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BACKGROUND Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. OBJECTIVES To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. METHOD The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. RESULTS Consensus was achieved for several statements and management strategies. CONCLUSION The updated guideline should improve management of hand eczema.

Veterinary assistants and veterinarians are at an increased risk of developing an occupational skin disease, for example, irritant/allergic contact dermatitis, contact urticaria and hand eczema (HE).We aimed to investigate the prevalence of skin problems and the influence of predisposing factors especially among veterinary assistants.We conducted a cross-sectional study among veterinary assistant staff (n = 103) and veterinarians (n = 19). A questionnaire, specific IgE determination and photographs of hands were evaluated for skin symptoms. Logistic regression models assessed predisposing factors.Over 50% (n = 62/122) of our study population reported hand eczema (HE) in the last 12 months (1-year prevalence). Twenty-seven subjects reported redness and contact urticaria directly after animal contact, 35 had a positive history of allergic contact dermatitis. HE was associated with (i) increased frequency of hand washing (11-15 times per day; OR 4.15, confidence interval [CI] 95% 1.18-14.6, p = 0.027, univariate model) and (ii) unprotected contact to fluids and tensides5 times per day (OR 4.56, CI 95% 1.53-13.6, multivariate model).We observed a high prevalence of self-reported HE among staff in veterinary practices. Excessive hand washing, unprotected contact with irritants and long-term glove use should be avoided.

Die Teledermatologie ist die Verwendung von Telekommunikationstechnologien zum Austausch medizinischer Informationen für Diagnostik, Konsultation, Therapie und Lehre in der Dermatologie. Während ihr Einsatz bei einem breiten Spektrum dermatologischer Diagnosen evaluiert wurde, liegen nur wenige Studien zu Validität, diagnostischer Präzision, Machbarkeit und Kosteneffektivität in der Berufsdermatologie vor; diese zeigen aber ein erhebliches Potenzial sowohl für Diagnostik, Prävention, Therapiebegleitung und Nachsorge von Berufskrankheiten der Haut. Ein dermatologisches asynchrones (Store and Forward; SAF) oder synchrones Telekonsil könnte Arbeitsmediziner und Betriebsärzte bei der gesetzlichen arbeitsmedizinischen Vorsorge in hautbelastenden Berufen, aber auch beim Hautkrebsscreening von Outdoorworkern unterstützen und so zu rascherer Prävention oder gezielter Berufskrankheitenmeldung beitragen. Mittels moderner von Technologien der künstlichen Intelligenz unterstützter mobiler Smartphone-Apps kann auch das Selbstmonitoring von Beschäftigten in Risikoberufen verbessert werden.

Teledermatology is the use of telecommunication technologies to exchange medical information for diagnosis, consultation, treatment and teaching in dermatology. While its use has been evaluated in a wide range of dermatological diagnoses, only few studies exist on its validity, diagnostic precision, feasibility, and cost-effectiveness in occupational dermatology. However, these studies show a considerable potential for diagnosis, prevention, treatment support and follow-up of patients with occupational skin diseases. Asynchronous (store and forward; SAF) or synchronous dermatology teleconsults could assist occupational medicine specialists not only in occupational preventive care, but also in the context of skin cancer screening in outdoor workers. Thus, teledermatology might contribute to earlier prevention and notification of occupational skin diseases. Modern smartphone apps with artificial intelligence technologies may also facilitate self-monitoring in employees working in high-risk jobs.

Background Squamous cell carcinoma (SCC) is among the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting UV-exposure during leisure time. However, the relative impact of occupational and non-occupational UV-exposure for SCC occurrence is unclear. Objectives To investigate the association between occupational and non-occupational UV-exposure with SCC in a multicenter population-based case-control study hypothesizing that high occupational UV-exposure increases the risk for SCC. Methods Consecutive patients with incident SCC (n=632) were recruited from a German national dermatology network. Population-based controls (n=996) without history of skin cancer were recruited from corresponding residents’ registration offices and propensity score matched to cases. Lifetime UV-exposure, sociodemographic and clinical characteristics were assessed by trained physicians. Occupational and non-occupational UV-exposure dosages were estimated by blinded investigators using established reference values. Odds ratios (OR) and corresponding 95%-confidence intervals (95%-CI) were assessed using conditional logistic regression adjusting for relevant confounders. Results Total solar UV-exposure was significantly associated with an increased SCC. The OR (95%-CI) for high (>90th percentile) vs. low (

