Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2015
Job-related hand dermatitis heads up the list of reported occupational diseases. So-called skin p... more Job-related hand dermatitis heads up the list of reported occupational diseases. So-called skin products - understood to mean protective creams, skin cleansers and skin care products - are used for the primary and secondary prevention of job- related hand dermatitis. In the interests of evidence-based medicine, the only preventive measures and/or occupational skin products that should be used are those whose potential uses and efficacy are underpinned by scientific research. To this end, the Arbeitsgemeinschaft für Berufs- und Umweltdermatologie e.V. (Working Group for Occupational and Environmental Dermatology, ABD) of the DDG (German Dermatological Society) and the Deutsche Gesellschaft für Arbeits- und Umweltmedizin (German Society for Occupational and Environmental Medicine, DGAUM) have summed up the latest scientific findings and recommendations in the updated guideline. The benefit of the combined application of protective creams and skin care products in the primary and secon...
Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 3, 2014
Photoallergic contact dermatitis (PACD) is an uncommon condition, and there is a lack of validate... more Photoallergic contact dermatitis (PACD) is an uncommon condition, and there is a lack of validated criteria for its diagnosis. To identify a set of relevant criteria to be considered when suspecting a diagnosis of PACD and to assess the reproducibility of these criteria. This was a diagnostic item selection and reliability study performed between July 2012 and October 2012. A panel of seven recognized experts was invited to consecutive rounds of a Delphi survey and to a conclusive face-to-face meeting with the aim of obtaining an agreement on criteria for the diagnosis of PACD. The panel was also provided with a series of 16 reports of suspected PACDs to be classified according to a five-point likelihood scale. Identified criteria with the weights attributed by experts were used to develop a score system for the diagnosis of PACD. Consensus was measured by calculating the Intraclass Correlation Coefficient (ICC). The performance of the score system was evaluated in terms of overall ...
Hintergrund: Beruflich bedingte Hauterkrankungen und Allergien sind häufig und betreffen überdurc... more Hintergrund: Beruflich bedingte Hauterkrankungen und Allergien sind häufig und betreffen überdurchschnittlich oft Atopiker. Unser Ziel war es, Jugendliche vor Aufnahme einer beruflichen Tätigkeit über gefährdende Berufe, Risikogruppen und Präventionsmöglichkeiten zu informieren, um das Risiko einer späteren berufsbedingten Hauterkrankung oder Allergie zu minimieren. Methodik: 1015 Schüler an nichtgymnasialen Schulen wurden von zwei Dermatologen/ Allergologen (Raum Heidelberg) und einem Pädagogen (Raum Potsdam) im Rahmen einer 90-minütigen Unterrichtseinheit interaktiv geschult. Anhand von praktischen Beispielen und Versuchen wurden hautbelastende, allergiegefährdete Berufe erläutert, besonders gefährdete Personengruppen identifiziert und Schutzmaßnahmen eingeübt. Der erreichte Wissenszuwachs wurde mittels eines Fragebogens, den die Schüler vor und mindestens 2 Wochen nach der Unterrichtseinheit ausfüllten, gemessen. Ergebnisse: In beiden Regionen wurde ein Wissenszuwachs durch die Schulungsmaßnahme erreicht, der mit durchschnittlich 6,6 Punkten im Raum Heidelberg statistisch signifikant höher ausfiel als im Raum Potsdam (4,4 Punkte im Mittelwert). 76 % der Schüler stuften das Thema als wichtig ein, über 67 % bewerteten die Unterrichtseinheit mit "sehr gut" oder "gut". Schlussfolgerungen: Wir konnten nachweisen, dass bei Schülern vor der Berufswahl ein großes Interesse an dieser Thematik besteht, die erarbeitete Unterrichtseinheit eine hohe Akzeptanz aufweist und zu einem Wissenszuwachs führt. Daher empfehlen wir eine bundesweite Einführung dieser Maßnahme zur Primärprävention an nichtgymnasialen Schulen.
