identification of allergenic compounds. These tests must be sensitive, specific, and safe. We describe a study to detect the presence of paraphenylenediamine (PPD) in hair dyes that are commercially available in Spain. Material and methods We undertook an experimental study involving qualitative and semiquantitative detection of PPD in hair dyes sold in Spain. The qualitative technique we used was a previously described colorimetric method involving dilution of the dye with isopropyl alcohol followed by addition of a reagent solution (1g of vanilla in 15 ml of isopropyl alcohol and 7.5 ml of hydrochloric acid). A quantitative study was then done in which the dye was extracted in 96% ethanol and subjected to 1-dimensional thin-layer chromatography. Results A total of 15 brown and 12 blonde dyes were analyzed. PPD was identified in all of the brown dyes analyzed, irrespective of whether it was indicated (n = 12) or not (n = 3) in the composition. PPD was found in 6 of the 9 blonde dyes that indicated it in the composition and 2 of the 3 in which it was not indicated. Semiquantitative analysis by thin-layer chromatography revealed that the concentration of PPD in brown hair dyes (mean, 3%) was higher than in blonde dyes (mean, 0.1–0.3%). Conclusions The presence of PPD in hair dyes is related to the color of the dye. It is consistently present in darker dyes and at low levels in blonde dyes. This study highlights the clinical and epidemiological importance of identifying allergens in dermatology, particularly in occupational dermatology.

Resume Introduction La prise en charge des dermatoses professionnelles est souvent complexe ; elle necessite des competences a la fois en dermatologie et en medecine du travail. Une consultation specialisee bi-disciplinaire de dermatologie professionnelle a ete mise en place au CHU de Brest depuis 2002. Le but de cette etude est de faire le point sur cinq ans d’activite de cette consultation et d’evaluer la place de l’atopie dans les dermatoses professionnelles. Malades et methodes Entre octobre 2002 et octobre 2007, 247 patients ont eu recours a la consultation bi-disciplinaire de dermatologie professionnelle. Cent quarante-cinq dossiers ont ete selectionnes a partir des criteres de Mathias comme concernant effectivement une dermatose professionnelle. Pour chacun de ces dossiers ont ete releves l’âge, le sexe et la profession du patient, les dermatoses presentees et les allergenes eventuellement impliques, les antecedents d’atopie cutanee ou non cutanee. De plus, 105 patients ont repondu a un questionnaire telephonique portant sur leur ressenti de la consultation, l’evolution de leur dermatose et leur devenir medicosocial. Resultats Les principales dermatoses rencontrees etaient l’eczema de contact (41 %), la dermite irritative (26 %), la poussee de dermatite atopique (10 %) et l’association dermite de contact et dermite irritative (9 %) ; diverses autres affections representaient 14 % des dossiers. Discussion Les professions rencontrees (professions de sante, BTP, metiers de bouche, agriculture, mecanique, coiffure, nettoyage, imprimerie) et les allergenes mis en cause etaient comparables a ceux trouves dans la litterature. Le pronostic etait globalement mediocre (48 % de guerison). La difference entre dermite irritative et dermite de contact etait parfois difficile et reposait sur des arguments cliniques, ainsi que la realisation de tests allergologiques. Un antecedent d’atopie etait present chez 32 % des patients et etait particulierement frequent en cas d’association d’une dermite irritative et d’un eczema de contact, ce qui peut s’expliquer par les mecanismes physiopathologiques de l’atopie. Conclusion L’interet d’une consultation bi-disciplinaire de dermatologie professionnelle est d’optimiser la prise en charge des patients concernes. Une meilleure declaration des dermatoses professionnelles permettrait de mieux les connaitre et donc de mieux les prevenir.

