Skin Disorders

• Author: David A. Morton III
• Pages: 833-906

8-1

Chapter 8

Skin Disorders

Part I - Adults

§8.00 Skin

§8.01 Category of Impairments, Skin

§8.02 Ichthyosis

§8.03 Bullous disease

§8.04 Chronic Infections

§8.05 Dermatitis

§8.06 Hydradenitis suppurativa

§8.07 Genetic photosensitivity disorders

§8.08 Burns

Part II – Children

§108.00 Skin

§108.01 Category of Impairments, Skin

§108.02 Ichthyosis

§108.03 Bullous disease

§108.04 Chronic infections

§108.05 Dermatitis

§108.06 Hydradenitis suppurativa

§108.07 Genetic photosensitivity disorders

§108.08 Burns

Part III – Forms

§8.02F Ichthyosis

§8.03F Bullous

§8.04F Chronic Infections of Skin

§8.05F Dermatitis

§8.06F Hydradenitis Suppurativa

§8.07F Genetic Photosensitivity Disorders

§8.08F Burns

Long Forms on Digital Access Only

§8.02F(L) Ichthyosis

§8.03F(L) Bullous

§8.04F(L) Chronic Infections of Skin

§8.05F(L) Dermatitis

§8.00 MEDICAL ISSUES IN SOCIAL SECURITY DISABILITY 8-2

Part I - Adults

§8.00 Skin Disorders (Adults)

[The applicable Listing of Impairments introduces

each chapter and is typeset in Helvetica. Author

comments follow each Listing subsection and are type-

set in Times.]

SSA Listing of Impairments

A. What skin disorders do we evaluate with these

listings? We use these listings to evaluate skin dis-

orders that may result from hereditary, congenital,

or acquired pathological processes. The kinds of

impairments covered by these listings are: Ichthyosis,

bullous diseases, chronic infections of the skin or

mucous membranes, dermatitis, hidradenitis suppu-

rativa, genetic photosensitivity disorders, and burns.

B. What documentation do we need? When we

evaluate the existence and severity of your skin dis-

order, we generally need information about the onset,

duration, frequency of flare-ups, and prognosis of

your skin disorder; the location, size, and appearance

of lesions; and, when applicable, history of exposure

to toxins, allergens, or irritants, familial incidence,

seasonal variation, stress factors, and your ability to

function outside of a highly protective environment.

To confirm the diagnosis, we may need laboratory

findings (for example, results of a biopsy obtained

independently of Social Security disability evalua-

tion or blood tests) or evidence from other medically

acceptable methods consistent with the prevailing

state of medical knowledge and clinical practice.

C. How do we assess the severity of your skin

disorder(s)? We generally base our assessment of

severity on the extent of your skin lesions, the fre-

quency of flare-ups of your skin lesions, how your

symptoms (including pain) limit you, the extent of

your treatment, and how your treatment affects you.

1. Extensive skin lesions. Extensive skin lesions

are those that involve multiple body sites or critical

body areas, and result in a very serious limitation.

Examples of extensive skin lesions that result in a

very serious limitation include, but are not limited to:

a. Skin lesions that interfere with the motion

of your joints and that very seriously limit your

use of more than one extremity; that is, two

upper extremities, two lower extremities, or one

upper and one lower extremity.

b. Skin lesions on the palms of both hands that

very seriously limit your ability to do fine and

gross motor movements.

c. Skin lesions on the soles of both feet, the

perineum, or both inguinal areas that very seri-

ously limit your ability to ambulate.

2. Frequency of flare-ups. If you have skin lesions,

but they do not meet the requirements of any of the

listings in this body system, you may still have an

impairment that prevents you from doing any gain-

ful activity when we consider your condition over

time, especially if your flare-ups result in exten-

sive skin lesions, as defined in C1 of this section.

Therefore, if you have frequent flare-ups, we may

find that your impairment(s) is medically equal to

one of these listings even though you have some

periods during which your condition is in remis-

sion. We will consider how frequent and serious

your flare-ups are, how quickly they resolve, and

how you function between flare-ups to determine

whether you have been unable to do any gain-

ful activity for a continuous period of at least 12

months or can be expected to be unable to do any

gainful activity for a continuous period of at least 12

months. We will also consider the frequency of your

flare-ups when we determine whether you have a

severe impairment and when we need to assess your

residual functional capacity.

3. Symptoms (including pain). Symptoms (includ-

ing pain) may be important factors contributing

to the severity of your skin disorder(s). We assess

the impact of symptoms as explained in Sec. Sec.

404.1528, 404.1529, 416.928, and 416.929 of this

chapter.

