Skin Disorders

• Author: David A. Morton III
• Pages: 789-858

8-1

CHAPTER 8

Skin Disorders

Contents

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

SKIN DISORDERS

§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. Author comments follow each Listing

subsection.]

SSA Listing of Impairments

A. What skin disorders do we evaluate with these list-

ings? We use these listings to evaluate skin disorders

that may result from hereditary, congenital, or acquired

pathological processes. The kinds of impairments cov-

ered by these listings are: Ichthyosis, bullous diseases,

chronic infections of the skin or mucous membranes,

dermatitis, hidradenitis suppurativa, genetic photosen-

sitivity disorders, and burns.

B. What documentation do we need? When we eval-

uate the existence and severity of your skin disorder,

we generally need information about the onset, dura-



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



  

example, results of a biopsy obtained independently of

Social Security disability evaluation or blood tests) or

evidence from other medically acceptable methods con-

sistent with the prevailing state of medical knowledge

and clinical practice.

C. How do we assess the severity of your skin disor-

der(s)? We generally base our assessment of severity on



of your skin lesions, how your symptoms (including pain)

limit you, the extent of your treatment, and how your



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 extrem-

ities, two lower extremities, or one upper and one

lower extremity.

b. Skin lesions on the palms of both hands that

 

motor movements.

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

or both inguinal areas that very seriously limit your

ability to ambulate.

2.  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 gainful activity when

we consider your condition over time, especially if your

 



  

equal to one of these listings even though you have some

periods during which your condition is in remission. We



how quickly they resolve, and how you function between



any gainful 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

  

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 §§ 404.1521, 404.1529,

416.921, and 416.929 of this chapter.

4. Treatment.    

therapy, surgery, and any other form of treatment you

receive when we determine the severity and duration of

your impairment(s). Skin disorders frequently respond

to treatment; however, response to treatment can vary

widely, with some impairments becoming resistant to



in themselves result in limitations.

a.  as

prescribed by determining if there is improvement in







treatment, we may need information about:

i. The treatment you have been prescribed (for

example, the type, dosage, method, and frequency

of administration of medication or therapy);

SKIN DISORDERS

8-3 SKIN DISORDERS §8.00

ii. Your response to the treatment;

iii.  of the treatment; and

iv. The expected duration of the treatment.

b. 

may be temporary

elapse to allow us to evaluate the impact and expected



8.07 and 8.08, you must follow continuing treatment as

prescribed for at least 3 months before your impairment

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 treatment for 3 months.) We



evaluate the overall severity of your impairment.

D. 

skin and other body systems? When your impairment

 

-

ment under the appropriate body system. Examples

include, but are not limited to the following.

1.  The

predominant features are seizures, which we evaluate

under the neurological listings in 11.00, and developmen-

tal delays or other mental disorders, which we evaluate

under the mental disorders listings in 12.00.

2. Malignant tumors of the skin (for example, malig-

nant melanomas) are cancers, or neoplastic diseases,

which we evaluate under the listings in 13.00.

3. Connective tissue disorders and other immune

system disorders (for example, systemic lupus erythe-

 

(HIV) infection, and Sjögren’s syndrome) often involve

-

orders under the immune system listings in 14.00. We

evaluate SLE under 14.02, scleroderma under 14.04,

Sjögren’s syndrome under 14.10, and HIV infection

under 14.08, and Sjogren’s syndrome under 14.11.

4.  

lesions may result in loss of sight, hearing, speech, and

the ability to chew (mastication). We evaluate these



speech listings in 2.00 and the digestive system listings in



-



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 the disorder. (See 8.00E3.) People who have XP have

a lifelong hypersensitivity 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 systems.

2. Other genetic photosensitivity disorders. Other

genetic photosensitivity disorders may vary in their

   

inability to engage in any gainful activity for a continu-

ous period of at least 12 months. Therefore, if you have

a genetic photosensitivity disorder other than XP (estab-



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 requirements 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 exposure to ultraviolet light (including sun-

light passing through windows and light from unshielded

 -

glasses, and use opaque broad-spectrum sunscreens in



genetic photosensitivity disorders can have very serious

 

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

and neoplastic (13.00). We will evaluate the predominant

feature of your impairment under the appropriate body

system, as explained in 8.00D.

3. 

a. General. We need documentation from an acceptable

medical source to establish that you have a medically

determinable impairment. In general, we must have

evidence of appropriate laboratory testing showing

that you have XP or another genetic photosensitivity

 

genetic photosensitivity disorder based on a report

from an acceptable medical source indicating that you



laboratory studies documenting appropriate chromo-

somal changes, including abnormal DNA repair or



type of photosensitivity disorder.

SKIN DISORDERS