Sogenannte fruhe Basaliome (Auftreten vor dem 40. Lebensjahr) fuhren haufig zu der Fragestellung, ob eine eventuelle Berufsbedingtheit vorliegen konnte. Dies ist beim Auftreten von Neoplasmen – als Unfallfolge – im Rahmen von beruflich bedingten Verbrennungsnarben moglich. Dabei handelt es sich bei Verbrennungsnarben meist um Plattenepithelkarzinome, die nach einer mittleren Latenzzeit von 30 Jahren auftreten, seltener auch Basaliome, deren durchschnittliche Latenzzeiten (20 Jahre) im Vergleich kurzer sind. Treten Basaliome – wie in dem berichteten Fall eines 39-jahrigen als Brenner und Flammer tatigen Versicherten – zu einem sehr fruhen Zeitpunkt in lichtexponierten Bereichen wie dem Gesicht auf und besteht dann gleichzeitig eine anamnestische Angabe einer scheinbar beruflich induzierten Verbrennungsnarbe, so besteht der Verdacht einer Tumorentstehung als Unfallfolge. Nach neueren Konsensusvereinbarungen (Bamberger Merkblatt Teil II) mussen jedoch die Kriterien zur Kausalitat eines Neoplasmas in einer Verbrennungsnarbe nach Ewing erfullt sein: 1. Beweise fur das Vorliegen einer Verbrennungsnarbe, 2. der Tumor muss innerhalb der Grenzen der Narbe entstanden sein, 3. ein bereits vorbestehender Tumor muss ausgeschlossen sein, 4. der histologisch nachgewiesen Zelltyp muss mit den Zelltypen ubereinstimmen, die sich in der Haut und der Narbe finden, 5. es muss ein adequates Intervall zwischen der Narbe und der Tumorentwicklung vorliegen. Zusatzlich muss in lichtexponierten Arealen ein fruhes Auftreten durch kunstliche UV-Strahlungsexposition, die beim Beruf des Flammers hatte gegeben sein konnen, evaluiert und gegebenenfalls ausgeschlossen werden. Neuere populationsbezogene Untersuchungen haben gezeigt, dass in den nachsten Jahren mit einer Zunahme der Basaliome bei unter 40-Jahrigen zu rechnen ist, die differentialdiagnostische Uberlegungen bei der Begutachtung notwendig machen. The early basal cell carcinoma: as consequence of occupational induced burn scar? The occurrence of early basal cell carcinoma (before the age of 40) often leads to the question if it might be induced occupationally. The occurrence of neoplasms in occupational induced burn injury scar – as consequence of an accident – are known for years. Commonly, these neoplasms are squamous cell carcinoma but also basal cell carcinomas may occur. Squamous cell carcinoma occurs after a mean latency period of 30 years while basal cell carcinoma might occur after already 20 years. According to newer regulatory attempts on the field of occupational dermatology (Bamberger Merkblatt part II) certain criteria have to be met before the diagnosis of a burn scar induced neoplasm is given. The Ewing’s postulates require: 1. evidence of a burn scar; 2. tumour within the boundaries of the scar; 3. no previous tumour in that location; 4. tumour histology must be compatible with the cell types found in the skin and the scar; and 5. there is an adequate interval between the burn injury and the tumour development . Additionally – if the squamous cell carcinoma or basal cell carcinoma is situated in light exposed areas like the face – artificial UV-radiation which might be found in certain professions must be discussed as causative agent. Recent population based studies have shown that in the next years an increase of basal cell carcinoma under the age of 40 may occur. This occurrence must induce a differentiated procedure when performing an expertise to rule out or to decide whether an occupational induced disease is at hand.

Objectives: This study assesses both the success of medical practitioners in accessing hazardous substances’ information from product manufacturers and the accuracy and clinical usefulness of Material Safety Data Sheets (MSDS) presented by workers with suspected occupational contact dermatitis (OCD). Patients/Methods: 100 consecutively presented MSDS were collected from 42 workers attending an occupational dermatology clinic. Product manufacturers were contacted to verify ingredients. MSDS were evaluated for compliance with the Australian criteria for listing of OCD relevant information (sensitizers present at a concentration ≥1%, irritants present at a concentration ≥20%), and for clinical usefulness. All sensitizers were checked for clinical relevance to the worker’s dermatitis. Results: Manufacturers supplied product constituents for 77/100 MSDS. 58 MSDS satisfied the Australian standard. 57/58 MSDS were deemed clinically useful. Irritants were listed for 19/23 MSDS and sensitizers were listed for 30/68 MSDS (P = 0.001). 3 MSDS contained sensitizers, which were clinically relevant to the presenting worker’s dermatitis, 1 appropriately listed, 1 present at ≥1% but not listed, and 1 present at