4. Treatment. We assess the effects of medication,

therapy, surgery, and any other form of treatment

you receive when we determine the severity and

duration of your impairment(s). Skin disorders fre-

quently respond to treatment; however, response to

treatment can vary widely, with some impairments

becoming resistant to treatment. Some treatments

can have side effects that can in themselves result in

limitations.

a. We assess the effects of continuing treat-

ment as prescribed by determining if there is

improvement in the symptoms, signs, and labora-

tory findings of your disorder, and if you experi-

SSA Pub No. 64-039 Listing of Impairments (footnote written by author)

8-3 SKIN DISORDERS §8.00

ence side effects that result in functional limita-

tions. To assess the effects of your treatment, we

may need information about:

i. The treatment you have been prescribed (for

example, the type, dosage, method, and frequen-

cy of administration of medication or therapy);

ii. Your response to the treatment;

iii. Any adverse effects of the treatment; and

iv. The expected duration of the treatment.

b. Because treatment itself or the effects of

treatment may be temporary, in most cases

sufficient time must elapse to allow us to evalu-

ate the impact and expected duration of treatment

and its side effects. Except under 8.07 and 8.08,

you must follow continuing treatment as pre-

scribed for at least 3 months before your impair-

ment can be determined to meet the requirements

of a skin disorder listing. (See 8.00H if you are

not undergoing treatment or did not have treat-

ment for 3 months.) We consider your specific

response to treatment when we evaluate the over-

all severity of your impairment.

D. How do we assess impairments that may

affect the skin and other body systems? When

your impairment affects your skin and has effects in

other body systems, we first evaluate the predomi-

nant feature of your impairment under the appro-

priate body system. Examples include, but are not

limited to the following.

1. Tuberous sclerosis primarily affects the brain.

The predominant features are seizures, which we

evaluate under the neurological listings in 11.00,

and developmental delays or other mental disorders,

which we evaluate under the mental disorders list-

ings in 12.00.

2. Malignant tumors of the skin (for example,

malignant melanomas) are cancers, or neoplastic dis-

eases, which we evaluate under the listings in 13.00.

3. Connective tissue disorders and other immune

system disorders (for example, systemic lupus ery-

thematosus, scleroderma, human immunodeficiency

virus (HIV) infection, and Sjogren’s syndrome)

often involve more than one body system. We first

evaluate these disorders under the immune system

listings in 14.00. We evaluate lupus erythematosus

under 14.02, scleroderma under 14.04, symptomatic

HIV infection under 14.08, and Sjogren’s syndrome

under 14.03, 14.09, or any other appropriate listing

in section 14.00.

4. Disfigurement or deformity resulting from

skin lesions may result in loss of sight, hearing,

speech, and the ability to chew (mastication). We

evaluate these impairments and their effects under

the special senses and speech listings in 2.00 and

the digestive system listings in 5.00. Facial dis-

figurement or other physical deformities may also

have effects we evaluate under the mental disorders

listings in 12.00, such as when they affect mood or

social functioning.

E. How do we evaluate genetic photosensitivity

disorders?

1. Xeroderma pigmentosum (XP). When you have

XP, your impairment meets the requirements of

8.07A if you have clinical and laboratory findings

showing that you have the disorder. (See 8.00E3.)

People who have XP have a lifelong hypersensitiv-

ity to all forms of ultraviolet light and generally

lead extremely restricted lives in highly protective

environments in order to prevent skin cancers from

developing. Some people with XP also experience

problems with their eyes, neurological problems,

mental disorders, and problems in other body sys-

tems.

2. Other genetic photosensitivity disorders.

Other genetic photosensitivity disorders may vary

in their effects on different people, and may not

result in an inability to engage in any gainful activ-

ity for a continuous period of at least 12 months.

Therefore, if you have a genetic photosensitiv-

ity disorder other than XP (established by clinical

and laboratory findings as described in 8.00E3),

you must show that you have either extensive

skin lesions or an inability to function outside of a

highly protective environment to meet the require-

ments of 8.07B. You must also show that your

impairment meets the duration requirement. By

inability to function outside of a highly protective

environment we mean that you must avoid expo-

sure to ultraviolet light (including sunlight pass-

ing through windows and light from unshielded

fluorescent bulbs), wear protective clothing and

eyeglasses, and use opaque broad-spectrum sun-

screens in order to avoid skin cancer or other

serious effects. Some genetic photosensitivity dis-

orders can have very serious effects in other body

systems, especially special senses and speech

(2.00), neurological (11.00), mental (12.00), and

neoplastic (13.00). We will evaluate the predomi-

nant feature of your impairment under the appro-

priate body system, as explained in 8.00D.

SSA Pub No. 64-039 Listing of Impairments (footnote written by author)