Werden Zwangs‐ und Persönlichkeitsstörungen bei Berufsdermatosen ausreichend berücksichtigt? Eine Diskussion anhand von drei Fallbeispielen

Abstract

Hand dermatitis is relatively common in the general population. Among work-related diseases, it is the most common form of occupational skin disease. Irritant hand dermatitis is the most frequent type. Besides wet work and direct contact to irritating occupational substances frequent hand washing can damage the barrier function of the skin facilitating the manifestation of hand dermatitis that frequently occurs chronically. According to own observations the role of obsessive-compulsive washing as part of an anxiety disorder or personality disorders may not be considered sufficiently. A possible pathogenetic relation between hand dermatitis and psychogenic disorders is discussed in a 22-year old physician's assistant, a 50-year old male nurse working in intensive care, and a 54-year old cleaner. All three patients complained about feelings of revulsion, fear of contamination and a high frequency of hand washing. These cases may encourage dermatologists to consider psychological aspects of hand dermatitis e.g. obsessive compulsive washing, overcome their inhibitions and consider these aspects in an integrated way when planning patient's therapy.

“The itching hand“– important differential diagnoses and treatment

“…Mental factors can also significantly impact the course of skin diseases, including dermatoses of the hands [31–33]. About 50 % of patients with dermatoses of the hand are convinced that “stress” affects the course of their skin disease [31].…”

“…In this study, it was also demonstrated that the subjective reaction to stress correlates with the severity of the skin disease, depression and the experience of significant life events [31]. In hand dermatoses or pruritus of the hands, compulsive disorders such as compulsive hand‐washing must be considered as well [32]. These patients are controlled by compulsive thoughts.…”

“…Bekanntermaßen können psychische Faktoren den Verlauf einer Hauterkrankung maßgeblich beeinfl ussen. Dies trifft auch auf Dermatosen der Hände zu [31][32][33]. Auch zeigt es sich, dass etwa 50 % der Patienten mit Dermatosen der Hand davon überzeugt sind, dass "Stress" den Verlauf der Hauterkrankung beeinfl usst [31].…”

“…Bei Handdermatosen bzw. Pruritus der Hände sind auch Zwangsstörungen wie Waschzwang zu berücksichtigen [32]. Diese Patienten Abbildung 11 Scabies der Hände mit rötlichen juckenden Papeln und Papulovesikel der linken Handinnenfläche bei einem 42-jährigen Krankenpfleger mit beruflicher Tätigkeit in einem Pflegeheim.…”