Background: Occupational dermatoses and allergies are frequent and often affect individuals with ... more Background: Occupational dermatoses and allergies are frequent and often affect individuals with atopic dermatitis. Our aim was to inform adolescents about potentially dangerous occupations, risk groups and preventive measures before they started apprenticeships in order to minimize the risk of occupational allergies or skin diseases. Methods: 1015 high-school students were instructed by two dermatologists/ allergists (Heidelberg) and a teacher (Potsdam) in a 90-minute instructional unit. This included the exemplification of occupational skin hazards and allergies, the identification of at-risk persons, and application of preventive measures. A questionnaire was filled in by the students prior to and at least two weeks after the training. Results: In both regions, the students showed an increase in knowledge after the training, which was statistically significant higher in the Heidelberg region (6.6 points on average vs. 4.4 points). 76 % of students termed the subject matter as "important", and 67 % rated the teaching unit as "very good" or "good". Conclusions: We demonstrate that students who have not yet chosen a career are highly interested in this subject, that the developed instructional unit is widely accepted, and that it leads to an increase in knowledge. Therefore we suggest nation-wide implementation of this primary prevention measure in high-schools.
Dermatology and Psychosomatics / Dermatologie und Psychosomatik, 2003
ABSTRACT Background: There are numerous questionnaires for adults to assess coping with disease a... more ABSTRACT Background: There are numerous questionnaires for adults to assess coping with disease and quality of life in patients with atopic eczema, but there are hardly any for children and adolescents. This is surprising because the prevalence of atopic eczema is higher in these age groups than in adults. Moreover, the patients in this age range are in a sensitive phase of emotional development with many new demands (e.g. puberty, first partnership, choice of profession). Objective: Adaptation or development of questionnaires on coping with disease and itching cognitions for children and adolescents with atopic eczema. Methods: Based on existing questionnaires for adults, questionnaires on coping with disease and itching cognitions were designed for two age groups (7–12 years, 13–18 years). After several preliminary studies the final versions were tested in a group of 204 children and 168 adolescents. In addition to the questionnaires, the SCORAD (severity scoring of atopic dermatitis) was used. Results: Two-factor scale solutions resulted for both questionnaires for children. With respect to coping with disease (COPEKI), the scales ‘depressive mood/social anxiety’ and ‘itching-scratching circle/stress from the disease’ resulted. With respect to itching cognitions (JUCKKI), the scales ‘catastrophizing’ and ‘coping’ resulted. The internal consistency can be rated satisfactory to good (α = 0.72–0.91). Similar scales resulted for the adolescents (COPEJU, JUCKJU). With respect to coping with disease the following scales resulted: ‘depressive mood/itching-scratching circle’, ‘social anxiety’ and ‘stress from the disease’. Satisfactory to good values for Cronbach�s α (0.66–0.89) were found for these scales. High scale intercorrelations and moderate correlations with the SCORAD were observed both in children and adolescents. Comparing two severity groups (SCORAD
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2014
In Germany over 2.5 million employees have an increased risk of skin cancer due to their occupati... more 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.
Type I allergy to natural rubber latex can be an important health problem for latex-exposed indiv... more Type I allergy to natural rubber latex can be an important health problem for latex-exposed individuals (e.g., health care workers, spina bifida children). Also beyond these risk groups, a high sensitization rate of varying and partly unknown clinical relevance has been reported. Atopy represents a risk factor for latex allergy and recent studies indicate that patients suffering from pollen allergies
A 35-year-old dairy farmer had had eczema on uncovered areas of her body for 7 years, which had h... more A 35-year-old dairy farmer had had eczema on uncovered areas of her body for 7 years, which had hitherto been diagnosed as atopic. Her past medical history and family history were negtive for atopic eczema, allergic rhinoconjunctivitis and bronchial asthma. At the . Eczema confined to the uncovered skin.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2014
ABSTRACT ZusammenfassungHintergrundDie Psoriasis ist eine anlagebedingte Erkrankung. Krankheitssc... more ABSTRACT ZusammenfassungHintergrundDie Psoriasis ist eine anlagebedingte Erkrankung. Krankheitsschübe können durch exogene mechanische oder irritative Reize ausgelöst werden. Bei der berufsdermatologischen Behandlung/Begutachtung muss differenziert werden, ob die berufliche Tätigkeit mit der Erkrankung in ursächlichem Zusammenhang steht oder ob der Spontanverlauf der Psoriasis im Vordergrund steht. Ziel der vorliegenden Arbeit ist, die sozialrechtlich bedingten Grundlagen für eine einheitliche Beurteilung darzustellen.Patienten und MethodikUnter Kenntnis der bestehenden Begutachtungsempfehlungen und Rechtsprechung wurden Empfehlungen zur Begutachtung von Patienten mit Psoriasis und arbeitsbedingten Einflüssen in einer Arbeitsgruppe der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD) und der Deutschen Kontaktallergie-Gruppe (DKG) in der Deutschen Dermatologischen Gesellschaft (DDG) entwickelt.ErgebnisseVoraussetzung für eine Berufskrankheit ist, dass zwischen versicherter Tätigkeit und Hautkrankheit ein ursächlicher Zusammenhang (im Sinne der Entstehung oder der Verschlimmerung) besteht. Dies ist der Fall, wenn die berufliche Tätigkeit die alleinige oder eine rechtlich wesentlich mitwirkende Bedingung für die Erkrankung darstellt. Ein rechtlich wesentlicher Ursachenzusammenhang ist zu verneinen, wenn für die Auslösung der Krankheitserscheinungen gewöhnliche Belastungen des täglichen Lebens ausreichen (Gelegenheitsursache). 1995–2010 wurden 130 Psoriasisfälle von den Unfallversicherungsträgern als berufsbedingt anerkannt.SchlussfolgerungenBei 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-Schätzung und rehabilitative Leistungen vorgestellt.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2015
The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence-and... more 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.