The aim of this study was to investigate the role of occupational and nonoccupational ultraviolet (UV)-exposure concerning the development of basal cell carcinoma (BCC).We undertook a population-based multicenter case-control study. Patients with first incident BCC (n = 836) were propensity score matched by age and sex to controls without skin cancer (n = 836). Sociodemographic characteristics, clinical characteristics, and lifetime UV-exposure were assessed by trained investigators. The differential estimation of occupational and nonoccupational UV-exposure dosages was based on validated instruments and established reference values. Associations were assessed using multivariable-adjusted conditional logistic regression models.Individuals with high levels of occupational UV-exposure were at significantly increased BCC-risk compared with individuals with low [odds ratio (OR) 1.84; 95% confidence interval (95% CI) 1.19 to 2.83 and moderate (OR 1.97; 95% CI 1.20 to 3.22) occupational UV-exposure. Nonoccupational UV-exposure was not independently associated with BCC.Skin cancer prevention strategies should be expanded to the occupational setting.

Zusammenfassung Beruflich bedingte Handekzeme stehen an der Spitze der angezeigten Berufskrankheiten. Zur Primar-und Sekundarpravention von beruflich bedingten Handekzemen werden sog. berufliche Hautmittel – worunter Hautschutz, Hautpflege- und Hautreinigungsmittel verstanden werden – eingesetzt. Im Sinne einer evidenzbasierten Medizin sollten nur solche Praventivmasnahmen bzw. nur solche beruflichen Hautmittel Verwendung finden, deren Einsatzmoglichkeiten und Wirksamkeit wissenschaftlich untermauert werden kann. Zu diesem Zwecke hat die Arbeitsgemeinschaft fur Berufs- und Umweltmedizin e.V. (ABD) der DDG und die Deutsche Gesellschaft fur Arbeits- und Umweltmedizin (DGAUM) den wissenschaftlichen Kenntnisstand und Empfehlungen dazu, in der aktualisierten Leitlinie dargelegt. Im Rahmen von rezenten klinisch-epidemiologischen Studien konnte der Benefit der kombinierten Anwendung von Hautschutz- und Hautpflegeprodukte in der Primar- und Sekundarpravention beruflich bedingter Kontaktekzeme weitgehend bestatigt werden. Die Leitlinie legt ferner dezidiert die Notwendigkeit der Darlegung des Wirksamkeitsnachweises von Hautschutz und Hautreinigungsmitteln durch in-vivo – Methoden im Sinne repetitiver Applikationen dar. Hierzu wurden zwischenzeitlich durch Multicenterstudien sowohl fur Hautschutzpraparate als auch fur die Hautreinigung transferfahige und standardisiertes Testverfahren fur die Untersuchung des Irritationspotentials und damit der Hautvertraglichkeit beruflicher Hautreinigungsmittel und der Reduktion der Irritation durch Hautschutzmittel entwickelt und multizentrisch validiert. Auserdem wird der Stand der aktuellen Sicherheitsbewertung der beruflichen Hautmittel dargelegt.

We present the case of a 52-year-old woman with a topic dermatitis since adolescence who developed work-related hand eczema, cough and runny nose 12 years after she had started working as a laboratory technician at a precious metals refinery. While skin prick test with sodium hexachloroplatinate (SPTPt ) was negative, patch testing with ammonium tetrachloroplatinate was positive after 24, 48, 72, and 96 hr. Inhalation challenge with sodium hexachloroplatinate yielded cough, mild shortness of breath, and a maximal decrease of FEV1 of 8% from baseline 24 hr after the challenge. Significant increases of bronchial hyperresponsiveness, exhaled nitric monoxide and sputum eosinophils were documented after the challenge. We conclude that eosinophilic airway disease due to platinum salts may occur in SPTPt negative subjects. Both, patch testing and inhalation challenge with platinum salts should be considered in SPT negative subjects with occupational exposure to precious metal salts and work-related allergic symptoms.