Late patch test reactions on day (D) 10-14, which on subsequent retesting appear in the normal time schedule on D2-D4, indicate active sensitization due to the patch test. The objective of this study was to report our series of late patch test reactions. We analysed the clinical records of all the patients who had reported late reactions for the date of the late reaction, the results of the first patch tests and retesting. Between January 2002 and February 2006, we had a total of 16 patients with late reactions (>or=D10). 12 of them were retested. Retesting confirmed active sensitization to 1 or more allergens in 11 patients (1.3% of 884 patients patch tested). In these 11 cases, none of the late reactions had clear relevance to the symptoms before its appearance. The commonest allergens were paraphenylenediamine (PPD) in 6 patients (0.72% of 826 PPD tests), elecampane (Inula helenium) and black-eyed Susan (Rudbeckia sp. hybr.) extracts in 3 patients, and 4-aminoazobenzene and Disperse Orange 3 in 2 patients. The late reaction did not generally affect the clinical course. Only 1 patient developed new dermatitis possibly due to active sensitization. Late reactions meeting the classic criteria of active sensitization were relatively common in our series from a special clinic of occupational dermatology.

Hand eczema is a disease of long duration, affecting the individual and society. The purpose of this study of 100 patients (51 females and 49 males) at an occupational dermatology clinic was to investigate whether the generic questionnaire Short Form-36 (SF-36), and the dermatology-specific Dermatology Life Quality Index (DLQI) are appropriate for assessing health-related quality of life (HRQL) in patients with hand eczema, and whether gender differences in HRQL could be detected. HRQL was affected by hand eczema, measured with both SF-36 and DLQI. The SF-36 showed more impaired HRQL for females than for males, in the mental health dimension, whereas no gender-related differences were detected with the DLQI. To compare the instruments we used factor analysis, with a polychoric correlation matrix as input, thus taking the ordinal aspect of the data into account. There was a high correlation between the instruments for physical health, but lower for mental health. In this context our interpretation of the factor analysis is that the SF-36 measures mental health better than the DLQI. The SF-36 therefore appears suitable for use in future studies for measuring HRQL, and gender differences in HRQL, in persons with reported hand eczema.

Das World Wide Web (WWW) bietet inzwischen Arzten und zugleich auch ihren Patienten eine Fulle von medizinischen Quellen, die innerhalb kurzer Zeit abgerufen werden konnen und das tagliche Arbeiten vereinfachen. Allerdings ist es oft schwierig, die benotigten Daten aus der Masse der Angebote herauszufiltern, und leider ist auch die Qualitat vieler medizinischen Webseiten mangelhaft, mit oft fragwurdigen und unbelegten Auskunften. Fur Berufsdermatologen kann das Internet besonders nutzlich sein, weil sie fur ihre Tatigkeit Informationen von einer Vielzahl von Institutionen benotigen. Viele davon konnen mittlerweile uber das Internet bezogen werden. In dieser Arbeit wird eine Auswahl deutschsprachiger Internetseiten vorgestellt und beschrieben, die fur den berufsdermatologisch tatigen Arzt von Interesse sein konnen. Ziel ist es dabei, ihm eine Sammlung von Webseiten zur Erleichterung seiner Arbeit zur Verfugung zu stellen. Anhand von Kriterien wie Design, vorhandener Suchfunktion, Linksammlung oder medizinischer Information wird die Qualitat der angefuhrten Webseiten bewertet. Die Ergebnisse zeigen besonders bei der Transparenz der Daten Mangel. So ist haufig weder ersichtlich, von wem die Angaben stammen, noch wann sie zuletzt aktualisiert wurden.