IMPORTANCE Skin disorders are common in the general population, and they may be associated with s... more IMPORTANCE Skin disorders are common in the general population, and they may be associated with significant disability. The use of daily skin products may affect the appearance and severity of skin conditions. OBJECTIVES To assess the prevalence of reported itchy rash lasting longer than 3 days among the general population and to evaluate lifetime avoidance of different types of consumer products because of skin problems. DESIGN, SETTING, AND PARTICIPANTS The European Dermato-Epidemiology Network (EDEN) Fragrance Study comprised a large descriptive epidemiological survey of the general population conducted in 6 European regions from August 20, 2008, to October 10, 2011. Participants were a random sample of individuals aged 18 to 74 years, based on electoral precincts. The participants were interviewed using a standardized questionnaire. EXPOSURES Lifetime exposure to products of common use was considered, including toiletry items that remained on the skin or were rinsed off and household and functional items. MAIN OUTCOMES AND MEASURES The 1-month, 1-year, and lifetime age-standardized prevalence rates of itchy rash that lasted longer than 3 days. RESULTS In total, 12 377 individuals (53.9% female; median age, 43 years) were interviewed. The overall prevalences of itchy rash were 19.3% (95% CI, 18.6%-20.0%) during the month preceding the interview, 31.8% (95% CI, 31.0%-32.6%) during the preceding year, and 51.7% (95% CI, 50.8%-52.6%) over a lifetime. In addition, the percentage of individuals who reported avoidance of any product varied from 37.0% for products intended to be left on the skin to 17.7% for household or functional products. CONCLUSIONS AND RELEVANCE Our findings confirmed the magnitude of skin problems among the general population reported in other surveys. Although itchy rash is a nonspecific manifestation, it may be considered in epidemiological surveys to reflect a constellation of skin conditions and to summarize the burden of these conditions on general health.
Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant... more Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T 0), discharge (T 1) and once the individual had returned to work and worked for 4 consecutive weeks (T 2) (n = 117). Intention was measured at T 0 and skin protection behaviour at T 2. Path analysis was used to assess the longitudinal associations of the models' constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.
Allergies to drugs are a major cause for hospitalisation and inappropriate prescriptions to patie... more Allergies to drugs are a major cause for hospitalisation and inappropriate prescriptions to patients. However, allergies can be prevented if the patient's history of drug allergy is known and coded. Assessment of the value of the widely used ICD-10 codes for drug-allergies (e.g. Z88, L27) as triggers for decision support in an electronic prescription system and evaluation of the potential impact of such an alert system. We also evaluated the usefulness of manual drug allergy notes recorded in patients' charts in the prevention of prescribing errors due to drug allergies. University hospital providing primary and tertiary care. Using Anatomical Therapeutic Chemical (ATC) classification codes we allocated to drug specifying ICD-10 codes (i.e. Z88) all drugs belonging to the same group of compounds or those known to induce cross-allergy. In a randomly selected cohort of 200 in-patients we then assessed documentation and coding of drug allergies and incident prescribing errors ignoring patients' drug allergies. Eighteen of the 200 patients had an allergy-related ICD code in the chart, 51 had a written note, and 13 had both. About 21% of patients with documented drug allergies were prescribed a drug potentially triggering the allergy. There was no difference in prescribing errors due to drugs potentially inducing allergies when the allergy was only documented as an ICD-10 code or the information was available in the paper record (P > 0.05). The findings of this study emphasise the necessity of a more precise and efficient documentation system of drug allergies along with the implementation of an electronic CDS for drug allergies that makes physicians aware of patients' drug allergies during the prescribing process.
