Occupational hand eczema among nursing staffs in Korea: Self‐reported hand eczema and contact sensitization of hospital nursing staffs

Occupational hand eczema is frequent in hospital workers, especially in nurses. A comprehensive understanding regarding hand eczema is essential for establishing proper prevention and treatment strategies. The purpose of this study was to identify the risk factors for hand eczema in hospital nursing staffs. A self‐administered questionnaire study was performed on hospital nursing staffs at a single general hospital in Korea. In addition, 70 patients with hand eczema underwent patch testing. Five hundred and twenty‐five of 700 invited nurses completed the study (response rate, 75.0%). The overall frequency of symptom‐based hand eczema was 75.6%, and self‐reported hand eczema was 31.0%. Risk factors for hand eczema were young age, history of atopic dermatitis, frequent hand washing (>20 times/day) and long duration of glove wearing (>5 min). Hand eczema was less frequent among frequent hand moisturizer users (>3–4 times/day). Positive patch test reactions were observed in 61.4%. Frequent allergens were nickel sulfate (35.7%), cobalt chloride (28.6%) and thiomersal (21.4%). Among various antibiotics, ciprofloxacin (11.4%), trimethoprim/sulfamethoxazole (11.4%) and gentamicin (7.1%) were revealed as common allergens, in order of frequency. Hand eczema is quite common among hospital nursing staffs. Proper preventive programs and educations are demanded.     

Wet work exposure and hand eczema among healthcare workers: a cross‐sectional study

Hand eczema is common among healthcare workers. One reason is high exposure to soap and water. To prevent the spreading of infections more rigorous hygiene procedures have been implemented in healthcare during the last decade. The purpose of this study was to see how the use of disposable gloves, alcoholic hand disinfectants, and soap is associated with hand eczema. An electronic questionnaire was sent to all hospital employees in southern Sweden. Only the respondents working as nurses, assistant nurses and physicians were included in the analyses. In this group 21% had had hand eczema during the last 12 months, which is higher compared to the general population. 30% washed their hands with soap more than 20 times per day at work, 54% used non‐sterile disposable gloves for more than 2 hours per day, and 45% used alcoholic hand disinfectant more than 50 times per day. Hand eczema was more common among those who more often used soap, and among those who used disposable gloves for longer times. However hand eczema was not associated with the use of alcoholic disinfectants. This study shows that hand eczema still is common in healthcare workers. Educational programmes directed at prevention of hand eczema are needed.     

Self-reported hand eczema in a hospital population

Occupational skin diseases are frequent in the healthcare sector. The objective of this study was to obtain baseline data on hand eczema and risk factors for hand eczema in an unselected hospital population. A questionnaire study on hand eczema and risk factors for hand eczema was performed among hospital employees at a middle-size Danish hospital. A total of 1909 employees from all job groups and all departments were included. Response rate was 65.3%. The overall frequency of self-reported hand eczema within the past 12 months was 23%. Divided into job groups, the frequencies varied from 8% to 32% and were significantly higher among assistant nurses (32%), nurses (30%), and nursing aids (27%). For the individual departments, the hand eczema frequencies varied from 7% to 50%, with the highest frequencies reported at medical and surgical wards. Occupational risk factors for hand eczema such as use of protective gloves and hand washing were significantly more frequent among respondents with hand eczema within the past year, which suggests a potential for prevention through workplace interventions. In conclusion, high frequencies of hand eczema were observed among assistant nurses, nurses, and nursing aids. Hand eczema was more frequent among women and in the younger age groups.     

