Prevention and Rehabilitation

  • Christoph SkudlikEmail author
  • Swen-Malte John
Living reference work entry


Due to the considerable medical and socio-economic relevance of OSD, effective prevention strategies have been developed for wet-work and other high risk professions in the context of a hierarchical prevention concept (primary-secondary-tertiary prevention).

Interdisciplinary prevention programs for OSD have successfully been implemented in recent years with the aim of reducing the incidence of OSD, achieving continuation of the occupation, decrease the costs for tax-payers and insurance systems and increase of the quality of life of the affected persons.

Further studies to evaluate the clinical and economic outcome of preventive measures are needed.


Multistep intervention approach No touch techniques Occupational skin diseases (OSD) SafeHair project Tertiary individual prevention (TIP) 


  1. Agner T, Held E (2002) Skin protection programmes. Contact Dermatitis 47:253–256CrossRefGoogle Scholar
  2. Allmers H, Schmengler J, John SM (2004) Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol 114:347–351CrossRefGoogle Scholar
  3. Anonymous (2010b).
  4. Bauer A, Kelterer D, Stadeler M, Schneider W, Kleesz P, Wollina U, Elsner P (2001) The prevention of occupational hand dermatitis in bakers, confectioners and employees in the catering trades: preliminary results of a prevention program. Contact Dermatitis 44:85–88CrossRefGoogle Scholar
  5. Bauer A, Kelterer D, Bartsch R, Pearson J, Stadeler M, Kleesz P, Elsner P, Williams H (2002) Skin protection in bakers’ apprentices. Contact Dermatitis 46:81–85CrossRefGoogle Scholar
  6. Bauer A, Schmitt J, Bennett C, Coenraads PJ, Elsner P, English J, Williams HC (2010) Interventions for preventing occupational irritant hand dermatitis (review). Cochrane Database Syst Rev 6:CD004414Google Scholar
  7. Berndt U, Hinnen U, Iliev D, Elsner P (1999) Role of the atopy score and of single atopic features as risk factors for the development of hand eczema in trainee metalworkers. Br J Dermatol 140:922–924CrossRefGoogle Scholar
  8. Brandenburg S (2011) Evidence-based prevention from an accident insurance’s point of view. Forum: multidisciplinary preventive networking in occupational contact dermatitis (director: John SM). In: 69th annual meeting American academy of dermatology (AAD), New Orleans, 04–08 Feb 2011 [Program Book], p 129Google Scholar
  9. de Jongh CM, John SM, Bruynzeel DP, Calkoen F, van Dijk FJH, Khrenova L, Rustemeyer T, Verberk MM, Kezic S (2008a) Cytokine gene polymorphisms and susceptibility to chronic irritant contact dermatitis. Contact Dermatitis 58:269–277CrossRefGoogle Scholar
  10. de Jongh CM, Khrenova L, Verberk M, Calkoen F, van Dijk FJH, Voss H, John SM, Kezic S (2008b) Loss-of-function polymorphisms in the filaggrin gene increase susceptibility to chronic irritant contact dermatitis. Br J Dermatol 159:621–627CrossRefGoogle Scholar
  11. Dickel H, Kuss O, Schmidt A, Diepgen TL (2002) Impact of preventive strategies on trend of occupational skin disease in hairdressers: population based register study. Br J Dermatol 324:1422–1423Google Scholar
  12. Diepgen TL, Fartasch M, Hornstein OP (1991) Criteria of atopic skin diathesis. Dermatosen 39:79–83Google Scholar
  13. Diepgen TL, Radulescu M, Bock M, Weisshaar E (2005) Rehabilitation after work related skin diseases. Hautarzt 56:637–643CrossRefGoogle Scholar
  14. Diepgen TL, Elsner P, Schliemann S, Fartasch M, Köllner A, Skudlik C, John SM, Worm M (2009) Guideline on the management of hand eczema. J Dtsch Dermatol Ges 7(Suppl 3):S1–S16PubMedGoogle Scholar
  15. Elsner P (2007) Skin protection in the prevention of skin diseases. In: Schliemann S, Elsner P (eds) Skin protection: practical applications in the occupational setting. Current problems in dermatology, vol 34. Karger, Basel, pp 1–10Google Scholar
  16. English JS (2004) Current concepts of irritant contact dermatitis. Occup Environ Med 61(722–6):674Google Scholar
  17. Flyvholm MA, Mygind K, Sell L, Jensen A, Jepsen KF (2005) A randomised controlled intervention study on prevention of work related skin problems among gut cleaners in swine slaughterhouses. Occup Environ Med 62:642–649CrossRefGoogle Scholar
