To elucidate the importance of hand eczema in the population of Gothenburg, a questionnaire was sent to 20,000 individuals aged 20-65 years, randomly selected from the population register of the city. After two reminders, a response rate of 83% was obtained. Those individuals considering themselves to have had hand eczema within the previous 12 months were invited to a dermatological examination including patch testing. 1385 persons (71%) participated. Analysis of drop-outs was performed by interview by telephone and post. The 1-year period prevalence of hand eczema was estimated to be about 11% and the point prevalence 5.4%. Hand eczema was twice as common among females as among males. The most common type of hand eczema was irritant contact dermatitis (35%), followed by atopic hand eczema (22%) and allergic contact dermatitis (19%). The most common contact allergies were to nickel, cobalt, fragrance-mix, balsam of Peru and colophony. Comparing these results with a 20-year earlier study on hand eczema, an increased prevalence, especially of atopic hand eczema, was found. The only occupational group that reported a significantly higher period prevalence of hand eczema was service workers. Of all occupations, cleaners had the highest period prevalence, 21.3%. Hand eczema was more common among people reporting some kind of occupational exposure. The most harmful exposure turned out to be to unspecified chemicals, water and detergents and dust and dry dirt. The only contact allergen that was statistically related to an occupational group was colophony among female office workers. Change of work, where the hand eczema was the main reason, was reported by 8% and was most common in service work. Hairdressers had the highest frequency of change. Hand eczema was shown to be a long-lasting disease with a relapsing course. 69% of the patients had consulted a doctor and 21% had been on sick-leave at least once because of their hand eczema. The mean total sick-leave time was 18.9 weeks, median 8 weeks. Treatment with topical steroids was reported by 51%, emollients by 85%. Frequent itching was reported by 54% of the patients. 81% experienced some kind of disturbance of their daily life considered to be caused by the hand eczema. A multiple logistic regression analysis revealed that the most important predictive factor for hand eczema was a history of childhood eczema. Number two was female sex, followed by occupational exposure, a history of asthma and/or hayfever and a service occupation.(ABSTRACT TRUNCATED AT 400 WORDS)