Hand eczema among University Hospital nursing staff: identification of high-risk sector and impact on quality of life

Background: Hand eczema is a commonly encountered occupational disease and has a negative impact on life quality. Objective: This study aimed to identify the specific conditions that may pose a higher risk for occurrence of hand eczema and evaluate the impact of hand eczema on life quality. Method: Nursing staff from a university hospital were invited to participate in a cross‐sectional study. Validated questionnaires for hand eczema and life quality were used to evaluate the point prevalence and determine the impacts of hand eczema, respectively. Results: The overall response rate was 93%, equivalent to 1132 completed questionnaires. Two hundred and forty‐eight (22%) reported occurrence of hand eczema. Occurrence of hand eczema was significantly associated with nursing for >10 years and working in a special care unit, with prevalences of 27% and 26%, respectively. In addition, hand eczema was associated with suboptimal life quality; pruritus or burning sensations were associated with a lower quality of life among those with hand eczema. Conclusion: Hand eczema is a work‐related problem for nursing staff; proper preventive programmes should be implemented for those nursing staff working in high‐risk areas to avoid further lowering of their quality of life.     

Quality of life, use of topical medications and socio-economic data in hand eczema: a Swedish nationwide survey

Hand eczema is common and has an adverse impact on the lives of patients. There is a need for population-based surveys on the pharmacoepidemiological aspects, quality of life and impact of socioeconomic factors in hand eczema. The aim of this cross-sectional study was to investigate these factors. A questionnaire-based nationwide survey of health was performed, including questions on hand eczema, use of pharmaceuticals and socioeconomic factors. Quality of life was estimated with the generic instrument Short Form 36 (SF-36). The questionnaire was sent to 7,985 persons (age range 18-84 years), response rate 61.1% (n = 4,875). The 1-year prevalence of hand eczema in the study population was 7.5%. In this group, quality of life was lower. All dimensions of SF-36 were affected, most markedly general health and those dimensions reporting on mental health. In the group with self-reported hand eczema, 51% reported using topical pharmaceuticals. Hand eczema was more common among women (9.1%, n = 2,630) than among men (5.6%, n = 2,245) and in the age group below 65 years (8.5%, n = 3,274) compared with those aged 65 years and over (4.3%, n = 1,151). This survey clearly demonstrates the impact of hand eczema on several dimensions of life and also highlights age, gender and socioeconomic differences.     

Exposures related to hand eczema: a study of healthcare workers

Background. Hand eczema is common in healthcare workers, owing to intensive exposure to wet work and skin irritants. Targeted interventions and vocational guidance based on documented exposures and risk factors are needed. Objectives. The aims of the study were to investigate the relationship between exposures (domestic and at work) and prevalence and severity of hand eczema. Methods. Self‐administered questionnaires were sent to 3181 healthcare workers in Denmark. Results. Two thousand two hundred and sixty‐nine (71%) workers responded to the questionnaire. Frequent hand washing was significantly related to the presence of hand eczema. Having children < 4 years old in the household was also related to the presence of hand eczema. A lower prevalence of hand eczema was found among those using moisturizers at work, and a higher prevalence was found among those using moisturizers at home. Conclusions. Although healthcare workers are recommended to use disinfectants when the hands are not visibly dirty, hand washing is still significantly related to hand eczema. Frequent hand washing may be a question of behavioural habits, and a focus for future guidance should be on changing hand washing habits. Attention should also be paid to healthcare workers with small children at home. The preventive effect of moisturizers used during working hours should be tested in future follow‐up studies.     

Validation of self-reporting of hand eczema among Danish hairdressing apprentices

Background. Hairdressing apprentices have a high incidence of hand eczema. Most studies use self‐reported hand eczema as a cost‐effective method to estimate the prevalence of hand eczema. No validation studies on self‐reported hand eczema among hairdressing apprentices exist. Objectives. To evaluate the validity of self‐reporting of hand eczema among Danish hairdressing apprentices. Methods. During their first 2 weeks of training, 502 hairdressing apprentices were enrolled in this study. All apprentices completed a self‐administered questionnaire including questions regarding, for example, current hand eczema, and they were all clinically examined for hand eczema three times during the first part of their education by use of the Hand Eczema Severity Index. The validity of self‐reporting of hand eczema was measured with the clinical examination as the gold standard. Results. The sensitivity of self‐reporting of hand eczema was 70.3%, and the specificity was 99.8%. The positive predictive value was 96.3%, and the negative predictive value was 98.5%. Conclusions. We found good agreement between self‐reporting of hand eczema and clinical examination. There was good sensitivity and high specificity. Self‐reporting of hand eczema among hairdressing apprentices is considered to be a valid method for estimating the prevalence of hand eczema, although it might underestimate the true prevalence.     

Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences

Background. Occupational hand eczema is common in hairdressers, owing to wet work and hairdressing chemicals. Objectives. To estimate the prevalence of hand eczema and its career consequences among hairdressers in Denmark. Methods. A register‐based study was conducted, comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self‐administered postal questionnaire including questions on hand eczema, atopic dermatitis, and career change. A response rate of 67.9% (n = 5324) was obtained. Results. Of the respondents, 44.3% no longer worked as hairdressers and had worked for an average of 8.4 years in the profession before leaving it. Hand eczema was more common among ex‐hairdressers (48.4%) than among current hairdressers (37.6%) (p < 0.0001), and significantly more ex‐hairdressers (26.8%) than current hairdressers (15.7%) had chronic hand eczema (p < 0.0001). Of the respondents with hand eczema, 75% were aged 15–24 years at onset, and 45.5% gave hand eczema as a reason for career change. In this group, logistic regression analysis showed that chronic hand eczema contributed the most to the decision to change career (odds ratio 50.12; 95% confidence interval 18.3–137). Conclusions. Hairdressers work an average of 8.4 years in the profession before leaving it, and hand eczema contributes significantly to this career change.     

Lifestyle factors and hand eczema in a Swedish adolescent population

Background: Hand eczema risk factors are potentially associated with lifestyle, and changes in lifestyle may influence the prevalence of this condition. Objectives: To report potential lifestyle risk factors and their association with hand eczema. Patients/Materials/Methods: Cross‐sectional questionnaire survey and standard patch test among Swedish upper secondary school children. The participation rate was 81% (6095/7543) for the questionnaire and 59% (4439/7543) for the test. Results: Girls reported piercing (84% versus 18%), tattooing (6% versus 3%), smoking (24% versus 16%) and vegetarianism (21% versus 7%) significantly more often than boys. Girls had significantly more hand eczema (7% versus 4%) than boys. Besides female sex (OR 2.0), allergic rhinitis (OR 1.8), flexural eczema (OR 4.5), and positive nickel test (OR 1.7) were significant risk factors in multivariate analysis. Piercing entailed a decreased risk (OR 0.6). Other lifestyle practices had no association with hand eczema. Vegetarian diet and dental braces which potentially increase oral nickel exposure were not associated with hand eczema prevalence in nickel sensitized individuals. Conclusions: The studied lifestyle practices were more prevalent in girls. Smoking, tattooing, and diet were not associated with the occurrence of hand eczema.     

The epidemiology of hand eczema in the general population – prevalence and main findings*

Numerous studies have investigated the prevalence and risk factors of hand eczema in the general population. These studies are of high value as they tend to be less biased than studies using clinical populations and as they are important for healthcare decision makers when they allocate resources. This study aimed to review the epidemiology of hand eczema in the general population. Literature was examined using Pubmed‐Medline, Biosis, Science Citation Index, and dermatology text books. On the basis of studies performed between 1964 and 2007, the point prevalence of hand eczema was around 4%, the 1‐year prevalence nearly 10%, whereas the lifetime prevalence reached 15%. Based on seven studies, the median incidence rate of hand eczema was 5.5 cases/1000 person‐years (women = 9.6 and men = 4.0). A high incidence rate was associated with female sex, contact allergy, atopic dermatitis, and wet work. Atopic dermatitis was the single most important risk factor for hand eczema. Hand eczema resulted in medical consultations in 70%, sick leave (> 7 days) in about 20%, and job change in about 10%. Mean sick time was longer among those with allergic hand eczema than those with atopic and irritant hand eczema. Moderate to severe extension of hand eczema was the strongest risk factor for persistence of hand eczema. Other risk factors included early onset of hand eczema and childhood eczema. The aetiology of hand eczema is multifactorial and includes environmental as well as genetic factors. Future studies should focus on unresolved areas of hand eczema, for example, genetic predisposition.     