Zusammenfassung Die Leitlinie gibt evidenz- und konsensbasierte Empfehlungen zum Management von Handekzemen. Sie berucksichtigt einen systematischen Cochrane-Review „Intervention for hand eczema“, der auf einer systematischen Literatursuche (einschlieslich Handsuche) basiert. Zusatzlich zu den evidenz- und konsensbasierten Empfehlungen zur Therapie von Handekzemen (HE) werden auch uberwiegend konsensbasierte Empfehlungen zur Diagnostik und Pravention (primare und sekundare Pravention) gegeben. Die Therapieempfehlungen umfassen nichtmedikamentose, topische, physikalische und systemische Behandlungsmoglichkeiten. Topische Glukokortikosteroide sind Therapie der ersten Wahl, jedoch wird eine Anwendung uber einen Zeitraum langer als sechs Wochen nur in Ausnahmefallen und unter sorgfaltiger arztlicher Kontrolle empfohlen. Alitretinoin wird als Therapie der zweiten Wahl (nach topischen Glukokortikosteroiden) fur Patienten mit schweren chronischen Handekzemen empfohlen. Fur andere systemische Therapieverfahren fehlen derzeit randomisierte klinische Studien (RCTs). Ein direkter Therapievergleich der unterschiedlichen systemischen Medikamente in RCTs wird gefordert. Die Leitlinie wurde von einer Arbeitsgruppe der European Contact Dermatitis Society (ESCD) in einem offentlichen Prozess mit dem Ziel entwickelt, aufgrund des derzeitigen Erkenntnistandes evidenz- und konsensbasierte Empfehlungen zu geben. Die Konsenskonferenzen wurden von einer professionellen Moderatorin der AWMF (Arbeitsgemeinschaft der medizinischen Wissenschaften) geleitet. Eine finanzielle Unterstutzung durch die pharmazeutische Industrie erfolgte nicht. Die Leitlinie ist bis Dezember 2017 gultig.

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest.

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful me-dical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in “head-to-head” RCTs are needed.The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wis-senschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medi-cal Societies in Germany).No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest.

We present the case of a 53 years old nonatopic female nurse who experienced repeated anaphylactic reactions at work without involvement in drug-specific tasks such as crushing of tablets or preparation of injections. The causal allergen was not identified until a further severe anaphylactic reaction occurred after oral use of cefuroxime during a respiratory infection. Sensitization to cefuroxime was demonstrated by specific IgE, basophil activation test and skin prick test. An inhalation challenge with a dosimeter induced generalized urticaria after a cumulative dose of about 10 μg of the drug, but no asthmatic reaction. Complete exposure cessation was initiated and a 1-year follow-up was without further allergic reactions. We conclude that work-related systemic allergic reactions to β-lactam antibiotics may occur in nurses after inhalation of low doses and without perceived association with drug-specific tasks like handling of antibiotics.

N-Phenyl-2-naphthylamine (P2NA) is an antioxidant used to protect rubbers from flex-cracking. P2NA can be converted in vivo to 2NA, one of the most potent bladder carcinogens. Here, we report the specific and ultra-sensitive quantification of P2NA in the receptor fluid of Franz diffusion cells by gas chromatography and isotope-dilution tandem-mass spectroscopy (GC-MS/MS). The experimental conditions were optimized to minimize losses of P2NA due to surface absorption on glass, plastic, and rubber material, and subsequently validated. Static and dynamic diffusion cell conditions were used to study the percutaneous penetration of P2NA into freshly prepared porcine skin. The experimental settings closely resembled those of the printing industry in the 1960s/1970s in Germany where P2NA-containing solutions in dichloromethane have been used. P2NA penetrated the skin at very low levels (0.02 ± 0.01 µg/cm

Zusammenfassung In Deutschland sind uber 2,5 Millionen Arbeitnehmer aufgrund ihrer beruflichen Tatigkeit als Outdoor-Worker im besonderen Mase gegenuber naturlicher UV-Strahlung exponiert. Der Arztliche Sachverstandigenbeirat „Berufskrankheiten“ beim Bundesministerium fur Arbeit und Soziales hat den Zusammenhang zwischen beruflicher UV-Strahlung und Hautkrebs gepruft und empfohlen, in die Anlage1 zur Berufskrankheiten-Verordnung folgende neue Berufskrankheit aufzunehmen: „Plattenepithelkarzinome oder multiple aktinische Keratosen der Haut durch naturliche UV-Strahlung“. Es wird aus Sicht der Arbeitsgemeinschaft fur Berufs- und Umweltdermatologie (ABD) in der Deutschen Dermatologischen Gesellschaft (DDG) und der Deutschen Gesetzlichen Unfallversicherung (DGUV) dargestellt, welche Voraussetzungen fur eine Meldung und Anerkennung einer beruflichen Hautkrebserkrankung durch naturliche UV-Strahlung erfullt sein mussen.

