Differences and similarities in medico-legal evaluations from two German centers of occupational dermatology [Unterschiede und gemeinsamkeiten in der begutachtung gemäß berufskrankheiten-Nr. 5101 an zwei berufsdermatologischen zentren]

Abstract

To date, in Germany, more than 20,000 cases of suspected occupational skin diseases are reported every year. In many of these cases medico-legal evaluations have to be performed by dermatologists for the national employers' liability insurance. Occupations, spectra of allergens and diagnoses of individuals which were subjected to a medico-legal evaluation process in two geographically distinct university centres of occupational dermatology (Osnabrueck, Dresden) were compared. Both centres are members of the German-Austrian Information Network of Departments of Dermatology (IVDK, Informationsverbund dermatologischer Kliniken), thus anamnestic and clinical data as well as patch test results are being obtained and recorded in a standardised fashion that complies to the norms established by this network. All 1074 patients that were consecutively examined for medico-legal evaluations and patch-tested from 1-1-1994 to 12-31-1998 were included in the study. Further analyses focussed on altogether 872 patients with proven occupational skin disease (Osnabrueck, N = 328; Dresden, N = 544). Additionally, these current observations could be compared with a well documented earlier Dresden survey (1962-1975). In both current groups there were remarkable similarities concerning age, sex and professions; "hairdressing" was the single most frequent occupation in both groups. Differences were found in the diagnostic assessment: whereas in Osnabrueck endogenous dermatoses (predominantly atopic skin manifestations) were diagnosed in 46 % of cases (single or in combination with irritant or allergic causes), only 12 % of cases in Dresden were similarly diagnosed. Comparable differences in the diagnosis profiles of the two centres were detected also if only the group of the hairdressers was analysed, or if only those individuals where an occupational sensitization had been identified were considered. In the Osnabrueck study group even in proven occupationally relevant sensitizations atopic skin manifestations were considered relevant in 47.3 %, as compared to only 7.8 % in the Dresden group. These differences in the expert opinions cannot be attributed solely to different geno- and phenotypic compositions of the study groups; instead, different pathogenetic concepts in the diagnostic judgement of the involved experts are apparent. With regard to the ongoing quality management process in occupational dermatology evidence-based criteria for etiologic weighting of exogenous (irritants, allergens) versus endogenous (mainly atopy) risk factors for occupational dermatoses have to be established.