Moisturizers are frequently used in the prevention of occupational contact dermatitis. This review discusses their chemistry and mode of action. Methods to prove their preventive efficacy are presented. In addition to pharmacological efficacy, subjective factors that influence application of the products and compliance come into play. In conclusion, moisturizers are only one element of skin-disease prevention at the workplace that should be viewed as a complex, inter-dependent system. The efficacy of the complete, integrated system of occupational skin care has to be proven.

Warmth is one of mankind's oldest remedies. Approximately 43% of solar radiation reaching the earth is infrared radiation (IR). In the course of history man got himself his own thermal radiators, namely fire, hot stones, stoves, sauna, later on therapeutic IR equipment and more recently millions of low-cost IR cabins mainly for wellness and fitness purposes at home. Effects of infrared radiation on human beings and their skin mainly depend on wavelength, amount and frequency of application. Nearly all of far IR radiation (IRC) becomes absorbed inside upper epidermis whereas substantial amounts of near IR (IRA) reach small superficial blood vessels, being transported by flowing blood and warming up the body from inside. This may result in different beneficial effects or damages. History, technology, kinetics, applications, physiology, pathology, advantages, hazards, the need for recommendations and regulations, and possible future developments in use of artificial IR are discussed. In the old clays of occupational dermatology erythema ab igne (Hitzemelanose), heat smart and heat cancer of professionals like blacksmith, welder, stoker, baker or actor had been well-known. On the other hand beneficial effects of all the kinds of artificial IR should be investigated carefully.

Cement, in particular Portland cement, is now widely used in the field of civil engineering and the construction industry. High alkalinity of wet cement and its tiny content of water-soluble chromate can cause occupational skin diseases. In this paper, we report four cases of contact dermatitis by cement and two cases of cement burn. The occupation of the patients included two plasterers, a truck driver, a manufacturer of cement ware and two construction workers. Skin of the hands and fingers of the cement dermatitis cases was dry and fissured, and had hyperkeratotic papules and erythemas or acute exudative eczematous lesions. In one of these cases, the eczematous lesions spread to the face, extremities and trunk. All cases resulted in a positive patch testing for sodium dichromate. The cement burn cases developed severe necrotic ulcers on the leg and/or foot following prolonged contact with wet cement inside their boots. Patch testing was negative for chromate. A field trip to a construction worksite showed that method of working as well as worker's clothing at present could not thoroughly protect the skin. Therefore we concluded that better protective clothing and gloves should be used and that working conditions be improved. Most skin diseases caused by cement occur among workers at small-scale enterprises. Therefore it is desirable that regional occupational health centers, which were established to promote the health care system for workers at small-scale enterprises, take prompt measures to avoid the skin diseases.

Occupational skin disorders are very common and are a surprisingly frequent cause of lost work time. Failure to suspect an occupational cause can lead to repeated treatment failure and needlessly prolong patient misery and frustration. Primary care providers play a key role in recognizing possible occupational causes and arranging appropriate education, preventive measures, and treatment. Occupational skin conditions often occur in nonindustrial settings in workers such as hardressers, health care personnel, and food handlers. Irritant contact dermatitis is by far the mos prevalent occupational skin conditions and is emphasized in this article. Allergic contact dermatitis, infections, skin cancers, and acneform eruptions may also have significant occupational associations. We will present criteria that suggests on occupational exposure, list common offending agents, and review the clinical presentations and relevant pathophysiology. We provide guidance on a directed history and physical examination and suggest when diagnostic testing is most likely to have value. Finally we outline preventive measures such as contact avoidance, barrier creams, and protective gloves and address therapy and indications for referral.