In Germany over 2.5 million employees have an increased risk of skin cancer due to their occupational exposure to natural UV-irradiation. The medical consultation board "Occupational diseases" of the Ministry of Labor and Social affairs has investigated the association between occupational UV-irradiation and skin cancer risk and recommends to add the following new occupational disease into the appendix1 of the German ordinance on occupational diseases: "Squamous cell carcinoma and multiple actinic keratosis due to natural UV-irradiation". In this article we report in the view of the German Society of Occupational and Environmental Dermatology (ABD) and the German Statutory accident insurance (DGUV), whose criteria have to be fulfilled for the notification and recognition of an occupational skin cancer due to natural UV-irradiation.

ZusammenfassungHintergrund Die Psoriasis ist eine anlagebedingte Erkrankung. Krankheitsschube konnen durch exogene mechanische oder irritative Reize ausgelost werden. Bei der berufsdermatologischen Behandlung/Begutachtung muss differenziert werden, ob die berufliche Tatigkeit mit der Erkrankung in ursachlichem Zusammenhang steht oder ob der Spontanverlauf der Psoriasis im Vordergrund steht. Ziel der vorliegenden Arbeit ist, die sozialrechtlich bedingten Grundlagen fur eine einheitliche Beurteilung darzustellen. Patienten und Methodik Unter Kenntnis der bestehenden Begutachtungsempfehlungen und Rechtsprechung wurden Empfehlungen zur Begutachtung von Patienten mit Psoriasis und arbeitsbedingten Einflussen in einer Arbeitsgruppe der Arbeitsgemeinschaft fur Berufs- und Umweltdermatologie (ABD) und der Deutschen Kontaktallergie-Gruppe (DKG) in der Deutschen Dermatologischen Gesellschaft (DDG) entwickelt. Ergebnisse Voraussetzung fur eine Berufskrankheit ist, dass zwischen versicherter Tatigkeit und Hautkrankheit ein ursachlicher Zusammenhang (im Sinne der Entstehung oder der Verschlimmerung) besteht. Dies ist der Fall, wenn die berufliche Tatigkeit die alleinige oder eine rechtlich wesentlich mitwirkende Bedingung fur die Erkrankung darstellt. Ein rechtlich wesentlicher Ursachenzusammenhang ist zu verneinen, wenn fur die Auslosung der Krankheitserscheinungen gewohnliche Belastungen des taglichen Lebens ausreichen (Gelegenheitsursache). 1995–2010 wurden 130 Psoriasisfalle von den Unfallversicherungstragern als berufsbedingt anerkannt. Schlussfolgerungen Bei der berufsdermatologischen Begutachtung von Psoriasiserkrankungen handelt es sich um eine Einzelfallbeurteilung durch den Gutachter. Im vorliegenden Positionspapier werden Empfehlungen zur einheitlichen Beurteilungsgrund­lage im Hinblick auf Diagnosesicherung, Beurteilung arbeitsbedingter Verursachung/Verschlimmerung der Psoriasis, MdE-Schatzung und rehabilitative Leistungen vorgestellt.

Summary Background Psoriasis is an immune-mediated disease with a genetic background. Local psoriatic changes can be triggered by exogenous mechanical or irritant factors. Causative occupational factors have to be distinguished from the spontaneous course of psoriasis in occupational medical evaluations. The objective of this work is to demonstrate the medico-legal grounds for a homogenous assessment. Patients and methods The presented recommendations were developed in a working group for Occupational and Environmental Dermatology (ABD) and the German contact dermatitis group (DKG) of the German Dermatologic Society (DDG) based on the German medico-legal framework. Results Causality between the insured activity and the appearance of psoriasis is a prerequisite for the recognition of the occupational nature of the disease. This is the case if the occupational activity is the exclusive or a legally essential contributing factor either for first manifestation or aggravation of the disease. A connection must be denied if everyday events are sufficient to trigger the psoriasis. From 1995 to 2010, 130 cases of psoriasis have been recognized as occupationally related by the German statutory accident insurance. Conclusions The appraisal of psoriatic disease in the occupational medical evaluation is subject to the case assessment of the expert witness. In this position paper we present recommendations for a homologous basis for diagnosis, causality assessment, estimation of reduction in earning capacity and rehabilitation of occupational psoriasis.

