LAUSR

Occupational skin diseases (OSD), mainly irritant and allergic contact dermatitis, have so far attracted relatively little attention in the global and national agendas for prevention of occupational diseases (OD). Yet OSD are amongst the most common occupational diseases in Europe and in many other countries around the Globe. Alone in Europe, OSD related costs vastly exceed 5 billion €/year, mainly by loss of productivity, causing detrimental socio-economic consequences due to often high rates of sickness absence, job loss and permanent disability. In the context of increased exposure of outdoor workers to solar UV radiation, occupational non-melanoma skin cancer (NMSC) is, in addition, becoming a rapidly rising problem, which deserves as much attention as addressed in a recent JEADV supplement. In 2009, the EU Commission defined lacking prevention of OSD a top priority problem. Two years later, in February 2011 at the first Global Workshop on Occupational Skin Diseases, jointly organized by WHO and EADV in Geneva, experts pointed to the fact that there is no coordinated action involving stakeholders at national and international levels. Already then all participants agreed that change can occur with the necessary political will. Regrettably, until today, the situation has not much improved: there are still few isolated efforts, and prevention programmes are poorly validated. Recommendations for personal skin protection are often controversial because standards to objectify effectiveness of gloves, protective creams, after-work emollients, skin cleansers and other personal protective equipment are lacking. Likewise, adequate prevention measures are hampered by a poor awareness of exposed workers regarding the causes and risk factors of OSD. Surveillance and diagnostics of OSD are also hindered, e. g. by a lack of standardized monitoring of new allergens in workplaces. Workplace exposure assessments, a pre-requisite to gain a better understanding of the underlying causes of the skin disorders, continue to be a challenge because many countries do not stipulate by law who is the responsible authority for such visits, and how they have to be performed. More often than not, the material safety data sheets (MSDS) are not updated and incomplete. We are far away from full declaration of ingredients. The EU Clinical Trials Directive (2001/20/EC) hampers listing new commercial patch test allergens. The only way to keep track with new workplace allergens is to patch test patients’ own products. Last but certainly not least, under-reporting is still common in many countries, not allowing policy-makers for a real appraisal of the problem. Unfortunately, the association of OSD with the working environment is frequently still not recognized neither by the worker/employer nor by the dermatologist. And, while OSD are recognized as an OD in most European countries, very few European countries recognize UV radiation inflicted occupational skin cancer as an OD. All this adds to the fact that OSD continue posing an economic threat to our health and occupational risks insurance schemes. Concerted action is needed to improve the often disjointed systems. The EU-funded Horizon 2020 COST Action “Development and Implementation of European Standards on Prevention of Occupational Skin Diseases (StanDerm)” launched in 2013, with an interdisciplinary network of 140 experts from 31 European countries, thus looked into these matters during its four-year lifetime with the objective to develop a blueprint of standards for the prevention, diagnosis and treatment of occupational skin disorders. The recommendations for such Europe-wide standards are entailed in the Position paper (Alfonso et al.), where StanDerm experts take a stand on the urgent need to implement evidence-based standards for the benefit of the patients. Since OSD do not differ across borders, affected patients should be assessed and treated in the same way. The implementation of coherent prevention however fails because key players cannot reach agreement on a standardized prevention strategy. The paper aims at closing this gap and is an important milestone in bringing OSD forward on national and European health agendas. It is excellent news, that in Austria, by the statutory accident insurance (AUVA), presently a nationwide system with specialized outpatient/inpatient units for secondary and tertiary OSD prevention is being implemented in cooperation with the dermatologists. Hopefully, other countries will follow this good practice example. The findings of Mahler et al. and Moldovan et al. corroborate with the previous statements: different national legal situations impede OSD prevention approaches. This includes the lack of educational programmes for workers and the often cumbersome notification process, if applied at all, making a comparison of the disease burden across countries very difficult as emphasized by Mahler. One salient feature pinpointed in both articles is indeed the massive lack of notifications. To our great concern, under-reporting is a prevailing phenomenon across Western and Eastern Europe. In this context, Moldovan0s survey results