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ABSTRACT: Skin cancer induced by occupational UV-irradiation is not an official occupational disease number in the appendix of the German ordinance on occupational diseases (Berufskrankheitenverordnung (BKV) but can be recognized as a "virtually" occupational disease according to § 9 (2) of the 7th book of the German Social Code (SGB VII). Epidemiological studies have demonstrated a positive, statistically significant and relevant association between occupational UV-irradiation and the risk of squamous cell carcinoma (SCC) and actinic keratoses (AK). Outdoor workers have on average a 100% higher risk to develop SCC compared to the general population. Therefore, the prerequisites for a new occupational disease are fulfilled and SCC and AK should be reported as an occupational disease if an additional 40% occupationally-related UV-irradiation is documented and the clinical criteria are typical for work- related skin cancer. Epidemiologic evidence also indicates a significant association between work-related UV-irradiation and basal cell carcinoma (BCC) risk: however the results are less consistent and the association is weaker than with SCC. There is an urgent need for further studies in outdoor workers on BCC and lentigo maligna melanoma.
Der Hautarzt 09/2012; 63(10):769-77. · 0.58 Impact Factor
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ABSTRACT: Skin cancer is by far the most common kind of cancer diagnosed in many western countries and ultraviolet radiation is the most important risk factor for cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Although employees at several workplaces are exposed to increased levels of UV radiation, skin cancer due to long-term intense occupational exposure to UV radiation is often not considered as occupational disease. The actually available evidence in the epidemiological literature clearly indicates that occupational UV radiation exposure is a substantial and robust risk factor for the development of cutaneous SCC and also clearly shows a significant risk for developing BCC. There is enough scientific evidence that outdoor workers have an increased risk of developing work-related occupational skin cancer due to natural UV radiation exposure and adequate prevention strategies must be implemented. The three measures which are successful and of particular importance in the prevention of nonmelanoma skin cancer in outdoor workers are changes in behaviour regarding awareness of health and disease resulting from exposure to natural UV radiation, protection from direct UV radiation by wearing suitable clothing, and regular and correct use of appropriate sunscreens.
British Journal of Dermatology 08/2012; 167 Suppl 2:76-84. · 3.67 Impact Factor
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ABSTRACT: Das Handekzem ist mit einer Lebenszeitprävalenz von bis zu 15% und einer medianen Neuerkrankungsrate von 6Fällen pro 1000Personenjahre
eine der häufigsten Hauterkrankungen. Weibliches Geschlecht, eine Kontaktallergie, das atopische Ekzem sowie Feuchtarbeit
stellen die wichtigsten assoziierten Risikofaktoren dar. Handekzeme haben eine hohe sozialmedizinische und gesundheitsökonomische
Bedeutung, da sie den Hauptteil berufsbedingter Hauterkrankungen ausmachen. Häufig verlaufen Handekzeme über viele Jahre chronisch,
chronisch rezidivierend oder persistieren. Sie gehen für die Betroffenen mit einem Verlust an gesundheitsbezogener Lebensqualität
einher. Die Krankheitskosten des Handekzems sind ähnlich hoch wie die Kosten einer mittelschweren bis schweren Psoriasis und
liegen höher als die des atopischen Ekzems. Zwar stehen zahlreiche therapeutische Optionen zur Verfügung, doch fehlt bislang
weitgehend eine Bewertung dieser Therapien in randomisierten, klinisch-kontrollierten Studien zur Erstellung einer Evidenzbasis.
Die Erforschung der Versorgung des chronischen Handekzems unter Alltagsbedingungen in Kliniken und Praxen steht ganz am Anfang.
Vom weltweit ersten Registerprojekt zum chronischen Handekzem (Akronym: carpe) werden wesentliche Einsichten in die Effektivität
und Sicherheit unterschiedlicher therapeutischer Maßnahmen erwartet. Damit verbunden wird auch eine Bewertung der Versorgungsqualität
im Licht der Leitlinie zum Management von Handekzemen erfolgen.
