A population-based study was performed to investigate incidence rates of occupational skin disease (OSD) in bakers, confectioners and cooks, as well as the rôle of endogenous and exogenous risk factors. In North Bavaria, all closed cases of OSD were recorded systematically in a 3-year period and the total number of employees in the food industry was known over the same period of time. Incidence rates of OSD and relative risks of atopic skin diathesis (AD) and respiratory atopy (RA) were calculated. The overall incidence rate (I) of OSD (in 3 years per 10.000 employees) was 67 (95% CI 58;76) in these occupations. Bakers had a higher risk of OSD, with an incidence of 191 (95% CI 156;226) compared to confectioners with I = 84 (95% CI 55;113) and cooks I = 34 (95% CI 28;40). Incidence rates were sex- and age-related. Females developed OSD with an incidence rate of 74 (95% CI 64;84) compared to males with I = 58 (95% CI 48;70). OSD occurred mostly between the ages of 15 and 24 years. Irritant contact dermatitis (ICD) was the main type of OSD. 36% of the bakers had an occupationally relevant Type I allergy, while Type I allergies were less frequent in confectioners (16%) and cooks (9%). Assuming a prevalence of 10% of AD in the general population the relative risk (RR) of developing OSD in bakers, confectioners and cooks with AD was 9.7, 10.5 and 5.2, respectively. There were only small differences in calculating sex-related RR of AD.(ABSTRACT TRUNCATED AT 250 WORDS)