[Prevention of hand eczema]

S2k-Leitlinie Diagnostik, Prävention und Therapie des Handekzems: S2k guideline diagnosis, prevention and therapy of hand eczema

Die S2k‐Leitlinie „Diagnostik, Prävention und Therapie des Handekzems (HE)“ gibt auf der Grundlage eines evidenz‐ und konsensbasierten Ansatzes konkrete Handlungsanweisungen und Empfehlungen für die Diagnostik, Prävention und Therapie des HE. Die Leitlinie wurde auf der Grundlage der deutschen Leitlinie „Management von Handekzemen“ aus dem Jahr 2009 und der aktuellen Leitlinie der European Society of Contact Dermatitis (ESCD) „Guidelines for diagnosis, prevention and treatment of hand eczema“ aus dem Jahr 2022 erstellt. Allgemeines Ziel der Leitlinie ist es, Dermatologen und Allergologen in der Praxis und Klinik eine akzeptierte, evidenzbasierte Entscheidungshilfe für die Auswahl sowie Durchführung einer geeigneten und suffizienten Therapie für Patienten mit Handekzemen zur Verfügung zu stellen. Die Leitlinie basiert auf zwei Cochrane‐Reviews zu therapeutischen und präventiven Interventionen beim HE. Die übrigen Kapitel wurden überwiegend basierend auf nicht systematischen Literaturrecherchen durch die Expertengruppe erarbeitet und konsentiert. Die Expertenkommission bestand aus Mitgliedern von allergologischen und berufsdermatologischen Fachgesellschaften und Arbeitsgruppen, einer Patientenvertretung und Methodikern. Im Rahmen einer Konsensuskonferenz am 15.09.2022 wurden die Vorschläge für die Empfehlungen und Kernaussagen unter Verwendung eines nominalen Gruppenprozesses konsentiert. Der strukturierte Konsensfindungsprozess wurde professionell moderiert. Die vorliegende Leitlinie hat eine Gültigkeit bis zum 22.02.2028.

S2k guideline diagnosis, prevention, and therapy of hand eczema

The consensus-based guideline "Diagnosis, prevention, and treatment of hand eczema (HE)" provides concrete instructions and recommendations for diagnosis, prevention, and therapy of HE based on an evidence- and consensus-based approach. The guideline was created based on the German guideline "Management von Handekzemen" from 2009 and the current guideline of the European Society of Contact Dermatitis (ESCD) "Guidelines for diagnosis, prevention, and treatment of hand eczema" from 2022. The general goal of the guideline is to provide dermatologists and allergologists in practice and clinics with an accepted, evidence-based decision-making tool for selecting and conducting suitable and sufficient therapy for patients with hand eczema. The guideline is based on two Cochrane reviews of therapeutic and preventive interventions for HE. The remaining chapters were mainly developed and consented based on non-systematic literature research by the expert group. The expert group consisted of members of allergological and occupational dermatological professional associations and working groups, a patient representative, and methodologists. The proposals for recommendations and key statements were consented by using a nominal group process during a consensus conference on September 15, 2022. The structured consensus-building process was professionally moderated. This guideline is valid until February 22, 2028.

[New guideline and treatment options for hand eczema]

Due to its high prevalence and associated socioeconomic consequences, hand eczema is a burden for those affected and for society. The various hand eczema subtypes must be differentiated from each other through structured anamnesis and diagnostics in order to initiate cause-related preventive measures in addition to symptomatic therapy. There are new developments in the diagnosis, prevention, and treatment of hand eczema. The diagnostic possibilities are being expanded through molecular methods. Modern topical and systemic therapies offer promising treatment options for patients with atopic but also chronic hand eczema regardless of the underlying etiology.

[Patient education in work-related hand eczema : Importance and challenges in health care practice]

Patient education can help patients with work-related hand eczema to cope with their skin disease in an informed and responsible manner and to improve their personal skin protection behavior in everyday working and private life. Skin protection education in centers specialized in occupational dermatology is a pivotal component of outpatient and inpatient individual prevention programs for individuals with work-related skin diseases provided by the statutory accident insurance institutions in Germany. Patient education should be patient-oriented and promote learning, e.g., through interactive, activating discussions and design, references to everyday life, and methodically and didactically well-prepared media and materials in clear, understandable language. Challenges may arise in educational practice, e.g., due to subjective illness perceptions, participants with a lack of motivation, language barriers, functional illiteracy, or heterogeneous patient groups. In this article, different challenges are presented and educational and health psychological perspectives are discussed to meet these challenges in order to provide an optimal, patient-oriented individual prevention measure.