Hand eczema is one of the most frequent skin diseases with a lifetime prevalence of up to 15% and a median incidence rate
of 6 cases per 1000 person-years. Female gender, contact allergy, atopic eczema and wet work have been identified as the most
important associated risk factors. Hand eczema has a high public health and socio-economic significance, since the vast majority
of occupational skin disease is hand eczema. Hand eczema is often chronic, chronically relapsing or persisting. It entails
substantial impairment of health-related quality of life for the affected individual. The cost-of-illness of hand eczema is
estimated to be in the range of moderate to severe psoriasis and even higher than that of atopic eczema. Although various
therapeutic options to treat hand eczema exist, an assessment of these options in randomized, controlled clinical trials to
build up an evidence base is mostly lacking. The investigation of the treatment of chronic hand eczema under everyday conditions
in dermatological clinics and private practices has only just begun. The first register of patients with chronic hand eczema
(acronym: carpe) is expected to yield substantial insights in the effectiveness and safety of different therapeutic measures.
A related task is the assessment of the quality of care in the light of the guidelines for the management of chronic hand
eczema.
SchlüsselwörterPrävalenz–Inzidenz–Gesundheitsbezogene Lebensqualität–Register–Handekzem
KeywordsPrevalence–Incidence–Health-related quality of life–Register–Hand eczema
Der Hautarzt 04/2012; 62(3):196-200. · 0.58 Impact Factor
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ABSTRACT: Seit 1994 existiert im Internet das dermatologische Informationsportal http://www.dermis.net, das mittlerweile über 40.000Seiten
mit mehr als 7500 dermatologischen Bildern in Atlasform besitzt. Präsentiert werden medizinische Informationen zu etwa 1200
dermatologischen Diagnosen und 1100Synonymen, die nach Lokalisation geordnet sind und auch alphabetisch aufgerufen werden
können. Mittlerweile gibt es 7 ausführliche Informationsmodule zu den Themen Hautkrebs, Neurodermitis, Rosazea, Hautpflege,
Ekzem, Mykosen und Hämorrhoiden. Dermatosen im Kindesalter können separat in der Plattform PeDOIA nachgesehen werden. Zusätzlich
sind zahlreiche Links zu weiteren medizinischen Informationsseiten, wie z.B. Cochrane Library, zu finden. Neben einer deutschen
und englischen Version ist http://www.dermis.net mittlerweile auch in spanischer, portugiesischer, französischer und türkischer
Sprache verfügbar. Die vorliegende Übersicht zeigt die aktuellen Inhalte und das Nutzerverhalten dieses Internetportals.
www.dermis.net was established in 1994 as a dermatological information system with now more than 4,000 pages and over 7,500
dermatological images in an atlas. 1,200 dermatological diagnoses and medical information with 1,100 synonyms can be searched
by body location and in alphabetical order. Additionally, there are seven information modules about skin cancer, atopic dermatitis,
rosacea, skin care, eczema, fungal diseases and hemorrhoids with links to other medical pages like Cochrane Library. Pediatric
skin diseases are covered in PeDOIA. www.dermis.net is meanwhile available in German, English, Spanish, Portuguese, French
and Turkish language. Current contents of this information system and user behavior are presented in this paper.
Der Hautarzt 04/2012; 60(12):979-983. · 0.58 Impact Factor
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ABSTRACT: Seit Etablierung der Dermatologie als eigenständiges Fach der Medizin Mitte des 19.Jahrhunderts ist auch Pruritus Gegenstand
der Forschung gewesen. Dies diente v.a. dem Ziel, seine Ursache zu entdecken, wirksame Therapien zu entwickeln und eine Einordnung
innerhalb des Systems der Hauterkrankungen zu erreichen. Die folgende Darstellung historischer Aspekte zu Hypothesen, Klassifikation
und Therapie von Pruritus demonstriert die großen Schwierigkeiten im Umgang mit diesem Symptom. Dies kennzeichnet streckenweise
auch die Pruritusforschung der Gegenwart. So existiert interessanterweise bis heute keine international einheitliche Klassifikation
von Pruritus. Bislang dominierten ätiologiebasierte Klassifikationen, die in jüngster Zeit von einer am klinischen Erscheinungsbild
orientierten Klassifikation ergänzt wurden.