Medical consultations in relation to severity of hand eczema in the general population

BACKGROUND: Hand eczema is a common disease with a wide severity spectrum. Little information exists concerning the association between the severity of hand eczema and medical consultations. OBJECTIVES: To describe the self-rated severity of hand eczema in a general population and the relationship to seeking medical attention. METHODS: A questionnaire on self-reported hypersensitivity including two questions on hand eczema was sent to a random sample of 6000 individuals, aged 18-69 years, living in Copenhagen, Denmark. A total of 4242 individuals (71%) answered the questionnaire. All individuals who reported hand eczema (n = 752) within the previous 12 months received a more detailed questionnaire focused on hand eczema and a previously validated photographic guide with four groups of severity ranging from almost clear to very severe. RESULTS: Five hundred and sixty-four individuals (75%) returned the second questionnaire. The 1-year period prevalence of hand eczema was estimated to be 14% in the population. Twenty-three per cent rated their hand eczema as moderate to very severe. In total, 67% had consulted their general practitioner and 44% had consulted a dermatologist because of hand eczema. Multivariate analysis showed a positive association (P < 0.05) between severity of hand eczema and medical consultations. Of those individuals (n = 102) who had not consulted a dermatologist 26% had experienced moderate to very severe hand eczema within the previous 12 months. CONCLUSIONS: A considerable proportion of individuals with moderate to very severe hand eczema in the general population miss out on the potential benefit of a dermatological examination, patch testing and a thorough-going exploration of environmental factors.     

Hand eczema and quality of life: a population-based study

Background Hand eczema is a common disease in the population and is of interest from a public health perspective. Health‐related quality of life (HRQoL) is increasingly being measured in dermatology. Objectives To investigate HRQoL in relation to hand eczema in the general population. Methods In the Public Health Survey of Stockholm County Council 2006, a questionnaire was sent to 57 009 randomly selected individuals aged 18–84 years. The response rate among persons of working age (18–64 years) was 58%. The questionnaire included a validated question concerning hand eczema and a generic instrument for measurement of HRQoL, the EQ‐5D. Results The proportion of individuals reporting problems was significantly larger among those with than without hand eczema in all five dimensions of the EQ‐5D. Gender differences were found in some age subgroups. The EQ‐5D index was lower for individuals with hand eczema than for those without, and on the same level as for psoriasis and asthma. Beta regression showed that the strongest confounding factors were low back pain, depression and hay fever/asthma. Conclusions HRQoL was negatively affected in individuals with hand eczema irrespective of age. With the EQ‐5D instrument it is also possible to detect certain gender differences. The EQ‐5D index for hand eczema was of the same size as for psoriasis and asthma, all common diseases with an impact on public health. It is of importance to acknowledge the influence of hand eczema on daily life, in order to give the patients good care.     

Presenteeism in a Dutch hand eczema population—a cross‐sectional survey

Background

Presenteeism (attending work despite complaints and ill health, which should prompt rest and absence) has been overlooked in the field of hand eczema.

Objectives

To examine the 1‐year prevalence of presenteeism related to hand eczema in a population of hand eczema patients who visited a tertiary referral centre. Secondary objectives: to identify intrinsic/extrinsic reasons for presenteeism and to evaluate associated factors.

Methods

This was a cross‐sectional questionnaire study. Presenteeism was defined as “going to work despite feeling you should have taken sick leave because of hand eczema”. Respondents answered questions about socio‐demographic factors, clinical features, occupational characteristics, and hand eczema related to occupational exposure.

Results

Forty‐one per cent (141/346) of patients who had both worked and had hand eczema during the past 12 months reported presenteeism. The most often reported reasons were: “Because I do not want to give in to my impairment/weakness” (46%) and “Because I enjoy my work” (40%). Presenteeism was associated with: mean hand eczema severity; absenteeism because of hand eczema; improvement of hand eczema when away from work; and high‐risk occupations.

Conclusions

In this study, presenteeism was common and predominantly observed in patients with more severe hand eczema and occupational exposure. The most frequently reported reasons for presenteeism were of an intrinsic nature.     

