Aim of the study: The aim of this study was to evaluate the evidence for the generally recommended three-step programme of skin protection for the prevention of occupational skin diseases, consisting of skin protection, skin cleansing and skin care measures. The skin care in three typical occupations was therefore investigated in order to assess the validity of this concept, according to the criteria of evidence-based medicine. Methods: In accordance with the five steps of evidence-based medicine, first of all the following question was asked: what kind of skin care might be best for a 35-year-old car mechanic, a 40-year-old surgeon and a 25-year-old metal worker? By asking these questions, we hoped to find typical problems in occupational medicine which were representative for other professions. The occupation of the car mechanic is representative for all other professions with exposure to greasy, contaminated substances, while the surgeon is representative for all other health care workers. In this case, disinfecting the hands and the use of gloves (occlusion) are acknowledged to be potential risk factors for skin damage. The occupation of the metal worker was chosen as a model for all other wet-work employees. Literature research was carried out via PubMed as the most convenient access to medline, and all data were evaluated for validity and relevance. Results and conclusions: We recommend the car mechanic should apply a protective skin cream before starting oily work because creams facilitate the removal of sticky oils, greases and resins, thus decreasing the need to wash with potentially irritative abrasives. The surgeon should use an alcohol-based hand rinse during ward rounds or before clinical examinations, should scrub up without the use of a brush, and should avoid the use of protective skin creams while wearing latex gloves. It is not possible at present to give evidence-based recommendations for the different skin care measures necessary for the metal working branch.