Since the establishment of dermatology as an independent discipline of medicine in the middle of the 19th century, pruritus
or itch has been a subject of research. The goals were to discover the etiology of pruritus, to develop useful therapies and
to achieve a classification within the system of skin diseases. Looking at historical aspects of pruritus demonstrates just
how difficult it has been to approach this problem. The difficulties even influence present day pruritus research. For example,
there is no definite international standard of pruritus. Etiology-oriented classifications have dominated, but have recently
been supplemented by a clinical classification.
Der Hautarzt 04/2012; 60(2):137-141. · 0.58 Impact Factor
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[show abstract]
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ABSTRACT: Pruritus (Jucken) als Krankheitsbild und insbesondere als Symptom von Erkrankungen war Gegenstand medizinwissenschaftlicher
Beschreibungen und Untersuchungen in allen Epochen seit der Antike und in den verschiedenen Kulturkreisen. War die Antike
noch die Zeit der Beobachtung und Beschreibung, wurde im Laufe der Medizingeschichte und insbesondere seit Etablierung der
Dermatologie zunehmend Wert auf Systematisierung und – darauf basierend – auf Ursachenforschung gelegt.
Pruritus (itching) as a disease state and especially as a disease symptom has been object of medical and scientific descriptions
and examinations in all epochs since the antiquity and in different cultural periods. Antiquity was dominated by observations
and descriptions but during the course of medical history and particularly since the establishment of dermatology, more and
more emphasis has been placed on classification and etiologic research.
Der Hautarzt 04/2012; 59(12):1000-1007. · 0.58 Impact Factor
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ABSTRACT: Hintergrund und Fragestellung. Berufsbedingte Hautkrankheiten stellen einen großen Anteil der Berufserkrankungen in Deutschland. Wir untersuchten die in
unserem Berufskrankheitenregister Haut-Nordbayern (BKH-N) gemeldeten Fälle mit einer Berufskrankheitenanzeige nach Nr. 5101.
Patienten/Methodik. Von 1990–99 wurden 5.285 Fälle bewertet und registriert. Da der durchschnittliche Beschäftigungsstand in den verschiedenen
Berufen bekannt war, ließ sich eine beschäftigungsbezogene Studie zur Untersuchung der Inzidenzen und demographischen Charakteristika
in 24 Berufsordnungsgruppen durchführen.
Ergebnisse. In den Berufsordnungsgruppen wurden 3.097 Fälle mit berufsbedingten Hautkrankheiten beobachtet, was einer Gesamtinzidenz
von 6,7 Fällen pro 10.000 Beschäftigte pro Jahr entspricht. Die höchste Inzidenz war bei Friseuren (97,4), Bäckern (33,2)
und Floristen (23,9), hingegen die größte Fallzahl bei Friseuren (856), Gesundheitsberufen (481) und Metalloberflächenbearbeitern
(260) zu finden. Der Altersmedian aller Fälle lag bei 25 Jahren. In 1.611 Fällen (52%) war eine beruflich relevante Spättypsensibilisierung
nachzuweisen.
Schlussfolgerungen. Die deskriptive Datenanalyse des BKH-N zeigt hautgefährdende Berufsordnungsgruppen auf. Die Ergebnisse fließen ein in Präventionsmaßnahmen
zur Verringerung der Inzidenz berufsbedingter Hautkrankheiten.
Background and Objective. Occupational skin diseases (OSD) rank at the top of occupational diseases in Germany. We studied the cases with initial medical
report of an OSD reported to our Register of OSD in North Bavaria (BKH-N).
Patients/Methods. From 1990–99 5.285 cases were closed and recorded. Since the number of employees in the different occupations was known,
a population-based study was performed to investigate incidences and demographic characteristics in occupations classified
into 24 groups.
Results. In the occupational groups in 3.097 cases a work-related skin disease was stated. The estimated overall incidence was 6.7
cases per 10,000 workers per year. The highest incidence was in hairdressers (97.4), bakers (33.2), and florists (23.9), while
the largest number of cases was in hairdressers (856), health services (481), and metal-surface workers (260). The median
age of all cases was 25 years. In 1.611 cases (52%) a delayed-type sensitisation with occupational relevance was perceived.