The (new) occupational disease no. 5101: "Severe or recurrent skin diseases"

Occupational dermatoses are among the most common occupational diseases, with BK 5101 accounting for the largest proportion. Historically, the latter was also the most frequently reported group of occupational diseases within the working age population. More than 80,000 suspected cases of occupational diseases were notified in 2019, of which 19,883 related to BK 5101. In Germany, work-related hand eczema accounts for 90 % of all BK 5101 diseases, and consists mainly of contact eczema. Especially young people working in the hairdressing sector, health care, metal, food or construction industries belong to the high-risk group. Diagnosis, therapy and prevention of BK 5101 play an important role, since advanced skin diseases are usually accompanied by a poor prognosis and long periods of inability to work, which can have considerable socio-economic consequences. On January 1^st , 2021, with the "Seventh Act amending the Fourth Book of the German Social Code (SGB) and other Laws", an amendment to the Occupational Diseases Law came into force, with which the obligation to cease work was abolished, thereby fulfilling a decades-long requirement for recognition of BK 5101. As of this year, only the "severe or repeated recurrences" of a skin disease remain as a criterion for the occurrence of an insured event, which will likely result in an increased number of notifications and acknowledged cases of occupational skin diseases.

[The "dermatologist's procedure" after the abolition of the obligation to refrain from risky work activities in occupational disease law]

Die Berufskrankheit (BK) Haut Nr. 5101 war bisher definiert als „schwere oder wiederholt rückfällige Hauterkrankungen, die zur Unterlassung aller Tätigkeiten gezwungen haben, die für die Entstehung, die Verschlimmerung oder das Wiederaufleben der Krankheit ursächlich waren oder sein können“. In einer weitreichenden Reform des Berufskrankheitenrechts, die zum 01.01.2021 in Kraft trat, hat der Gesetzgeber beschlossen, den „Unterlassungszwang“ als Voraussetzung für die Anerkennung einer Berufskrankheit abzuschaffen. Dieser Unterlassungszwang sollte mit dem 1972 eingeführten Hautarztverfahren und den dort etablierten Präventionsinstrumenten (dermatologische Behandlung, Sanierung des Arbeitsplatzes, Hautschutzmaßnahmen, gesundheitspädagogische Maßnahmen) verhindert werden, was in einem Großteil der Fälle auch gelang. Während die Abschaffung des Unterlassungszwangs die Anerkennung von schweren oder wiederholt rückfälligen Hauterkrankungen als Berufskrankheiten erleichtert, wird das Hautarztverfahren jedoch weiterhin Bedeutung behalten für die beruflichen Hauterkrankungen, insbesondere Handekzeme, die primär nicht die Kriterien der Schwere und/oder der wiederholten Rückfälligkeit erfüllen und die durch geeignete Behandlungs- und Präventionsmaßnahmen beherrscht werden können. Um bei einer BK-Anzeige wegen der Schwere oder wiederholten Rückfälligkeit einer Hauterkrankung Verzögerungen in der Sekundärprävention zu vermeiden, sollte gleichzeitig über einen Hautarztbericht zur BK-Anzeige der Unfallversicherungsträger die für zeitnahe Präventionsmaßnahmen und einen dermatologischen Behandlungsauftrag erforderlichen Informationen erhalten. Ein Anhaltspunkt für die Schwere könnte der Erfolg oder der Misserfolg des Hautarztverfahrens sein.

Experimental evaluation of nickel and cobalt release from tools and self-reported prevalence of nickel and cobalt allergy in the German hairdressing trade

BACKGROUND

Nickel release from some metal tools in the hairdressing trade has been sporadically evidenced, whereas data about cobalt release from metal tools in the hairdressing trade are lacking.

OBJECTIVES

To screen metal tools for nickel and cobalt release and to estimate the prevalence of nickel allergy and cobalt allergy in the German hairdressing trade.

METHODS

Four hundred seventy-five metal tools in the hairdressing trade were tested in three North German states with a nickel spot test for nickel release and with a cobalt spot test for cobalt release. Seventy hairdressers were surveyed with a standardized questionnaire to collect data about the tested metal tools as well as the prevalence of nickel allergy and cobalt allergy.

RESULTS

One hundred thirty-one of 475 metal tools (27.6%) - 60 of 60 hair clips (100%), five of five crochet hooks (100%), 24 of 40 tweezers (60.0%), 33 of 75 sectioning clips (44.0%), five of 32 straight razors (15.6%), and four of 45 tail combs (8.9%) - released nickel and 10 of 475 metal tools (2.1%) - three of 40 tweezers (7.5%), four of 60 hair clips (6.7%), one of 32 straight razors (3.1%), and two of 75 sectioning clips (2.7%) - released cobalt. Eight of 63 female hairdressers (12.7%) suffered from nickel allergy and two of 63 female hairdressers (3.2%) suffered from cobalt allergy.

CONCLUSIONS

Metal tools in the German hairdressing trade - with which a prolonged skin contact is intended - release nickel and cobalt in allergologically relevant amounts and thus should be taken into account as occupational sources of exposure to nickel and cobalt.