Tertiary prevention of occupational skin diseases [Tertiäre prävention von berufsdermatosen]

Abstract

Background: Inpatient tertiary prevention of occupational skin diseases is indicated when the employee is threatened with loosing their job. Earlier studies have shown that with intensive tertiary preventive measures, 2/3 of such individuals can continue their jobs long-term. Data on the effectiveness of tertiary prevention for various occupational groups has not been previously available. Patients and Methods: The outcome of all participants treated in the year 2002 was analyzed according to occupational groups with respect to diagnosis, medical intervention prior and during the inpatient period. Results: In 91% of 296 cases contact dermatitis of the hands was diagnosed (75% primary irritant contact dermatitis (37% chronic irritant contact dermatitis, 38% irritated atopic hand eczema, 16% allergic contact dermatitis). Clinically relevant Type IV-delayed hypersensitivity (allergic contact dermatitis) reactions were identified in 42% of cases; in most cases, the delayed hypersensitivity followed irritant contact dermatitis. In more than 83% of cases, a complete or nearly complete remission was achieved. Clinical relevant Type IV sensitization was most frequent in hairdressers (66%). Cleaning and housekeeping personnel most frequently used corticosteroids on a regular basis (60%) and most often experienced corticosteroid withdrawal (53%) and atrophy of the skin of the hands (23%). Conclusion: The data from studies on the tertiary prevention of occupational skin diseases reveal strategies for the optimization of outpatient care indicate specific occupational risk factors. The variance between professions may reflect differing approaches to secondary prevention.