Conclusions. The descriptive data of the BKH-N highlight occupational groups being at risk for OSD. The results assist in working out
prevention measures aiming on lowering the incidence of OSD.
Der Hautarzt 04/2012; 52(7):615-623. · 0.58 Impact Factor
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ABSTRACT: Dermato-epidemiology is an important scientific discipline which investigates skin diseases using epidemiological methods. Epidemiology is the science of the distribution and determinants of disease in specified populations. We describe fundamental terms of dermato-epidemiology (measures of disease occurrence, measures of risk), different study types (observational studies, interventional studies), the selection of statistical tests, bias and confounding as well as the principles of evidence-based dermatology, and give illustrative examples.
Der Hautarzt 11/2011; 62(11):859-68; quiz 869-70. · 0.58 Impact Factor
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T L Diepgen
British Journal of Dermatology 09/2011; 165(3):455. · 3.67 Impact Factor
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H Lessmann,
W Uter, T L Diepgen,
H Drexler,
M Fartasch,
H Greim,
A Hartwig,
P Kreis,
E Löser,
R Merget,
H Merk,
D Nowak,
A Rothe,
G Stropp,
A Schnuch
[show abstract]
[hide abstract]
ABSTRACT: A systematic classification of substances (or mixtures of substances) with regard to various toxicological endpoints is a prerequisite for the implementation of occupational safety strategies. As its principal task the "Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area" of the "Deutsche Forschungsgemeinschaft" (DFG-MAK Commission) derives and recommends maximum workplace concentrations and biological tolerance values (MAK and BAT values) based exclusively on scientific arguments. Several endpoints are evaluated separately in detail, e.g. carcinogenicity, risks during pregnancy, germ cell mutagenicity or contribution to systemic toxicity after cutaneous absorption. Skin- and airway sensitization is also considered; the present paper focuses on these two endpoints.
Regulatory Toxicology and Pharmacology 07/2011; 61(1):1-8. · 2.43 Impact Factor
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ABSTRACT: It is broadly assumed that costs caused by chronic hand eczema (CHE) are significant. However, there is a lack of cost-of-illness studies on CHE.
To determine the direct and indirect costs of CHE under routine conditions in Germany from the societal perspective.
A cross-sectional survey was conducted in 24 outpatient practices and clinics across Germany. Patients with CHE refractory to potent topical steroids and insured by statutory health insurance were eligible. Clinical and cost data were collected using standardized questionnaires. Severity classes were defined according to a photographic guide and physician global assessment (PGA). Four treatment stages were defined based on the German CHE guidelines: topical treatments only (stage I), additionally ultraviolet (UV) radiation therapy (II), systemic therapy (III) and inpatient treatment (IV). Bivariate associations between costs and severity as well as treatment stage were assessed.
Two hundred and twenty-three patients with CHE (mean age 45·7years, 56% women) enrolled in the study, of whom 63·2% were treated only with topical treatments, 15·7% additionally with UV radiation and 11·7% with systemic treatments. Of all patients, 9·4% had been admitted to hospital. Total costs per year and patient were €2128, including €1742 direct costs and €386 indirect costs. The total costs increased with treatment stages I-IV (P<0·001): €1044, €2307, €2697 and €8407, respectively. Accordingly, costs also correlated with clinical severity.
Patients with CHE refractory to topical steroids incur marked costs to society. The costs increase disproportionately with escalating treatment stages, especially in patients admitted to hospital. Hence, new treatments may help to reduce the societal costs of CHE.
British Journal of Dermatology 05/2011; 165(4):845-51. · 3.67 Impact Factor
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ABSTRACT: The most important risk factor for basal cell carcinoma (BCC) is ultraviolet (UV) radiation. It is reasonable to assume that outdoor workers with a long history of work-related UV exposure are at increased risk of developing BCC.
To analyse systematically the epidemiological literature concerning the evidence of an association between occupational UV exposure and BCC risk in outdoor workers.
