Objective: The aim of this prospective follow-up study was to quantify the impact of hand dermatitis (HD) in bakers, confectioners and bakery shop assistants, and to investigate related risk factors. Method: Bakers', confectioners' and bakery-shop assistants were included in a prospective follow-up study in the region of East Thuringia starting in August 1996. At the beginning of their vocational training 91 apprentices were interviewed and examined in a standardised way. Follow-up examinations and interviews were done after 6 months (n = 79), 12 months (n = 63) and at the end of the training (n = 69) after 36 months. Results: In their case histories 3.3% (n = 3) of the apprentices reported previous HD in childhood and adolescence. The first assessment after 2 to 4 weeks of vocational training revealed HD in 17.5% (n = 16) of the individuals. At the follow-up examination after 6 months, point prevalence of HD was 29.1% (n = 23), after 12 months 27.0% (n = 17) and after 36 months 27.5% (n = 19). Mild to moderate irritant contact dermatitis was the most frequent finding. Finally, an atopic skin diathesis (> 10 points, "atopy score") (OR = 4.89; CI 95% 1.15-20.79), previous HD (OR = 41.1; CI 95% 4.99-339.13) as well as flexural dermatitis (OR = 6.8; CI 95% 1.72-27.22) proved to be predictive factors for the development of HD. No association was found to respiratory atopy (OR = 1.29; CI 95% 0.35-4.7) and mental sensitisation (OR = 1.1; CI 95% 0.29-4.35). Exogenous irritant factors did not show a strong association towards a risk increase. Wet work in general, as well as distinct occupational tasks showed only a tendency for being a risk factor for HD. However, leisure time activities, especially house building and rebuilding (OR = 5.4; CI 95% 1.05-27.81), were associated with an elevated risk. Conclusions: Endogenous and exogenous factors contribute to the development of HD in bakers' and confectioners' apprentices.
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