  18. Frosch PJ, Aberer W, Agner T, August PJ, Conde-Salazar L, Constandt L, Engasser P, Heras F, John SM, Lauerma A, Le Coz C, Lindberg M, Maibach HI, Muston HL, Nixon RL, Rast H, van Tichelen WI, Williams J (2011) International comparison of legal aspects of worker’s compensation for occupational contact dermatitis. In: Duus Johansen J, Frosch PJ, Lepoittevin JP (eds) Contact dermatitis, 5th edn. Springer, Berlin/Heidelberg, pp 1029–1051CrossRefGoogle Scholar
  19. John SM, Skudlik C (2006) New forms of management in dermatology. Integrated in-patient-out-patient prevention of severe occupational dermatoses: cornerstones for an effective integrated management in clinics and practices. Gesundheitswesen 68:769–774CrossRefGoogle Scholar
  20. John SM, Skudlik C, Romer W, Blome O, Brandenburg S, Diepgen TL, Harwerth A, Koellner A, Pohrt U, Rogosky E, Schindera I, Stary A, Worm M (2007) Recommendation: dermatologist’s procedure. Recommendations for quality assurance of the German society of dermatology (DDG) and the task force on occupational and environmental dermatology (ABD). J Dtsch Dermatol Ges 5:1146–1148CrossRefGoogle Scholar
  21. Kaatz M, Ladermann R, Stadeler M, Fluhr JW, Elsner P, Bauer A (2008) Recruitment strategies for hand dermatitis prevention programme in the food industry. Contact Dermatitis 59:165–170CrossRefGoogle Scholar
  22. Kuetting B, Baumeister T, Weistenhöfer W, Pfahlberg A, Uter W, Drexler H (2010) Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year. Br J Dermatol 162(2):362–370CrossRefGoogle Scholar
  23. Li H, Dai Y, Huang H, Li L, Leng S, Cheng J, Niu Y, Duan H, Liu Q, Zhang X, Huang X, Xie J, Feng Z, Wang J, He J, Zheng Y (2007) HLA-B 1301 as a biomarker for genetic susceptibility to hypersensitivity dermatitis induced by trichloroethylene among workers in China. Environ Health Perspect 115:1553–1556CrossRefGoogle Scholar
  24. Löffler H, Bruckner T, Diepgen TL, Effendy I (2006) Primary prevention in health care employees: a prospective intervention study with a 3-year training period. Contact Dermatitis 54:202–209CrossRefGoogle Scholar
  25. Matterne U, Diepgen TL, Weisshaar E (2010) Effects of a health-educational and psychological intervention on socio-cognitive determinants of skin protection behavior in individuals with occupational dermatoses. Int Arch Occup Environ Health 83:183–189CrossRefGoogle Scholar
  26. Mertin M, Frosch P, Kügler K, Sieverding M, Goergens A, Wulfhorst B, John SM (2009) Skin disease prevention courses for secondary prevention in metal workers Dermatol Beruf Umw 57:29–35Google Scholar
  27. Nicholson PJ, Llewellyn D, English JS (2010) Evidence-based guidelines for the prevention identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis 63:177–186CrossRefGoogle Scholar
  28. Nienhaus A, Rojahn K, Skudlik C, Wulfhorst B, Dulon M, Brandenburg S (2004) Secondary individual prevention and rehabilitation in female hairdressers suffering from skin diseases. Gesundheitswesen 66:759–764CrossRefGoogle Scholar
  29. Rogosky E, Zec S (2009) Praeventionskampagne haut. Final report. Deutsche gesetzliche unfallversicherung/German social accident insurance (DGUV). DCM Druck Meckenheim, BerlinGoogle Scholar
  30. Schürer NY, Klippel U, Schwanitz HJ (2005) Secondary individual prevention of hand dermatitis in geriatric nurses. Int Arch Occup Environ Health 78:149–157CrossRefGoogle Scholar
  31. Schwanitz HJ, Riehl U, Schlesinger T, Bock M, Skudlik C, Wulfhorst B (2003) Skin care management: educational aspects. Int Arch Occup Environ Health 76:374–381CrossRefGoogle Scholar
  32. Skudlik C, John SM (2007) Skin protection in hairdressers. In: Schliemann S, Elsner P (eds) Skin protection. Current problems in dermatology, vol 34. Karger, Basel, pp 133–137Google Scholar
  33. Skudlik C, Schwanitz HJ (2004) Tertiary prevention of occupational skin diseases. J Dtsch Dermatol Ges 2:424–434CrossRefGoogle Scholar
  34. Skudlik C, Breuer K, Junger M, Allmers H, Brandenburg S, John SM (2008a) Optimal care of patients with occupational hand dermatitis: considerations of German occupational health insurance. Hautarzt 59:690–695CrossRefGoogle Scholar