Systematic literature review of cohort studies and case-control studies providing data on occupational UV exposure and BCC occurrence. PubMed (up to 28 January 2011) was searched, supplemented by hand searching and consultation of experts in the field. The association between occupational UV exposure and BCC risk is presented as odds ratios (ORs). A random-effects meta-analysis and sensitivity analysis including meta-regression on study-specific covariates were performed.
Twenty-four relevant epidemiological studies (five cohort studies, 19 case-control studies) were identified. Twenty-three studies reported sufficient data to be included in the meta-analysis. The pooled OR for the association between outdoor work and BCC risk was 1·43 (95% confidence interval 1·23-1·66; P = 0·0001). Studies adjusting for sex (P < 0·0001) and individual nonoccupational UV exposure (P = 0·014) showed a significantly stronger association of occupational UV exposure and BCC risk. Meta-regression revealed a significant inverse relationship between occupational UV radiation exposure and BCC risk with latitude (P = 0·015).
Published epidemiological literature indicates that outdoor workers are at significantly increased risk for BCC. This finding is highly relevant for health policy to stimulate the implementation of effective prevention strategies.
British Journal of Dermatology 05/2011; 165(3):612-25. · 3.67 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Hand eczema is one of the most frequent skin diseases with a lifetime prevalence of up to 15% and a median incidence rate of 6 cases per 1000 person-years. Female gender, contact allergy, atopic eczema and wet work have been identified as the most important associated risk factors. Hand eczema has a high public health and socio-economic significance, since the vast majority of occupational skin disease is hand eczema. Hand eczema is often chronic, chronically relapsing or persisting. It entails substantial impairment of health-related quality of life for the affected individual. The cost-of-illness of hand eczema is estimated to be in the range of moderate to severe psoriasis and even higher than that of atopic eczema. Although various therapeutic options to treat hand eczema exist, an assessment of these options in randomized, controlled clinical trials to build up an evidence base is mostly lacking. The investigation of the treatment of chronic hand eczema under everyday conditions in dermatological clinics and private practices has only just begun. The first register of patients with chronic hand eczema (acronym: carpe) is expected to yield substantial insights in the effectiveness and safety of different therapeutic measures. A related task is the assessment of the quality of care in the light of the guidelines for the management of chronic hand eczema.
Der Hautarzt 02/2011; 62(3):196-200. · 0.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Eczema is a chronic inflammatory skin disease and is among the most frequent chronic conditions in childhood and adolescence. It is the aim of this study to investigate determinants of eczema in German children and adolescents.
Data were drawn from the public use files of the German Interview and Examination Survey for Children and Adolescents (KIGGS), a nationwide cross-sectional representative survey conducted between 2003 and 2006, including 17,641 children aged 0-17 (response rate: 66.6%). We investigated the association of a broad set of environmental and lifestyle exposures with ever physician-diagnosed eczema by means of univariable analyses and multivariable logistic regression modelling.
The weighted prevalence of ever physician-diagnosed eczema was 13.2% [95% confidence interval (CI) 12.5-13.9%]. In multivariable analysis, significant positive associations of parental allergies (OR 1.94, 95% CI 1.72-2.19), parent-reported infection after birth (OR 1.45, 95% CI 1.05-2.00) and parent-reported jaundice after birth (OR 1.27, 95% CI 1.04-1.54) were revealed. Being a migrant (OR 0.63, 95% CI 0.49-0.80) and keeping a dog (OR 0.78, 95% CI 0.64-0.96) showed significant inverse associations with eczema. Other lifestyle (alcohol consumption during pregnancy) and environmental factors (mould on the walls, pets, origin from East/West Germany) were not significantly related to eczema.
This study suggests that a family history of allergies is the strongest determinant of eczema. Perinatal health problems were associated with eczema, pointing to the importance of early life factors in the manifestation of eczema.
Allergy 02/2011; 66(2):206-13. · 6.27 Impact Factor
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ABSTRACT: 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.
To evaluate whether effects on socio-cognitive determinants of skin protection behaviour vary between patients with work related atopic dermatitis (AD) and other work related skin diseases.
