[The three-step programme of skin protection. A useful instrument of primary prevention or more effective in secondary prevention?].

For many years the three-step programme of skin protection, consisting of skin protection before work, cleaning and skin care after work, is one of the generally recommended measures to prevent occupational contact dermatitis. While protective creams are supposed to prevent skin damage caused by irritant contact, skin cleansing should mildly remove aggressive substances from the skin, whereas post-exposure skin care is intended to enhance epidermal barrier regeneration. This programme is strongly followed by most of the employees. But in spite of intensive preventive measurements the rate of reported occupational skin diseases according to BK 5101 is with a mean of 27.9% unchanged high since 1980. Occupational dermatologists even suggest that the reported cases mimic the top of an iceberg and that the incidence of occupational skin diseases might be much higher. These findings raise the question of how effective the actual recommended three-step programme really is in primary and secondary prevention of occupational contact dermatitis. This review is aimed to give an evaluation on the evidence of each single element of the three-step concept. Following results can be determined: In cases of impaired skin condition the therapeutic properties of skin protection (secondary prevention) is undoubted. The effectiveness of barrier creams in the primary prevention of hand eczema could not be proven. Beyond doubt is the fact that barrier creams facilitate the removal of sticky oils, greases, and resins from the skin, thus decreasing the need to wash with potentially irritating abrasives and waterless cleansers.