title: Prevention of hand dermatitis in bakers' apprentices: different efficacy of skin protection measures and UVB hardening.
abstract: OBJECTIVE
  The objective of this controlled intervention study was to quantify the efficacy of skin protection (SP) measures and ultraviolet B (UVB) hardening in the prevention of hand dermatitis in bakers' apprentices.
  
  
  METHODS
  SP measures were compared against UVB hardening in a controlled clinical trial of 94 apprentices. The apprentices were assigned to the intervention arms class-wise. Bakers' apprentices involved in a previous follow-up study served as additional controls representing no intervention. The apprentices were interviewed and examined in a standardised way at the beginning of the training and at 4 monthly follow-ups. Transepidermal water loss (TEWL) was measured at the back of the hands.
  
  
  RESULTS
  Demographic profile and atopy criteria were equally distributed in the two intervention arms and the control group. Point prevalence of hand dermatitis after 6 months was highest in the controls (29.1%) followed by the UVB (19.4%) and the SP group (13.3%). UVB hardening and SP measures reduced hand dermatitis prevalence by 9.7% (95%CI: -8.5 to 28.1) and 15.7% (95%CI: -2.4 to 33.9), respectively. Application of SP measures reduced the odds ratios (ORs) for hand dermatitis 0.8-fold (95%CI: 0.17-3.70) and 0.33-fold (95%CI: 0.09-1.23) compared with the UVB group and the controls, respectively. These clinical trends were confirmed by statistically significant differences in TEWL values. TEWL values were consistently higher in the UVB group than in the SP group ( P=0.002).
  
  
  CONCLUSIONS
  This study provided evidence, based on significant differences in TEWL levels, that general SP measures may be more effective than UV light hardening of the skin, which in turn was more effective than no intervention. This trend was supported by the frequency of development of clinical hand dermatitis, although differences did not reach statistical significance. A multi-centre trial is recommended to confirm the efficacy of SP measures in a larger randomised study.
authors.affiliation: Department of Dermatology and Allergology, Friedrich-Schiller-University Jena, Erfurterstrasse 35, 07740 Jena, Germany. abau@derma.uni-jena.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Bauer
authors.forename: Daniela
authors.initials: D
authors.lastname: Kelterer
authors.forename: Reinhard
authors.initials: R
authors.lastname: Bartsch
authors.forename: Anja
authors.initials: A
authors.lastname: Schlegel
authors.forename: James
authors.initials: J
authors.lastname: Pearson
authors.forename: Martina
authors.initials: M
authors.lastname: Stadeler
authors.forename: Peter
authors.initials: P
authors.lastname: Kleesz
authors.forename: Romano
authors.initials: R
authors.lastname: Grieshaber
authors.forename: Rainer
authors.initials: R
authors.lastname: Schiele
authors.forename: Peter
authors.initials: P
authors.lastname: Elsner
authors.forename: Hywel
authors.initials: H
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D003296:Cooking; D017453:Dermatitis, Irritant / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006225:Hand / Q000473:pathology* / Q000528:radiation effects; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D008297:Male; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D014466:Ultraviolet Rays; D014870:Water Loss, Insensible / Q000528:radiation effects; D000078329:Workforce