A total of 14 inpatients with work related AD and 87 inpatients with other work related skin diseases completed measures on socio-cognitive determinants of skin protection behaviour before and after a 3-week inpatient TIP. Mixed model analyses, using maximum-likelihood estimation tested whether there were differential effects of the intervention on socio-cognitive determinants of skin protection behaviour.
Although patients with AD reported more favourable cognitions towards skin protection behaviour than patients with other skin diseases at admission, these cognitions deteriorated or remained on the same level. Patients with other forms of OSD on the other hand developed more favourable cognitions during the intervention.
Professionals working in the field of OSD should not cease to assist AD patients in achieving optimal skin protection behaviour. Tertiary individual prevention measures may need to pay more attention to the needs of individuals with an occupationally relevant AD. This may contribute to their being able to remain active in the workforce. The alternative would entail regular sick leave, poorer quality of life and economic hardship for the AD patient.
Journal of the European Academy of Dermatology and Venereology 03/2010; 24(9):1089-93. · 2.98 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: www.dermis.net was established in 1994 as a dermatological information system with now more than 4,000 pages and over 7,500 dermatological images in an atlas. 1,200 dermatological diagnoses and medical information with 1,100 synonyms can be searched by body location and in alphabetical order. Additionally, there are seven information modules about skin cancer, atopic dermatitis, rosacea, skin care, eczema, fungal diseases and hemorrhoids with links to other medical pages like Cochrane Library. Pediatric skin diseases are covered in PeDOIA. www.dermis.net is meanwhile available in German, English, Spanish, Portuguese, French and Turkish language. Current contents of this information system and user behavior are presented in this paper.
Der Hautarzt 10/2009; 60(12):979-83. · 0.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Since the establishment of dermatology as an independent discipline of medicine in the middle of the 19th century, pruritus or itch has been a subject of research. The goals were to discover the etiology of pruritus, to develop useful therapies and to achieve a classification within the system of skin diseases. Looking at historical aspects of pruritus demonstrates just how difficult it has been to approach this problem. The difficulties even influence present day pruritus research. For example, there is no definite international standard of pruritus. Etiology-oriented classifications have dominated, but have recently been supplemented by a clinical classification.
Der Hautarzt 02/2009; 60(2):137-41. · 0.58 Impact Factor
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T. Werfel,
D. Staab, T.L. Diepgen,
M. Fartasch,
J. Kupfer,
T. Lob-Corzilius,
J. Ring,
S. Scheewe,
R. Scheidt,
G. Schmid-Ott,
C. Schnopp,
R. Szczepanski,
M. Wittenmeier,
U. Wahn,
U. Gieler
Journal of Investigative Dermatology. 01/2009; 125(3):606-606.
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[show abstract]
[hide abstract]
ABSTRACT: Pruritus (itching) as a disease state and especially as a disease symptom has been object of medical and scientific descriptions and examinations in all epochs since the antiquity and in different cultural periods. Antiquity was dominated by observations and descriptions but during the course of medical history and particularly since the establishment of dermatology, more and more emphasis has been placed on classification and etiologic research.
Der Hautarzt 12/2008; 59(12):1000-6. · 0.58 Impact Factor
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T L Diepgen,
K E Andersen,
F M Brandao,
M Bruze,
D P Bruynzeel,
P Frosch,
M Gonçalo,
A Goossens,
C J Le Coz,
T Rustemeyer,
I R White,
T Agner
[show abstract]
[hide abstract]
ABSTRACT: Hand eczema is a long-lasting disease with a high prevalence in the background population. The disease has severe, negative effects on quality of life and sometimes on social status. Epidemiological studies have identified risk factors for onset and prognosis, but treatment of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system for hand eczema is needed.
The present study attempts to characterize subdiagnoses of hand eczema with respect to basic demographics, medical history and morphology.
Clinical data from 416 patients with hand eczema from 10 European patch test clinics were assessed.
A classification system for hand eczema is proposed.
It is suggested that this classification be used in clinical work and in clinical trials.
British Journal of Dermatology 11/2008; 160(2):353-8. · 3.67 Impact Factor