Zusammenfassung Hintergrund Qualitatssicherung ist Aufgabe der Arzteschaft, aber auch der gesetzlichen Unfallversicherung (GUV). Daten zur Qualitat der Interaktion zwischen berufsdermatologisch tatigen Arzten und Unfallversicherungstragern stehen nur begrenzt zur Verfugung. Material und Methodik Bei 854 Mitgliedern der Arbeitsgemeinschaft fur Berufs- und Umweltdermatologie in Deutschland wurde im Oktober 2013 eine Online-Umfrage durchgefuhrt. Erfasst wurden demographische Daten, die Beurteilung der Zusammenarbeit mit den Tragern der GUV, eine betriebswirtschaftliche Beurteilung der Vergutung berufsdermatologischer Leistungen sowie prioritar zu optimierende Fragestellung(en) in der Zusammenarbeit. Ergebnisse Die Beteiligung an der Umfrage lag bei 182 Teilnehmern (21,3 % der Befragten). Die Zusammenarbeit mit den Unfallversicherungstragern beurteilten 10,8 % als „sehr gut“, 56,7 % als „gut“, 24,2 % als „befriedigend“, 7,0 % als „ausreichend“ und nur 1,3 % als „mangelhaft“. 93,4 % auserten sich zu Problemen bzw. Verbesserungspotenzial in der Zusammenarbeit Ihrer Praxis/Klinik mit der GUV. An vorderer Stelle stehen Abrechnungsfragen (44,7 %), gefolgt von Eingriffen in die Behandlungsfreiheit (36,5 %) und dem Behandlungsauftrag im Hautarztverfahren (29,4 %). Schlussfolgerungen Optimierungspotenziale fur die Zusammenarbeit zwischen berufsdermatologisch tatigen Arzten und GUV bestehen in der Vergutung der dermatologischen Leistungen bezuglich der „sprechenden Medizin“, in der Ermoglichung leitliniengerechter Diagnostik und Therapie und in zeitnaher Erteilung von Behandlungsauftragen im Hautarztverfahren zur Nutzung des therapeutischen Fensters in der Pravention von Berufsdermatosen. Summary Background Quality assurance is a task of the medical profession, but it is also a duty of the occupational health insurance (OHI). Data on the interaction quality between physicians practicing occupational dermatology and the OHI are limited. Material and Methods An online survey was performed in 854 German members of the Working Group on Occupational and Environmental Dermatology in October 2013. Items included demographic data, a judgment on the cooperation between the dermatologists and OHI companies, an economic grading of the current compensation scheme, and priorization of optimization tasks. Results 182 members (21.3 % of the invited population) participated in the survey. The cooperation with the OHI companies was judged as ivery goodi by 10.8 %, as igoodi by 56.7 %, as isatisfactoryi by 24.2 %, as isufficienti by 7.0 % and as iinsufficienti by 1.3 %. 93.4 % of the interviewed mentioned problems and improvement potentials in the cooperation of their practice or clinic with OHI companies. Main points of criticisms were reimbursement (44.7 %), followed by impairments of the treatment options (36.5 %) and the delay or scope of the treatment in the dermatologist's procedure (29.4 %). Conclusions While most physicians practicing occupational dermatology give a positive judgment of their cooperation with OHI companies, quality optimization potentials exist regarding the reimbursement of dermatological services, especially regarding time-intensive counselling in the prevention of occupational skin diseases, in the enablement of diagnostic and therapeutic procedures according to current guidelines and in a timely preventive intervention to use the therapeutic window before chronification of skin diseases may occur.

Die Bedeutung des Pflege- und Fachpersonals an Kliniken und Praxen fur die Sicherstellung einer hochqualitativen dermatologischen Patientenversorgung nimmt angesichts des wachsenden Bedarfs an dermatologischen Leistungen einerseits und des sich abzeichnenden Facharztmangels in Deutschland andererseits zu. Da bisher ausreichend zertifizierte Fortbildungsangebote fur dermatologische Pflegekrafte und Fachangestellte kaum existiert haben, entwickelt die Deutsche Dermatologische Akademie (DDA) nicht nur zertifizierte Fortbildungsangebote fur Facharzte, sondern auch facharztlich fundierte, praxisorientierte, zertifizierte Module fur eine Fortbildung zur dermatologischen Pflegekraft/Fachangestellten. Die Arbeitsgemeinschaft fur Berufs- und Umweltdermatologie (ABD) hat seit 1998 ein Zertifikat „Berufsdermatologie (ABD)“ eingefuhrt, das von Facharzten fur Dermatologie nach Absolvierung von zunachst drei, seit 2010 vier Seminaren erworben werden kann. Die Ruckmeldungen der zertifizierten Berufsdermatologen haben immer wieder gezeigt, dass auch ein Bedarf fur eine spezifische Fortbildung ihrer nichtarztlichen Mitarbeiter in der Berufsdermatologie besteht. Daher hat der Vorstand der ABD auf der Basis der Anforderungen aus der Praxis ein eigenstandiges Curriculum fur dermatologische Pflegekrafte und Fachangestellte erarbeitet. Das vorliegende Curriculum „Berufsdermatologie fur Pflegekrafte und Fachangestellte (DDA)“ befahigt die Absolventen, den Facharzt bei der Diagnostik, Therapie, Pravention und Begutachtung von Berufsdermatosen kompetent zu unterstutzen und Verantwortung in der Organisation und Korrespondenz bei Hautarztverfahren und Gutachten zu ubernehmen.

