Elsner P, Schliemann S
Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland,
Hautarzt. 2015 Mar;66(3):184-8. doi: 10.1007/s00105-015-3582-4.
The different definitions of skin disease in medicine and in law are frequently confusing for dermatologists. While a skin disease may be defined medically referring to the definition of health by the WHO as a pathological condition of the skin leading to a disruption of the physical, mental and social well-being of the individual, legal definitions vary depending on the field of insurance law that is referred to. In the law of private health insurance, a skin disease is defined as an anomalous condition of the skin requiring medical treatment that exists independently of the subjective judgement of the insured person and needs to be objectively confirmed by a medical evaluation. In contrast, in the law of the social health insurance, the Federal Court of Social Justice defines disease as irregular physical or mental condition, deviating from the perception of a healthy human being that requires medical treatment or leads to inability to work. Substantial bodily disfigurement may be regarded as an irregular physical condition. In the law of the statutory accident insurance, occupational skin diseases are defined under clause 5101 of the occupational disease regulation as serious or repeatedly relapsing skin diseases that have forced a person to refrain from any work activities causal for the development, the aggravation or the recurrence of the disease. The Federal Court of Social Justice interprets the term "skin disease" from the protective purpose of the law, i.e. the protection against the economic and health consequences of the exposure to harmful agents and a thereby forced change of profession. This broad interpretation of the term "skin disease" leads to the recognition of diseases of the conjunctiva of the eye or diseases of the blood vessels of the skin due to cold damage as skin diseases according to clause 5101. For the correct treatment and possibly notification of occupational skin diseases in collaboration with various insurance carriers, dermatologists should be familiar not only with the medical definition, but also with these different legal definitions of skin disease.
医学和法律中对皮肤病的不同定义常常让皮肤科医生感到困惑。虽然从医学角度来看，根据世界卫生组织对健康的定义，皮肤病可被定义为导致个人身体、心理和社会福祉受到干扰的皮肤病理状况，但法律定义会因所涉及的保险法领域不同而有所差异。在私人健康保险法中，皮肤病被定义为一种需要医学治疗的皮肤异常状况，它独立于被保险人的主观判断而存在，并且需要通过医学评估进行客观确认。相比之下，在社会健康保险法中，联邦社会正义法院将疾病定义为偏离健康人的认知、需要医学治疗或导致无法工作的身体或精神异常状况。严重的身体毁容可被视为身体异常状况。在法定事故保险法中，职业皮肤病在职业病条例第5101条中被定义为严重的或反复复发的皮肤病，这些疾病迫使一个人停止任何对疾病的发展、加重或复发有因果关系的工作活动。联邦社会正义法院从法律的保护目的出发解释“皮肤病”一词，即保护人们免受接触有害因素所带来的经济和健康后果以及由此导致的被迫职业变更。对“皮肤病”一词的这种宽泛解释导致根据第5101条将眼部结膜疾病或因寒冷损伤导致的皮肤血管疾病认定为皮肤病。为了与各种保险公司合作正确治疗并可能通报职业皮肤病，皮肤科医生不仅应熟悉医学定义，还应熟悉这些不同的皮肤病法律定义。
