Diagnosis tinea of the skin in occupational dermatology - BK 3102 or: the species determines the social insurance body

Abstract

Dermatomycoscs often remain undetected. The clinical appearance of superficial mycoses on the skin is polymorphic. As differential diagnoses usually various dermatoses are to be considered, in particular inflammatory skin diseases. The diagnosis of dermatomycoses is based on the clinical appearance and the fungal pathogen detection. Furthermore, the identification of the correct fungal pathogen is essential for therapy and also for the prevention of a dermatophyte infection. Under certain conditions, a tinea may be an occupational disease (BK No. 3102) - ``Diseases transmissible from animals to humans''. If applicable treatment has to be provided according to the German law (Sozialgesetzbuch VII, State Insurance Code 7) by the statutory accident insurance. We present the case of a female patient who worked as a zoo keeper and cared also for rodents. She developed inflammatory skin lesions on the dominant right hand. The dermatologist's procedure had been initiated by a dermatologist's practice under the diagnosis of bilateral occupational hand eczema, which had proved to be refractory to therapy in the course of the treatment. By means of mycological diagnostics including sequencing of the ``internal transcribed spacer'' (ITS) region of the rDNA (ribosomal deoxyribonucleic acid) of the fungus, genotype IV (zoophilic isolate) within the species T mentagrophytes could be identified. In combination with the profession as a zoo keeper caring for the fungal disease transmitting rodents the criteria for an occupational disease No. 3102 of the Ordinance on Occupational Diseases (BKV) were thus fulfilled and the antimycotic therapy at the expense of the statutory accident insurance was indicated.