  35. Skudlik C, Wulfhorst B, Gediga G, Bock M, Allmers H, John SM (2008b) Tertiary individual prevention of occupational skin diseases: a decade’s experience with recalcitrant occupational dermatitis. Int Arch Occup Environ Health 81:1059–1064CrossRefGoogle Scholar
  36. Skudlik C, Dulon M, Wendeler D, John SM, Nienhaus A (2009a) Hand eczema in geriatric nurses in Germany. Prevalence and risk factors. Contact Dermatitis 60:136–143CrossRefGoogle Scholar
  37. Skudlik C, Jünger M, Palsherm K, Breuer K, Brandenburg S, John SM (2009b) Cooperation among clinics and practices. Integrated medical care in occupational dermatology. Hautarzt 60:722–726CrossRefGoogle Scholar
  38. Skudlik C, Weisshaar E, Wulfhorst B, Scheidt R, Schönfeld M, Elsner P, Diepgen TL, John SM (2009c) Multicenter study “medical-occupational rehabilitation procedure skin – optimizing and quality assurance of inpatient-management (ROQ)”. J Dtsch Dermatol Ges 7:122–127PubMedGoogle Scholar
  39. Skudlik C, Weisshaar E, Scheidt R, Elsner P, Wulfhorst B, Schönfeld M, John SM, Diepgen TL (2011) first results from the multicentre study “rehabilitation of occupational skin diseases – optimisation and quality Assurance of Inpatient Management (ROQ)”. (shared last authorship) Contact Dermatitis; Epub 09 Nov 2011Google Scholar
  40. Slodownik D, Lee A, Nixon R (2008) Irritant contact dermatitis: a review. Australas J Dermatol 49:1–9CrossRefGoogle Scholar
  41. Thyssen JP, Ross-Hansen K, Menné T, Johansen JD (2010) Patch test reactivity to metal allergens following regulatory interventions: a 33-year retrospective study. Contact Dermatitis 63:102–106CrossRefGoogle Scholar
  42. Uter W, Pfahlberg A, Gefeller O, Schwanitz HJ (1998) Risk factors for hand dermatitis in hairdressing apprentices results of the “prevention of occupational skin disease in hairdressers” study. Dermatosen 46:151–158Google Scholar
  43. Uter W, Geier J, Lessmann H, Schnuch A (2006) Is contact allergy to glyceryl monothioglycolate still a problem in Germany? Contact Dermatitis 55:54–56CrossRefGoogle Scholar
  44. van Gils RF, Boot CRL, van Gils PF, Bruynzeel D, Coenraads PJ, van Mechelen W, Riphagen II, Anema JR (2011) Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature. Contact Dermatitis 64:63–72CrossRefGoogle Scholar
  45. Voß H, Mentzel F, Wilke A, Maier B, Gediga G, Skudlik C, John SM (2009) Optimized dermatologist’s report and hierarchical multi-step invention: randomized evaluation of the cornerstones of preventive occupational dermatology. Hautarzt 60:695–701CrossRefGoogle Scholar
  46. Weisshaar E, Radulescu M, Soder S, Apfelbacher CJ, Bock M, Grundmann JU, Albrecht U, Diepgen TL (2007) Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees: aims, experiences and descriptive results. Int Arch Occup Environ Health 80(6):477–484CrossRefGoogle Scholar
  47. Wigger-Alberti W, Maraffio B, Wernli M, Elsner P (1997) Training workers at risk for occupational contact dermatitis in the application of protective creams: efficacy of a fluorescence technique. Dermatology 195:129–133CrossRefGoogle Scholar
  48. Wulfhorst B, Bock M, Skudlik C, John SM (2006) Worker education and teaching programs: the German experience. In: Frosch P, Menné T, Lepoittevin J (eds) Textbook of contact dermatitis. Springer, Berlin/Heidelberg/New York, pp 855–861Google Scholar
  49. Wulfhorst B, Bock M, Gediga G, Skudlik C, Allmers H, John SM (2010) Sustainability of an interdisciplinary secondary prevention program in hairdressers. Int Arch Occup Environ Health 83(2):165–171CrossRefGoogle Scholar
  50. Wulfhorst B, Bock M, Skudlik C, Wigger-Alberti W, John SM (2011) Prevention of hand eczema – gloves, barrier creams and workers’ education. In: Duus Johansen J, Frosch PJ, Lepoittevin JP (eds) Contact dermatitis, 5th edn. Springer, Berlin/Heidelberg, pp 985–1028CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Faculty of Human Sciences, Department of Dermatology, Environmental Medicine and Health TheoryUniversity of OsnabrückOsnabrückGermany
  2. 2.Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and EducationUniversity of OsnabrückOsnabrückGermany

Personalised recommendations