In occupational dermatology, repeat patch testing is a frequent occurrence when an expert opinion is required. As a result, discrepancies in test results may affect the legal position in respect of insurance and a reduction in the level of disability. The strip patch test (SPT) supports the diagnosis of allergic contact dermatitis when a weak sensitization is present or when a weak sensitizer with poor epidermal penetration is involved leading to a false-negative patch test result. We report on a 30-year-old man working as an industrial mechanic from 1995 to 2006. After approval of an occupational disease no. 5101 of the German ordinance on industrial disease in 2007, he went to court claiming compensation. The sensitization with clinical and occupational relevance to potassium dichromate that was decisive for the evaluation for insurance purposes was first confirmed in a patch test in 2005. Succeeding tests in 2006 in the context of an expert opinion and in 2008 in the context of our decisive expert opinion remained negative. We could reconfirm the potassium dichromate sensitization only by the SPT performed in the proposed standardized manner. The potassium dichromate allergy was the determining factor in the assessment for insurance purposes. This resulted in an adjustment in the severity of disability and a pension entitlement. From this case it is obvious that the detection of a SPT-positive and patch test-negative sensitization may have a significant impact on the situation with respect to the legal and insurance position.

From the beginning of 1990 a trained nurse has been employed at our Department of Dermatology to give information about skin care, allergen avoidance and skin protection to the patients. To find out the possible benefit obtained by this patient education, a questionnaire was sent out to 540 patients who had been diagnosed with an occupational skin disease established at the Department of Dermatology between 1985 and 1992. It is evident that direct comparison in this kind of longitudinal follow-up must be carried out with great criticism, since changes in patients' work exposure and socioeconomical situation during the follow-up time will also affect the prognosis. In this study, 424 patients returned the questionnaire, 252 who had been examined before 1990 and 172 later. According to the answers, it appeared that during the last 12 months, the majority (65%) had suffered from dermatitis, 13% from constant and 52% from periodic symptoms. However, when the diagnosis had been irritant contact dermatitis without allergens found, the prognosis was signicantly better (p < 0.008) among those who had received “extra education” and none had persistent dermatitis. Patients with contact allergy to metals or synthetic resins had also managed better, as compared to those who had received traditional treatment (p < 0.002, p < 0.003). Other factors such as personal motivation and possibilities for work reorganization were also important for the prognosis. 60% of patients were not initially aware of the decision given by the insurance companies, although 94% of their skin diseases had been accepted as occupational dermatoses. Generally, the patients were satised with the extra information given by the nurse.

The clinic for Dermatology and Allergology Wiesbaden is a Public Hospital for maximal medical care and a Teaching Hospital of the Unversity of Mainz. The whole range of dermatology, venerology and allergology is provided. At the ward with 34 beds, 1400 patients are treated per year. Additionally, the whole spectrum of dermatology is offered at the daily care unit and the outpatient department. Main fields of interest are dermato-oncologic surgery, aesthetic reconstructive dermato-surgery, allergology and occupational dermatology. In 2006, six clinical studies started and five studies in aesthetic reconstructive dermatology were concluded. Four new conferences were held, called the "Wiesbadener Dermatologenabende” with certified training. Projects for the reduction of MRSA infection time at the ward and for an interdisciplinary wound concept were successfully finished.

The dermatology clinic in Krefeld has treated a wide range of patients since its founding in 1845. Nowadays the spectrum consists of allergology, occupational dermatology, phototherapy, dermatosurgery, phlebology and proctology as well as special clinics for andrology, sexually transmitted diseases and patients with HIV-infection.