Journal of the European Academy of Dermatology and Venereology, 2010
Background Occupational skin disease (OSD) is common. Tertiary individual prevention programmes (... more Background Occupational skin disease (OSD) is common. Tertiary individual prevention programmes (TIP) aim at helping individuals with refractory OSD to remain active in the workforce. Evidence exists that these interventions improve skin protection behaviour related cognitions. However, it is not clear whether these effects generalize to all types of OSD.
Journal of the American Academy of Dermatology, 1998
The results of an open, single-center study suggested that phototherapy with high doses of UVA1 r... more The results of an open, single-center study suggested that phototherapy with high doses of UVA1 radiation (UVA1R; 340-400 nm) is effective for acute, severe exacerbations of atopic dermatitis (AD). The purpose of this study was to assess the effectiveness of high-dose UVA1 phototherapy for acute, severe AD in a randomized multicenter trial in direct comparison with topical glucocorticoid therapy. Patients were treated with high-dose UVA1R (10 days, 130 J/cm2/day; n = 20), topically with fluocortolone (10 days, 1 x daily; n = 17), or with UVA-UVB therapy (10 days, 1 x daily, minimal erythema dose-dependent; n = 16). With a clinical scoring system, significant differences in favor of high-dose UVA1R and fluocortolone therapy were observed (p < 0.0001), as compared with UVA-UVB therapy. At day 10, high-dose UVA1R was superior to fluocortolone (p < 0.002) therapy. Serum levels of eosinophil cationic protein and the blood eosinophil count were significantly reduced after high-dose UVA1 or fluocortolone, but not UVA-UVB therapy. This study confirms the therapeutic effectiveness of high-dose UVA1 monotherapy for treatment of severe exacerbations of AD.
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2015
Job-related hand dermatitis heads up the list of reported occupational diseases. So-called skin p... more Job-related hand dermatitis heads up the list of reported occupational diseases. So-called skin products - understood to mean protective creams, skin cleansers and skin care products - are used for the primary and secondary prevention of job- related hand dermatitis. In the interests of evidence-based medicine, the only preventive measures and/or occupational skin products that should be used are those whose potential uses and efficacy are underpinned by scientific research. To this end, the Arbeitsgemeinschaft für Berufs- und Umweltdermatologie e.V. (Working Group for Occupational and Environmental Dermatology, ABD) of the DDG (German Dermatological Society) and the Deutsche Gesellschaft für Arbeits- und Umweltmedizin (German Society for Occupational and Environmental Medicine, DGAUM) have summed up the latest scientific findings and recommendations in the updated guideline. The benefit of the combined application of protective creams and skin care products in the primary and secon...
Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 3, 2014
Photoallergic contact dermatitis (PACD) is an uncommon condition, and there is a lack of validate... more Photoallergic contact dermatitis (PACD) is an uncommon condition, and there is a lack of validated criteria for its diagnosis. To identify a set of relevant criteria to be considered when suspecting a diagnosis of PACD and to assess the reproducibility of these criteria. This was a diagnostic item selection and reliability study performed between July 2012 and October 2012. A panel of seven recognized experts was invited to consecutive rounds of a Delphi survey and to a conclusive face-to-face meeting with the aim of obtaining an agreement on criteria for the diagnosis of PACD. The panel was also provided with a series of 16 reports of suspected PACDs to be classified according to a five-point likelihood scale. Identified criteria with the weights attributed by experts were used to develop a score system for the diagnosis of PACD. Consensus was measured by calculating the Intraclass Correlation Coefficient (ICC). The performance of the score system was evaluated in terms of overall ...
