title: Psoriasis predisposition and occupational triggering factors in the appraisal of occupational medical expertises.
abstract: BACKGROUND
  Psoriasis is an immune-mediated disease with a genetic background. Local psoriatic changes can be triggered by exogenous mechanical or irritant factors. Causative occupational factors have to be distinguished from the spontaneous course of psoriasis in occupational medical evaluations. The objective of this work is to demonstrate the medico-legal grounds for a homogenous assessment.
  
  
  METHODS
  The presented recommendations were developed in a working group for Occupational and Environmental Dermatology (ABD) and the German contact dermatitis group (DKG) of the German Dermatologic Society (DDG) based on the German medico-legal framework.
  
  
  RESULTS
  Causality between the insured activity and the appearance of psoriasis is a prerequisite for the recognition of the occupational nature of the disease. This is the case if the occupational activity is the exclusive or a legally essential contributing factor either for first manifestation or aggravation of the disease. A connection must be denied if everyday events are sufficient to trigger the psoriasis. From 1995 to 2010, 130 cases of psoriasis have been recognized as occupationally related by the German statutory accident insurance.
  
  
  CONCLUSIONS
  The appraisal of psoriatic disease in the occupational medical evaluation is subject to the case assessment of the expert witness. In this position paper we present recommendations for a homologous basis for diagnosis, causality assessment, estimation of reduction in earning capacity and rehabilitation of occupational psoriasis.
authors.affiliation: Department of Dermatology, University Hospital, Erlangen.
authors.forename: Vera
authors.initials: V
authors.lastname: Mahler
authors.forename: Thomas
authors.initials: T
authors.lastname: Diepgen
authors.forename: Christoph
authors.initials: C
authors.lastname: Skudlik
authors.forename: Detlef
authors.initials: D
authors.lastname: Becker
authors.forename: Heinrich
authors.initials: H
authors.lastname: Dickel
authors.forename: Manige
authors.initials: M
authors.lastname: Fartasch
authors.forename: Johannes
authors.initials: J
authors.lastname: Geier
authors.forename: Michael
authors.initials: M
authors.lastname: Häberle
authors.forename: Uwe
authors.initials: U
authors.lastname: Hillen
authors.forename: Steffen
authors.initials: S
authors.lastname: Krohn
authors.forename: Swen Malte
authors.initials: SM
authors.lastname: John
authors.forename: Elke
authors.initials: E
authors.lastname: Weisshaar
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
authors.forename: Fred
authors.initials: F
authors.lastname: Zagrodnik
mesh_terms: D000465:Algorithms; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000235:genetics*; D004185:Disability Evaluation; D018450:Disease Progression; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D020022:Genetic Predisposition to Disease; D005858:Germany; D006229:Hand Dermatoses / Q000175:diagnosis* / Q000235:genetics*; D006801:Humans; D007346:Insurance, Accident / Q000331:legislation & jurisprudence; D016273:Occupational Exposure / Q000009:adverse effects / Q000331:legislation & jurisprudence; D011565:Psoriasis / Q000175:diagnosis* / Q000235:genetics*; D014938:Work Capacity Evaluation; D014942:Workers' Compensation / Q000331:legislation & jurisprudence