1658e Challenges in diagnosis and prevention of occupational skin diseases

Abstract

Work-related skin diseases (WRSD) are at the top of all notified occupational diseases with a share of more than 40% in some European countries. For example, currently, in Germany, about 30% of annual notifications fall on irritant or allergic contact dermatitis, another 10% on certain forms of occupational nonmelanoma skin cancer by solar UV radiation exposure at the workplace. For WR contact dermatitis (ILO-list: 2.2.1 and 2.2.2), it can be stated that targeted prevention strategies have shown to be highly effective in notified cases, however, the reach out to affected workers is still limited in many countries due to underreporting. Prevention measures include improved workers´ education, specific barrier-recovery oriented skin care methods, better use of protective equipment, selection of safer products, and early medical intervention. Recently, required minimum standards for WRSD prevention, postulating the above mentioned concepts in an interlocking preventive system, have recently been published in Europe. Regarding WR skin cancer in outdoor workers a similar efficacy of organisational measures, workers’ education, and suitable protective equipment based prevention measures is to be expected; again, such preventive measures would be similarly easy and comparatively cheap to implement. However, in occupational skin cancer, even more so than with WR contact dermatitis, preventive measures are neglected. Furthermore, occupational skin cancer by solar UV radiation exposure at the workplace is not yet recognised as an occupational disease in many countries, contributing amongst other factors largely to the gross underreporting, and, thus, lack of preventive intervention. UV radiation has been clearly identified as carcinogenic to humans by the International Agency for Research on Cancer (IARC), even fulfilling group I definitions for complete carcinogens, like eg Plutonium and Arsenic. The more it is astounding, that there is yet no clear work protection regulation for outdoor workers on the level of the EU; so far work protection does only comprise artificial UVR sources. The ILO list of occupational diseases includes multiple reference to occupational cancers and occupational diseases by physical radiation. The ILO Guidance Notes on Diagnostic and Exposure Criteria for Occupational Diseases will describe this specific occupational risk in outdoor workers. This will be an important step to meet the yet unmet challenge of nonmelanoma skin cancer to occupational medicine, considering that it is by far the most frequent and by incidence and prevalence fastest growing occupational malignancy.