ARTICLE
Auteur(s) : HJ Schwanitz†, DP
Bruynzeel
Definition
Prevention includes primary, secondary and tertiary prevention.
Primary prevention is employed by all individuals exposed to a
given potential risk, with the intent of preventing work-induced
accidents or diseases. In the field of dermatology,
well-established measures of prevention usually involve educational
campaigns; two well-known and successful types of programs are
those encouraging the populace to avoid excessive UV-light
exposure, or those in which individuals entering the hair dressing
profession are evaluated for risk factors and counseled.
Secondary prevention is directed to early recognition and early
intervention. Early recognition of pigmented skin lesions and solar
skin damage are two examples. Another example of secondary
prevention is the early recognition of an atopic disposition in
children, in order to interfere with the genetically determined
course of the disease. Secondary prevention identifies patients at
particular risk and attempts to help them to avoid developing
active disease. When initial skin findings are the stimulus for
prompt measures, secondary prevention can be inexpensive and
rewarding.
Tertiary prevention is part of rehabilitation, enabling affected
individuals to remain functional. The goals are to modify or
reverse the course of the disease, avoid or minimize flare-ups, and
to prevent further complications.
Impact of prevention
Within the last years, the incidence of many skin disorders has
increased dramatically. The most important arena for prevention is
a reduction in exposure to UV light with the goal of reducing the
number of light-induced cutaneous cancers. Partly because of change
in life- style habits, the western population is increasingly
exposed to UV light. This behavior results in an increased
incidence of skin cancer. The best therapy of malignant skin tumors
is early recognition. Another problem is the increasing incidence
of atopic dermatitis, a disease which appears to incorporate both
inherited and life-style risk factors. Dermatologists have
developed attractive programs for early recognition of affected
infants and then appropriate intervention. Dietary measures,
avoidance of allergens, and avoidance of other trigger factors such
as wool clothing, coupled with directed job counseling for
adolescents, can all help to make the life of the individual more
pleasant and at the same time reduce societal costs for job-related
illness and disability.
Therapy
Improved therapeutic modalities for skin disorders are well
documented: optimized surgical approach and the development of
completely new therapeutic options, including specific modulation
of the immune system. Further, the efficiency of rehabilitation on
both the out- and inpatient level is well-documented. For example,
patients with atopic dermatitis or allergic asthma may benefit from
stays in an environment where aeroallergens are sparse, such as at
high altitudes or the sea shore. Patient education and training has
been proven to be of great benefit in a variety of clinical
settings.
Methods of prevention
An exact dermatological diagnosis is the essential starting point.
Patient education follows with a personalized approach for each
individual. Frequently, the relapsing course of skin disorders
leads to frustration and resignation, as the patient accepts their
disease as “fate” rather than continuing to try preventive
measures. Ideally, a patient should be encouraged to learn to take
control of his disease, with the aid of a health care team. Modern
concepts of rehabilitation therefore include motivation of the
individual and provision of support networks.
Primary and secondary prevention involve educational material,
such as brochures, internet sites, and patient handouts. Interested
individuals may then be able to recognize if they or their family
members are at risk, or have early signs of a disease and seek
appropriate dermatologic care.
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