Studies on occupational skin diseases in workers of the automotive industry are few.To investigate the prevalence of occupational skin diseases in workers of the automotive industry.Between September and December 2011, a total of 405 workers from the automotive repair industry in Diyarbakır were interviewed. They were active workers in the repair industry who had been employed for at least six months. Business owners, sellers of spare parts and accounting officers were not included. The employees were examined at their workplaces and the working conditions were observed. Detailed dermatological examination was performed.The mean age of the 405 workers who participated in the study was 27.7 ± 10.3. The mean working time of employees was 13.3 ± 10.4 years. All of the employees were male. Dermatological diseases were not detected in 144 out of 405 workers (35.6%) and at least one condition was diagnosed in 261 (64.4%). The most frequent diagnosis was callus, hyperkeratosis, clavus (27.7%), followed by nail changes (16.8%) and superficial mycoses (12.1%). Contact dermatitis was seen at a rate of 5.9%.Traumatic lesions such as hyperkeratotic lesions and nail changes were found most frequently. Traumatic lesions were common among individuals who did not use gloves. Most nail changes were localized leuconychia, a finding not reported in the studies on automotive industry workers. In accordance with the literature, irritant contact dermatitis was observed in patients with a history of atopy and who had been working for a long time.Occupational skin diseases comprise an important field in dermatology, deserving much attention. Further studies on occupational dermatology are necessary.

The author presents four cases in which investigation has led to new knowledge of causes and new diagnostic tools for occupational dermatoses.

Background: Over the years, studies have been performed to analyze contact dermatitis in metalworkers. Results for industrial workers in general have shown that about 25% clear, 50% improve, and 25% do no better or worsen. This retrospective study looked at the machinists who were treated in the occupational dermatology clinic at the Hershey Medical Center to evaluate their presentation, patch test results, diagnosis, and prognosis. In addition, we looked at the usefulness of patch testing in the subjects' outcome. A total of 20 machinists' charts were reviewed. Results: Five workers had allergic contact dermatitis, five had irritant contact dermatitis, four had endogenous dermatitis, and six had mixed dermatitis. Conclusions: We found that 25% of our workers cleared (5 of 20), 55% improved (11 of 20), and 20% were unable to be reached to further evaluate their prognosis (4 of 20). The results of patch testing seemed to have aided the improvement or clearance of dermatitis in seven cases.

Clinical Epidemiology.- Classification of Occupants.- Dermatotoxicology.- Systemic Toxicity.- Occupational Marks.- Job Fitness Evaluation.- Diagnostic Patch Testing.- Therapy.- Prevention and Rehabilitation.- Computerized Product Database.- Job Descriptions with their Irritants and Allergens.- List of Patch Test Allergens.

In experimental dermatology, the determination and evaluation of parameters of individual skin sensitivity has long been an object of research. It is noticeable, however, that persons who do not suffer from sensitive skin have hardly been the subject of scientific research. Important knowledge could also be gained from research into parameters that require and/or lead to the development of specific insensitivity, which could be put to use for preventative and therapeutic needs. In this study into the ‘hardening effect’, an assessment will be made of factors relating to the individual’s (in)sensitivity of the skin, factors which have previously been neglected and run counter to current discussion among experts.

Objectives: The Surveillance by General Practitioners of Occupational Contact Dermatitis Project (Spot) has been designed to provide disease estimates for occupational contact dermatitis within a defined geographic area in Melbourne, Australia. Method: Spot collected reports of occupational contact dermatitis from four separate sources: general practitioners, dermatologists, a Dermatology Outpatient clinic, and an Occupational Dermatology Clinic. Case definition was stratified into two levels, suspected and confirmed. All cases of suspected occupational contact dermatitis reported to Spot were assessed and required to undergo diagnostic confirmation, including appropriate patch testing by an occupational dermatologist. The rates generated by Spot were compared to the rates generated by Victorian workers’ compensation data (Victorian Work Cover Authority) for “Contact dermatitis and other and unspecified dermatitis.” Results: To date, a total of 125 suspected cases have been reported to Spot. 56 cases of occupational contact dermatitis have been confirmed with an incidence rate of 12.5 per 100,000 full-time workers and a prevalence rate of 28 per 100,000. This can be compared to the rate from Victorian WorkCover Authority of 4 per 100,000 (with information not available for incidence or prevalence). Conclusions: Although limited by resources, clinician and worker participation rates, Spot provides a better estimate for occupational contact dermatitis in an Australian urban setting than that currently available through workers’ compensation statistics. The information generated by Spot will provide an important contribution towards the characterisation of occupational contact dermatitis in Australia.