Wet work defined as unprotected exposure to humid environments/water; high frequencies of hand washing procedures or prolonged glove occlusion is believed to cause irritant contact dermatitis in a variety of occupations. This review considers the recent studies on wet-work exposure and focuses on its influence on barrier function. There are different methods to study the effect of wet work on barrier function. On the one hand, occupational cohorts at risk can be monitored prospectively by skin bioengineering technology and clinical visual scoring systems; on the other hand, experimental test procedures with defined application of water, occlusion and detergents are performed in healthy volunteers. Both epidemiological studies and the results of experimental procedures are compared and discussed. A variety of epidemiological studies analyze occupational cohorts at risk. The measurement of transepidermal water loss, an indicator of the integrity of the epidermal barrier, and clinical inspection of the skin have shown that especially the frequencies of hand washing and water contact/contact to aqueous mixtures seem to be the main factors for the occurrence of barrier alterations. On the other hand, in a single cross-sectional study, prolonged glove wearing (e.g. occlusion for 6 h per shift in clean-room workers) without exposure to additional hazardous substances seemed not to affect the skin negatively. But regarding the effect of occlusion, there is experimental evidence that previously occluded skin challenged with sodium lauryl sulfate leads to an increased susceptibility to the irritant with an aggravation of the irritant reaction. These findings might have relevance for the real-life situation in so far as after occupational glove wearing, the skin is more susceptible to potential hazards to the skin even during leisure hours.

Wet work defined as unprotected exposure to humid environments/water; high frequencies of hand washing procedures or prolonged glove occlusion is believed to cause irritant contact dermatitis in a variety of occupations. This review considers the recent studies on wet-work exposure and focuses on its influence on barrier function. There are different methods to study the effect of wet work on barrier function. On the one hand, occupational cohorts at risk can be monitored prospectively by skin bioengineering technology and clinical visual scoring systems; on the other hand, experimental test procedures with defined application of water, occlusion and detergents are performed in healthy volunteers. Both epidemiological studies and the results of experimental procedures are compared and discussed. A variety of epidemiological studies analyze occupational cohorts at risk. The measurement of transepidermal water loss, an indicator of the integrity of the epidermal barrier, and clinical inspection of the skin have shown that especially the frequencies of hand washing and water contact/contact to aqueous mixtures seem to be the main factors for the occurrence of barrier alterations. On the other hand, in a single cross-sectional study, prolonged glove wearing (e.g. occlusion for 6 h per shift in clean-room workers) without exposure to additional hazardous substances seemed not to affect the skin negatively. But regarding the effect of occlusion, there is experimental evidence that previously occluded skin challenged with sodium lauryl sulfate leads to an increased susceptibility to the irritant with an aggravation of the irritant reaction. These findings might have relevance for the real-life situation in so far as after occupational glove wearing, the skin is more susceptible to potential hazards to the skin even during leisure hours.

In den unterschiedlichsten Arbeitsbereichen kann es zur Exposition der Haut mit UV-Strahlung aus kunstlichen Quellen kommen. Diese UV-Strahlung unterscheidet sich von der solaren UV-Strahlung meist bezuglich der Intensitat und des Spektrums. In Folge werden im Rahmen einer Ubersicht die bisherigen aktuellen Entwicklungen mit der Einfuhrung von rechtsverbindlichen Expositionsgrenzwerten fur Arbeitsplatze mit UV-Strahlung aus kunstlichen Quellen, eine Auswahl der betroffenen Tatigkeitsfelder und eine Ubersicht uber das Auftreten von Dermatosen und dermatologisch relevanten Hauterkrankungen durch diese spezifischen beruflichen Expositionen gegeben. Letzteres ist im Rahmen der berufsdermatologischen und arbeitsmedizinischen Beratung von Patienten und Arbeitnehmern relevant. Anhand der existierenden Studien an Schweiserkollektiven und an Arbeitsplatzen mit „offenen Flammen“ (am Beispiel der Glasblaser) wird evident, dass es bisher zwar keine belastbaren Daten bezuglich einer chronischen Lichtschadigung oder dem Auftreten von UV-typischen Hautkrebserkrankungen gibt, aber eindeutige Erkenntnisse bezuglich des regelmasigen Auftretens von akuten Lichtschadigungen.