Tobacco smoking and hand eczema: a population‐based study

Background Tobacco smoking has been proposed to promote hand eczema. Objectives To examine the association between tobacco smoking and hand eczema and to investigate a possible dose‐response relation. Methods A national environmental health survey was performed in 2007. A questionnaire was mailed to 43 905 individuals and responses were obtained from 25 851 (59%). Questions on 1‐year prevalence of hand eczema and on previous and current smoking were included. Respondents were asked to report number of cigarettes per day and to provide information on history of atopy and frequency of hand exposure to water. Results In total, answers regarding smoking and hand eczema were obtained from 25 428 individuals. Of regular daily smokers, 10·0% reported hand eczema vs. 9·1% of nonsmokers (P = 0·0951). A history of atopy showed the strongest influence on the occurrence of hand eczema: prevalence proportion ratio (PPR) 3·46. The PPR for hand eczema among individuals smoking > 15 cigarettes per day was 1·25 and 1·40 in uni‐ and multivariate analysis, respectively. Age, history of atopy, sex and water exposure were found to be confounders but not effect modifiers. A dose‐response relation between level of smoking and 1‐year prevalence of hand eczema was revealed with a PPR of 1·05 (P < 0·001) for the continuous variable of smoking habits, indicating a significantly increased prevalence of hand eczema among individuals with higher consumption of tobacco. Conclusions An association between heavy smoking and hand eczema was confirmed. It is important to consider the level of exposure, as a dose‐response relation was revealed, and to be aware of confounding factors.     

Hand eczema in Swedish adults - changes in prevalence between 1983 and 1996

Hand eczema is the most frequent occupational skin disease. Our aim was to study changes in its prevalence in Swedish adults. Cross-sectional studies were performed in 1983 and 1996. Random samples from the population of Gothenburg, Sweden, aged 20-65 y, were drawn from the population register. Data were collected with a postal questionnaire, which was identical in the two studies. The response rate was 83.5% (16,708 out of 20,000) in 1983 and 73.9% (2218 out of 3000) in 1996. The reported 1 y prevalence of hand eczema decreased from 11.8% in 1983 to 9.7% in 1996 (p < 0.01), a large difference being found in the youngest age group. Reported childhood eczema increased from 10.4% to 12.4%, however (p < 0.01). Of those with childhood eczema 27.9% and 25.2% reported hand eczema, compared to 10.0% and 7.5% among those without childhood eczema. In total 76.8% were gainfully employed in 1983 and 68.3% in 1996 (p < 0.001). In 1983 23.0% were employed in "high-risk" occupations for hand eczema compared to 19.4% in 1996 (p < 0.001). Even though the increase in childhood eczema was largest in the youngest group, there was a large decrease in the prevalence of hand eczema in that age group among both sexes. The study indicates that the prevalence of hand eczema in Swedish adults had decreased between 1983 and 1996 despite an increasing prevalence of childhood eczema. Secular changes in reporting hand eczema and childhood eczema may explain some of the changes, but a decreased occupational exposure to skin irritants is a probable cause, implying that occupational factors may be important predictors of hand eczema.     

The effect of tobacco smoking and alcohol consumption on the prevalence of self‐reported hand eczema: a cross‐sectional population‐based study

Summary Background Hand eczema is a prevalent disorder that leads to high health care costs as well as a decreased quality of life. Important risk factors include atopic dermatitis, contact allergy and wet work whereas the role of null mutations in the filaggrin gene complex remains to be clarified. It has been debated whether life‐style factors such as tobacco smoking and alcohol consumption are associated with hand eczema. Objectives The current study aimed to investigate whether self‐reported hand eczema was associated with smoking and alcohol consumption in the general population. Methods Between June 2006 and May 2008, a cross‐sectional study was performed in the general population in Copenhagen, the capital of Denmark. A random sample of 7931 subjects aged 18–69 years old was invited to participate in a general health examination including a questionnaire; 3471 (44%) participated. Data were analysed with logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CI). Results The prevalence of hand eczema was higher among previous smokers (OR = 1·13; CI = 0·90–1·40), current light smokers (OR = 1·51; CI = 1·14–2·02) and current heavy smokers (OR = 1·38; CI = 0·99–1·92) compared with never‐smokers. Conclusions Tobacco smoking was positively associated with hand eczema among adults from the general population in Denmark. Apparently, current light smokers (< 15 g daily) had a higher prevalence of hand eczema than current heavy smokers (> 15 g daily) but this needs to be reconfirmed. Alcohol consumption was not associated with hand eczema.     

Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis

Summary Background Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick‐leave periods and need for changes of work and re‐training put an economic burden on society, and there is an interest indeveloping cost‐effective epidemiological surveillance instruments such as a screening questionnaire. Objectives In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self‐reported signs. Methods Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist (‘gold standard’) were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification. Results Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the ‘gold standard’. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0·62 and a specificity of 0·87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0·87 and a specificity of 0·79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a κ‐value of 0·65 (95% CI 0·55–0·75), and the poorest was for papules with 0·47 (95% CI 0·32–0·62). Conclusions It was difficult for the individual to identify skin signs compatible with the clinical diagnosis of hand eczema. Asking ‘Do you have hand eczema?’ had high sensitivity and specificity compared to the suggested gold standard for hand eczema. However, the validity of a screening questionnaire depends on the type of population investigated.     

Hand eczema in geriatric nurses in Germany – prevalence and risk factors

Background and objectives:  The aim of this cross-sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany.
Methods:  1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians.
Results:  Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86).
Conclusions:  Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease.     

Type I and Type IV allergy to unfractionated heparin and low-molecular-weight heparin with no reaction to recombinant hirudin

Aim:  To investigate the risk of adult hand eczema and possible influence on later working life in persons with childhood atopic dermatitis.
Method:  After reviewing medical records from the school healthcare in Stockholm regarding individuals born 1960–69, 600 individuals where signs of atopic dermatitis were noted ("cases") and 600 matched controls without eczema or allergic disease ("controls") were identified. 405 cases and 378 controls answered a questionnaire regarding past and present skin disease, choice of job, exposure at work and possible change of job due to eczema.
Results: Hand eczema was more than 3 times more common among cases, 42%, compared to controls, 13%(p < 0.001). Hand eczema during the past 12 months was reported by 24% of the cases and 9% of the controls (p < 0.001). The proportion of individuals working in jobs with high‐risk for hand eczema was equal between the groups, as well as exposure to water, detergents, chemicals and hand washing. Among the cases 9% reported change of job due to eczema compared to 2% of controls (p < 0.001) and sick leave 10% compared to 2%(p < 0.001).
Conclusions: Childhood atopic dermatitis is a risk factor for hand eczema. As the proportion of individuals in jobs with high‐risk for hand eczema and the exposure was the same in cases and controls measures preventive measures are important to reduce consequences like sick leave and change of job.     

Do hairdressers in Denmark have their hand eczema reported as an occupational disease? Results from a register‐based questionnaire study

Background. Occupational hand eczema is common in hairdressers, owing to wet work and chemicals. Objectives. To estimate whether hairdressers in Denmark have their hand eczema reported as an occupational disease and to clarify the reasons for not reporting. Methods. A register‐based study was performed, comprising trained hairdressers (n = 7840), using a self‐administered postal questionnaire including questions on hand eczema and it being reported as an occupational disease. A response rate of 67.9% (n = 5324) was obtained. Results. Overall, 2186 respondents ever had hand eczema; 71.3% were apprentices at the time of hand eczema onset. The majority (61.9%) had had hand eczema several times and 21.3% (almost) all of the time, but only 20.7% had reported their hand eczema as being occupational to the National Board of Industrial Injuries (Denmark). A positive association between severity of hand eczema and filing a report was found (odds ratio 19.2; 95% confidence interval 8.18–45.06). The main reasons for not reporting were ‘I thought it would eventually get better’ (40.4%) and ‘My doctor didn't tell me it was possible to report it' (26.6%). Conclusions. Hand eczema is considerably under‐reported as an occupational disease; the perception of hand eczema among hairdressers and the lack of reporting from doctors are the main reasons for this.