Hintergrund: Beruflich bedingte Hauterkrankungen und Allergien sind häufig und betreffen überdurc... more Hintergrund: Beruflich bedingte Hauterkrankungen und Allergien sind häufig und betreffen überdurchschnittlich oft Atopiker. Unser Ziel war es, Jugendliche vor Aufnahme einer beruflichen Tätigkeit über gefährdende Berufe, Risikogruppen und Präventionsmöglichkeiten zu informieren, um das Risiko einer späteren berufsbedingten Hauterkrankung oder Allergie zu minimieren. Methodik: 1015 Schüler an nichtgymnasialen Schulen wurden von zwei Dermatologen/ Allergologen (Raum Heidelberg) und einem Pädagogen (Raum Potsdam) im Rahmen einer 90-minütigen Unterrichtseinheit interaktiv geschult. Anhand von praktischen Beispielen und Versuchen wurden hautbelastende, allergiegefährdete Berufe erläutert, besonders gefährdete Personengruppen identifiziert und Schutzmaßnahmen eingeübt. Der erreichte Wissenszuwachs wurde mittels eines Fragebogens, den die Schüler vor und mindestens 2 Wochen nach der Unterrichtseinheit ausfüllten, gemessen. Ergebnisse: In beiden Regionen wurde ein Wissenszuwachs durch die Schulungsmaßnahme erreicht, der mit durchschnittlich 6,6 Punkten im Raum Heidelberg statistisch signifikant höher ausfiel als im Raum Potsdam (4,4 Punkte im Mittelwert). 76 % der Schüler stuften das Thema als wichtig ein, über 67 % bewerteten die Unterrichtseinheit mit "sehr gut" oder "gut". Schlussfolgerungen: Wir konnten nachweisen, dass bei Schülern vor der Berufswahl ein großes Interesse an dieser Thematik besteht, die erarbeitete Unterrichtseinheit eine hohe Akzeptanz aufweist und zu einem Wissenszuwachs führt. Daher empfehlen wir eine bundesweite Einführung dieser Maßnahme zur Primärprävention an nichtgymnasialen Schulen.
Background: Occupational dermatoses and allergies are frequent and often affect individuals with ... more Background: Occupational dermatoses and allergies are frequent and often affect individuals with atopic dermatitis. Our aim was to inform adolescents about potentially dangerous occupations, risk groups and preventive measures before they started apprenticeships in order to minimize the risk of occupational allergies or skin diseases. Methods: 1015 high-school students were instructed by two dermatologists/ allergists (Heidelberg) and a teacher (Potsdam) in a 90-minute instructional unit. This included the exemplification of occupational skin hazards and allergies, the identification of at-risk persons, and application of preventive measures. A questionnaire was filled in by the students prior to and at least two weeks after the training. Results: In both regions, the students showed an increase in knowledge after the training, which was statistically significant higher in the Heidelberg region (6.6 points on average vs. 4.4 points). 76 % of students termed the subject matter as "important", and 67 % rated the teaching unit as "very good" or "good". Conclusions: We demonstrate that students who have not yet chosen a career are highly interested in this subject, that the developed instructional unit is widely accepted, and that it leads to an increase in knowledge. Therefore we suggest nation-wide implementation of this primary prevention measure in high-schools.
Dermatology and Psychosomatics / Dermatologie und Psychosomatik, 2003
ABSTRACT Background: There are numerous questionnaires for adults to assess coping with disease a... more ABSTRACT Background: There are numerous questionnaires for adults to assess coping with disease and quality of life in patients with atopic eczema, but there are hardly any for children and adolescents. This is surprising because the prevalence of atopic eczema is higher in these age groups than in adults. Moreover, the patients in this age range are in a sensitive phase of emotional development with many new demands (e.g. puberty, first partnership, choice of profession). Objective: Adaptation or development of questionnaires on coping with disease and itching cognitions for children and adolescents with atopic eczema. Methods: Based on existing questionnaires for adults, questionnaires on coping with disease and itching cognitions were designed for two age groups (7–12 years, 13–18 years). After several preliminary studies the final versions were tested in a group of 204 children and 168 adolescents. In addition to the questionnaires, the SCORAD (severity scoring of atopic dermatitis) was used. Results: Two-factor scale solutions resulted for both questionnaires for children. With respect to coping with disease (COPEKI), the scales ‘depressive mood/social anxiety’ and ‘itching-scratching circle/stress from the disease’ resulted. With respect to itching cognitions (JUCKKI), the scales ‘catastrophizing’ and ‘coping’ resulted. The internal consistency can be rated satisfactory to good (α = 0.72–0.91). Similar scales resulted for the adolescents (COPEJU, JUCKJU). With respect to coping with disease the following scales resulted: ‘depressive mood/itching-scratching circle’, ‘social anxiety’ and ‘stress from the disease’. Satisfactory to good values for Cronbach�s α (0.66–0.89) were found for these scales. High scale intercorrelations and moderate correlations with the SCORAD were observed both in children and adolescents. Comparing two severity groups (SCORAD
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2014
In Germany over 2.5 million employees have an increased risk of skin cancer due to their occupati... more 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.