Summary Skin cancer is by far the most common kind of cancer diagnosed in many western countries and ultraviolet radiation is the most important risk factor for cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Although employees at several workplaces are exposed to increased levels of UV radiation, skin cancer due to long-term intense occupational exposure to UV radiation is often not considered as occupational disease. The actually available evidence in the epidemiological literature clearly indicates that occupational UV radiation exposure is a substantial and robust risk factor for the development of cutaneous SCC and also clearly shows a significant risk for developing BCC. There is enough scientific evidence that outdoor workers have an increased risk of developing work-related occupational skin cancer due to natural UV radiation exposure and adequate prevention strategies must be implemented. The three measures which are successful and of particular importance in the prevention of nonmelanoma skin cancer in outdoor workers are changes in behaviour regarding awareness of health and disease resulting from exposure to natural UV radiation, protection from direct UV radiation by wearing suitable clothing, and regular and correct use of appropriate sunscreens.

Summary Background. Exposure to humid environments/water and prolonged glove occlusion are both believed to cause irritant contact dermatitis. Objectives. Tostudytheeffectsofdifferentformsofwetwork,especiallythedifferences between water exposure and occlusion, by using an experimental model simulating occupational wet work. Methods. The responses to water exposure and occlusion over multiple daily exposure periods for 7 days were compared in 73 volunteers. After the 1 week exposure, the sites were irritated with sodium lauryl sulfate (SLS). Comparison was performed via visual inspection and bioengineering methods. Results. Whereas occlusion did not induce measurable alterations in skin physiology, water exposure for more than 3 hr daily caused a significant increase in transepidermal water loss (TEWL) as compared with the control areas. SLS irritation of the previously occluded and the water-exposed sites induced higher TEWL and clinical scores in a time-dependent fashion as compared with the control areas, with more pronounced reactions in the water-exposed sites than in the occluded sites. Conclusion. Both previous occlusion and water exposure were capable of inducing higher susceptibility to SLS irritation. Skin hydration by occlusion had a different biological effect than water exposure. Short occlusions seem to harm the skin less than water exposure for the same duration.

Beim Auftreten von malignen Tumoren in berufsbedingten Narben sind besondere Kriterien bei der Begutachtung zur Anerkennung als Unfallfolge zu berucksichtigen. Nach aktuellen Konsensusempfehlungen [Bamberger Merkblatt, Teil II (BM II)] konnen Basaliome und Plattenepithelkarzinome auf berufsbedingten Narben wie eine Berufskrankheit anerkannt werden und zu einer Minderung der Erwerbsfahigkeit in rentenberechtigendem Grade fuhren. Es wurden 217 berufsbezogene, im Zeitraum von 2007–2009 am IPA erstattete dermatologische Gutachten einer retrospektiven Analyse unterzogen und nach unfallversicherungsrechtlichen Kriterien unter Berucksichtigung des BM II fur eine Anerkennung als Berufskrankheit bzw. Unfallfolge exploriert. Es wurden 3 Falle ermittelt, bei denen eine Berufskrankheitenanzeige oder falschlicherweise ein Hautarztbericht mit der Verdachtsdiagnose narbenbedingter maligner Tumore vorlag. Hieran wurden die Anerkennungskriterien nach Empfehlungen des BM II analysiert. Bei der Beurteilung von Malignomen auf dem Boden berufsbedingter Narben besteht eine Unsicherheit bei der Bewertung der Latenzzeiten bis zum Auftreten der Tumore und der Beweissicherung einer tatsachlich vorbestehenden Narbe, da die Versicherten bereits mit exzidierten Tumoren vorstellig werden. Hier empfiehlt sich die histologische Nachbegutachtung des primaren Exzidates, um die Narbe im Vollbeweis zu sichern.

