Scientists in Germany have discovered a novel way of helping children and adolescents that suffer from atopic eczema or neurodermatitis - an extremely uncomfortable skin disorder. The condition is on the rise in industrialised countries and experts estimate that as many as 20% of children in Europe suffer from it. Results of the study are presented in the Journal of Allergy and Clinical Immunology. A research team led by Dr Astrid Peters and Professor Katja Radon from Ludwig-Maximilians-Universität (LMU) München in Germany carried out a longitudinal study monitoring the course of atopic dermatitis in almost 4,000 subjects from early childhood to adulthood. They highlighted the importance of this research given the stress the disorder can cause in young children, who often scratch until they bleed, which in turn may lead to infection of the inflamed skin. Atopic eczema is classified as an allergic disorder and scientists believe that the condition most likely results from a combination of genetic and environmental factors. Cigarette smoke and household dust are among the factors associated with the disease, while contact with siblings or other children reduces the risk of contracting the disorder. The disease may manifest itself in infancy, but then often clears up as children get older, although in some individuals, puberty markedly exacerbates the condition. The researchers compared the onset and progression of atopic dermatitis in a follow-up patient cohort at 9-11 and 16-20 years and assessed the factors associated with primary manifestation, re-emergence or maintenance of a pre-existing condition during adolescence. In about 7% of the participants, atopic dermatitis first appeared during this phase, with girls being at a higher risk of developing the condition during their teenage years, while boys were overrepresented among younger patients. Moreover, as expected, the chance of developing neurodermatitis increased significantly if a close relative suffered from the disorder. 'Based on the data we obtained, we developed a probabilistic model that can predict the progress of the disorder during puberty, a phase which is often critical,' said Professor Radon. 'It emerged that the most important risk factor for adolescents is occupational exposure to substances such as flour or disinfectants. These results have significant implications for patient care, particularly with respect to their career choices. 'It is known that a patient's choice of career is one factor that plays a role, but there was no way to predict how the disorder might progress as patients got older. We have re-evaluated data from several previous studies on asthma and allergies, which has allowed us to obtain a general picture of the course of atopic dermatitis during puberty, to identify exacerbating factors - and to model its development in individual cases.' Commenting on the factors that trigger this disorder, Dr Peters said; 'Children who were breast-fed, had siblings and attended kindergarten tended not to develop the condition in early childhood.' However, she pointed out that 'strikingly, these factors have much less effect on risk for the late-onset form. Occupational exposure to irritating substances seems to be the only predisposing factor of major significance in cases of late-onset neurodermatitis'. Groups that are at increased risk include bakers, cleaners and nurses. 'Even short-term exposure to the chemicals one encounters in these settings can have a negative effect,' said Dr Peters. She urged allergologists to 'take these findings into account when dispensing career counseling to young patients or adolescents at risk for neurodermatitis'.