Type I allergy to natural rubber latex can be an important health problem for latex-exposed indiv... more Type I allergy to natural rubber latex can be an important health problem for latex-exposed individuals (e.g., health care workers, spina bifida children). Also beyond these risk groups, a high sensitization rate of varying and partly unknown clinical relevance has been reported. Atopy represents a risk factor for latex allergy and recent studies indicate that patients suffering from pollen allergies
A 35-year-old dairy farmer had had eczema on uncovered areas of her body for 7 years, which had h... more A 35-year-old dairy farmer had had eczema on uncovered areas of her body for 7 years, which had hitherto been diagnosed as atopic. Her past medical history and family history were negtive for atopic eczema, allergic rhinoconjunctivitis and bronchial asthma. At the . Eczema confined to the uncovered skin.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2014
ABSTRACT ZusammenfassungHintergrundDie Psoriasis ist eine anlagebedingte Erkrankung. Krankheitssc... more ABSTRACT ZusammenfassungHintergrundDie Psoriasis ist eine anlagebedingte Erkrankung. Krankheitsschübe können durch exogene mechanische oder irritative Reize ausgelöst werden. Bei der berufsdermatologischen Behandlung/Begutachtung muss differenziert werden, ob die berufliche Tätigkeit mit der Erkrankung in ursächlichem Zusammenhang steht oder ob der Spontanverlauf der Psoriasis im Vordergrund steht. Ziel der vorliegenden Arbeit ist, die sozialrechtlich bedingten Grundlagen für eine einheitliche Beurteilung darzustellen.Patienten und MethodikUnter Kenntnis der bestehenden Begutachtungsempfehlungen und Rechtsprechung wurden Empfehlungen zur Begutachtung von Patienten mit Psoriasis und arbeitsbedingten Einflüssen in einer Arbeitsgruppe der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD) und der Deutschen Kontaktallergie-Gruppe (DKG) in der Deutschen Dermatologischen Gesellschaft (DDG) entwickelt.ErgebnisseVoraussetzung für eine Berufskrankheit ist, dass zwischen versicherter Tätigkeit und Hautkrankheit ein ursächlicher Zusammenhang (im Sinne der Entstehung oder der Verschlimmerung) besteht. Dies ist der Fall, wenn die berufliche Tätigkeit die alleinige oder eine rechtlich wesentlich mitwirkende Bedingung für die Erkrankung darstellt. Ein rechtlich wesentlicher Ursachenzusammenhang ist zu verneinen, wenn für die Auslösung der Krankheitserscheinungen gewöhnliche Belastungen des täglichen Lebens ausreichen (Gelegenheitsursache). 1995–2010 wurden 130 Psoriasisfälle von den Unfallversicherungsträgern als berufsbedingt anerkannt.SchlussfolgerungenBei 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-Schätzung und rehabilitative Leistungen vorgestellt.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2015
The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence-and... more 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.
IMPORTANCE Skin disorders are common in the general population, and they may be associated with s... more IMPORTANCE Skin disorders are common in the general population, and they may be associated with significant disability. The use of daily skin products may affect the appearance and severity of skin conditions. OBJECTIVES To assess the prevalence of reported itchy rash lasting longer than 3 days among the general population and to evaluate lifetime avoidance of different types of consumer products because of skin problems. DESIGN, SETTING, AND PARTICIPANTS The European Dermato-Epidemiology Network (EDEN) Fragrance Study comprised a large descriptive epidemiological survey of the general population conducted in 6 European regions from August 20, 2008, to October 10, 2011. Participants were a random sample of individuals aged 18 to 74 years, based on electoral precincts. The participants were interviewed using a standardized questionnaire. EXPOSURES Lifetime exposure to products of common use was considered, including toiletry items that remained on the skin or were rinsed off and household and functional items. MAIN OUTCOMES AND MEASURES The 1-month, 1-year, and lifetime age-standardized prevalence rates of itchy rash that lasted longer than 3 days. RESULTS In total, 12 377 individuals (53.9% female; median age, 43 years) were interviewed. The overall prevalences of itchy rash were 19.3% (95% CI, 18.6%-20.0%) during the month preceding the interview, 31.8% (95% CI, 31.0%-32.6%) during the preceding year, and 51.7% (95% CI, 50.8%-52.6%) over a lifetime. In addition, the percentage of individuals who reported avoidance of any product varied from 37.0% for products intended to be left on the skin to 17.7% for household or functional products. CONCLUSIONS AND RELEVANCE Our findings confirmed the magnitude of skin problems among the general population reported in other surveys. Although itchy rash is a nonspecific manifestation, it may be considered in epidemiological surveys to reflect a constellation of skin conditions and to summarize the burden of these conditions on general health.
Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant... more Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T 0), discharge (T 1) and once the individual had returned to work and worked for 4 consecutive weeks (T 2) (n = 117). Intention was measured at T 0 and skin protection behaviour at T 2. Path analysis was used to assess the longitudinal associations of the models' constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.
Allergies to drugs are a major cause for hospitalisation and inappropriate prescriptions to patie... more Allergies to drugs are a major cause for hospitalisation and inappropriate prescriptions to patients. However, allergies can be prevented if the patient's history of drug allergy is known and coded. Assessment of the value of the widely used ICD-10 codes for drug-allergies (e.g. Z88, L27) as triggers for decision support in an electronic prescription system and evaluation of the potential impact of such an alert system. We also evaluated the usefulness of manual drug allergy notes recorded in patients' charts in the prevention of prescribing errors due to drug allergies. University hospital providing primary and tertiary care. Using Anatomical Therapeutic Chemical (ATC) classification codes we allocated to drug specifying ICD-10 codes (i.e. Z88) all drugs belonging to the same group of compounds or those known to induce cross-allergy. In a randomly selected cohort of 200 in-patients we then assessed documentation and coding of drug allergies and incident prescribing errors ignoring patients' drug allergies. Eighteen of the 200 patients had an allergy-related ICD code in the chart, 51 had a written note, and 13 had both. About 21% of patients with documented drug allergies were prescribed a drug potentially triggering the allergy. There was no difference in prescribing errors due to drugs potentially inducing allergies when the allergy was only documented as an ICD-10 code or the information was available in the paper record (P > 0.05). The findings of this study emphasise the necessity of a more precise and efficient documentation system of drug allergies along with the implementation of an electronic CDS for drug allergies that makes physicians aware of patients' drug allergies during the prescribing process.
Journal of the European Academy of Dermatology and Venereology, 2010
Background Occupational skin disease (OSD) is common. Tertiary individual prevention programmes (... more Background Occupational skin disease (OSD) is common. Tertiary individual prevention programmes (TIP) aim at helping individuals with refractory OSD to remain active in the workforce. Evidence exists that these interventions improve skin protection behaviour related cognitions. However, it is not clear whether these effects generalize to all types of OSD.
Journal of the American Academy of Dermatology, 1998
The results of an open, single-center study suggested that phototherapy with high doses of UVA1 r... more The results of an open, single-center study suggested that phototherapy with high doses of UVA1 radiation (UVA1R; 340-400 nm) is effective for acute, severe exacerbations of atopic dermatitis (AD). The purpose of this study was to assess the effectiveness of high-dose UVA1 phototherapy for acute, severe AD in a randomized multicenter trial in direct comparison with topical glucocorticoid therapy. Patients were treated with high-dose UVA1R (10 days, 130 J/cm2/day; n = 20), topically with fluocortolone (10 days, 1 x daily; n = 17), or with UVA-UVB therapy (10 days, 1 x daily, minimal erythema dose-dependent; n = 16). With a clinical scoring system, significant differences in favor of high-dose UVA1R and fluocortolone therapy were observed (p < 0.0001), as compared with UVA-UVB therapy. At day 10, high-dose UVA1R was superior to fluocortolone (p < 0.002) therapy. Serum levels of eosinophil cationic protein and the blood eosinophil count were significantly reduced after high-dose UVA1 or fluocortolone, but not UVA-UVB therapy. This study confirms the therapeutic effectiveness of high-dose UVA1 monotherapy for treatment of severe exacerbations of AD.
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Papers by Thomas Diepgen