Summary Background: Presently, percutaneous absorption of potentially hazardous chemicals in humans can only be assessed in animal experiments, in vitro, or predicted mathematically. Our aim was to demonstrate the proof-of-principle of a novel quantitative in vivo assay for percutaneous absorption: confocal Raman micro-spectroscopy (CRS). The advantages and limitations of CRS for health risk assessments are discussed. Patients and Methods: 2-butoxyethanol, toluene, and pyrene were applied in pure form, diluted in water, or in ethanol on the skin of three healthy volunteers. CRS measurements were done following application for 15 min and 3 hours. The concentrations of the three substances as a function of distance to the skin surface were calculated and further analyzed with regard to mass transport into the stratum corneum (μg/cm2) and the flux through the stratum corneum (μg/cm2h). The results were compared with the available data from literature. Results: Considering the preliminary nature of these data, good accordance with data from the literature was observed. In addition, we observed that 2-butoxyethanol penetrates markedly faster when dissolved in water as compared to ethanol. This observation is also in agreement with previous results. Conclusions: CRS has the potential to provide fast, accurate and reliable results for advanced studies of in vivo percutaneous absorption kinetics of hazardous substances in human skin. This will require further research with other substances and under differing conditions.

Hintergrund Eine Vitiligo der Haut ist meist idiopathisch; allerdings konnen Berufsstoffe diese ebenfalls auslosen. Fuhrt beruflicher Kontakt mit p-tert.-Butylphenol (ptBP) zu einer Vitiligo, kann eine Berufskrankheit der Nr. 1314 anerkannt werden. Neben ptBP existieren Substanzen, die sowohl zu lokalisierten als auch zu Vitiligo-artigen Veranderungen mit symmetrischer Verteilung und Genitalbefall fuhren und deren Auftreten die atiologische Differenzierung erschwert. Liegt eine Vitiligo durch andere Chemikalien vor, kann dies nach § 9 Abs. 2 der Berufskrankheitenverordnung behandelt werden.

Summary Background: The dermatologist's procedure (“procedure for early detection of occupational skin diseases”) enables dermatologists to conduct the relevant diagnostics at the expenses of the statutory employers’ liability insurance funds (UVT) if there is a possibility of a work-related skin disorder in an employee. Acceptance of this most relevant tool for secondary prevention in occupational dermatology in Germany is high and most dermatologists make careful use of this unparalleled privilege. However, there have been occasional complaints by the UVT, concerning overly extensive diagnostics. Consequently, the Task Force on Occupational and Environmental Dermatology (ABD) of the German Society of Dermatology set up a review board in May 1999. Results: Dermatologists’ reports in question were submitted by the UVT to the review board and reviewed separately by two experienced occupational dermatologists both in the 1st period (1999–2003) and now in the second period (June 2003 – November 2009). The criticism of the reviewers was mostly directed towards the number of tests and an insufficient documentation in the dermatologist's report. There were 69 dermatologists’ reports submitted to the review board (as compared to 155 in the 1st period). Conclusions: The decreased number of dermatologists’ reports submitted could be a result of the review process itself. Other factors may include the optimization of the dermatologist's report with a better reimbursement as well as the recent publication of guidelines and continuous education in occupational dermatology with certification of more than 700 dermatologists. These measures of quality assurance are aimed to further optimize the dermatologist's procedure and to allow for improved and more rapid care for patients with occupational dermatoses by dermatologists.

Objective The objective of this study was to prove training-specific effects in children with atopic dermatitis (AD) and their parents concerning coping with the disease after their participation in a training program. In the 1-year follow-up, the changes in the training group were compared to the changes in a waiting control group while controlling the effects of the changes in severity scores. Methods One hundred eighty-five children aged 8–12 years and their parents participated in the study. Complete data sets at the 1-year follow-up were available for 185 parent-child pairs (102 training group; 83 waiting control group). In addition to the severity of the AD [measured with the Scoring Atopic Dermatitis (SCORAD)], data on children's itching-scratching cognitions and coping behavior and on parents handling their affected children were used in the analysis. To study whether the intervention group experienced an additional psychological benefit, which is not due to the SCORAD values, analyses of covariance with repeated measures with standardized residual change scores of the SCORAD as covariate were calculated. Results The intervention group showed greater improvement in children's coping behavior and in parents' handling their affected children. Additional effects of the training program not due to somatic improvement could be seen in the scales of itching-scratching cognitions and in three of four scales on parents dealing with their affected children. Conclusion The training program, which was tested in the German Atopic Dermatitis Intervention Study, had effects on almost all explored psychological variables. Therefore, additional psychological benefit in the training group does not only depend on the greater improvement of SCORAD values in this group.