Interdisciplinary and multiprofessional outpatient secondary individual prevention of work-related skin diseases in the metalworking industry: 1-year follow-up of a patient cohort

Abstract

BackgroundIn Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance.MethodsThe multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity.ResultsData from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program.ConclusionsThe results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a “high-risk” profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining.Electronic supplementary materialThe online version of this article (10.1186/s12895-018-0080-2) contains supplementary material, which is available to authorized users.

Effectiveness of secondary prevention in metalworkers with work‐related skin diseases and comparison with participants of a tertiary prevention program: A prospective cohort study

“…[3][4][5]7 A recent study in 94 MWs with WRSD from Germany showed that 1 year after taking part in a SIP, the disease severity was significantly lower than at baseline and 88.3% had remained in their profession. 6 The TIP is offered to patients with severe symptoms refractory to secondary prevention measures, whereas the SIP targets patients with early and/or mild symptoms of the disease, shortly after notification of the statutory accident insurances. Accordingly, the disease severity was significantly lower and its prior duration significantly shorter in SIP patients than in TIP patients.…”

“…In accordance with other studies, irritant contact dermatitis was the most common diagnosis in both groups. 6,10 Atopic skin diathesis and AD, which are associated with impaired skin barrier function, are well-recognized risk factors for developing WRSDs, particularly irritant contact dermatitis. 18,34,35 In the present study, an atopic hand eczema component and AD observed at body areas other than the hands were significantly more common in TIP patients than in SIP patients.…”

“…The short-and long-term effectiveness of these programs has been demonstrated before in occupations at risk. [3][4][5][6][7][8] Patients with severe WRSD refractory to such secondary prevention measures are invited to take part in an interdisciplinary inpatient/outpatient tertiary individual prevention program (TIP). 2,9 The TIP is based on a 3-week inpatient phase in a specialized center providing intensified diagnostics and treatment as well as health education and psychological counseling followed by a 3-week outpatient phase before returning to work.…”

“…The set‐up and content of the SIP may differ, but it usually involves an outpatient skin protection seminar with emphasis on health education. The short‐ and long‐term effectiveness of these programs has been demonstrated before in occupations at risk 3‐8 . Patients with severe WRSD refractory to such secondary prevention measures are invited to take part in an interdisciplinary inpatient/outpatient tertiary individual prevention program (TIP) 2,9 .…”

Health education decreases incidence of hand eczema in metal work apprentices: Results of a controlled intervention study

“…In the first weeks of apprenticeship, they received a structured 90‐minute training on causes and prevention of work‐related HE consisting of an oral, interactive, and dialogue‐oriented presentation by an experienced health educator, combined with hands‐on practical exercises on correct use of protective gloves, barrier creams, and skin care products. This training was based on seminars regularly conducted by the University of Osnabrück for patients with work‐related HE and previous studies with adjustments for MWAs . The maximum number of MWAs receiving the training at a time was 25.…”