Psoriasis and occupation: retrospective evaluation of clinical presentation and risk factors of a tertiary individual prevention collective

Abstract

Introduction: Patients with psoriasis suf-fer from a significant impairment of quality of life and work productivity. In this study, find-ings on occupational risk and prognosis fac-tors in patients with psoriasis in occupations that strain the skin are presented and con-nections between occupational skin strain and psoriasis are reflected upon. Methods: A retrospective evaluation of data from the study ``Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assur-ance of Inpatient Management'' (ROQ I and ROQ II) funded by the German Statutory Ac-cident Insurance (DGUV) was carried out. The subgroup considered (total number of patients: 1,788) includes 100 patients with the initial or differential diagnosis of psoriasis who have taken part in an inpatient measure of individual prevention (tertiary individual prevention, TIP). Results: With regard to the severity of the skin changes (measured by a score describing inflammatory morphology and its surface area), there is no significant difference between the causality groups work-related (i.e., occupationally first-mani-fested/caused or aggravated) and non-work -related (F(1.98) = 0.07, p = 0.798) at T1 (start of TIP measure). With regard to the severity of the skin changes, there were no statisti-cally significant differences with regard to the wet work in hours per day, the pressure in hours per day and the friction in hours per day (F(4.95) = 0.64, p = 0.633, F(4.95) = 0.25, p = 0.906 und F(4.95) = 1.16, p = 0.332). The severity of skin changes in insured persons with work-related psoriasis was significantly reduced by participating in the TIP measure; this effect was evident from T2 (end of TIP measure) and continued until T6 (3 years after TIP measure) (comparison of T1 and T2, t(37) = 5.69, p < 0.001; comparison of T1 and T6, t(32) = 6.10, p < 0.001). Discussion: Overall, in the context of this secondary data analysis, no disease-specific risk profile with regard to the severity and course of the skin symptoms on the hands could be identified in the subgroup of patients with occupation-al psoriasis of the hands. Particular empha-sis should be placed on the fact that partici-pation in the TIP measure can be described as effective and sustainable for the collec-tive. Conclusion: The possible trigger factors ``mechanical stress'' and ``wet work'' should not be classified as irrelevant in patients with psoriasis based on the results of this study. In the sense of primary prevention, it is rather of high importance to reduce any trigger factors in patients with psoriasis and the associated disruption of the epidermal barrier function. In practice, patients with psoriasis on the hands should be given the same individual preventive approach as pa-tients with hand eczema; it can be assumed that both patient groups benefit equally from those measures.