Hand eczema is a pruritic inflammatory skin disease characterised in the acute phase by erythema, oedema and sometimes vesicles, while in the chronic state the skin changes are dominated by infiltration, scaling and fissures, which may cause pain. The disease is common[
1]; in a recent Danish study a one-year prevalence of 14% was found, of which 23% had severe or moderate eczema[
2]. Hand eczema is not a uniform disease as it exists in a continuum of severity with variations in morphology. Aetiologically, hand eczema may be due to irritant contact dermatitis, which is most prevalent followed by allergic contact dermatitis and atopic hand eczema[
3]. Multi-causality is frequent and in order to provide adequate treatment and tertiary prevention aetiological factors need to be determined[
4].
Hand eczema often has a chronic course with symptoms persisting 10–15 years after onset[
3],5] and with psychosocial consequences such as long term sick leave, involuntary job rotation or early retirement[
5]. Furthermore, quality of life has been shown to correlate negatively to the severity of the disease[
4,
6]. No consensual definition of chronic hand eczema exists although some authors have used the definition of hand eczema which persists throughout more than three months or which reoccurs twice or more within a 12 month time frame[
7]. Chronic hand eczema typically has a dynamic course with intermittent eruptions of eczema[
4]. A guideline for the overall treatment principles for hand eczema has been proposed by the Danish Contact Dermatitis Group[
4]. However, although chronic hand eczema affects numerous functions in daily life, no specific recommendations as to self-manage the disease beyond the acute stage are given. Patients’ knowledge of their diagnosis may determine their prognosis[
8]. Also, medical treatment of hand eczema is often prolonged and should be accompanied by skin protection and skin care measures[
9]. However, some evidence based recommendations of skin protection may be experienced as complex[
10]. Among dermatological patients it is estimated that 34–45% do not comply with instructions regarding medical treatment[
11,
12]. This may also depend on the satisfaction with and an overall experience of effectiveness of the treatment[
13]. The patient’s self-management in the course is pivotal as it applies both to handling the acute eczema and to the continuous preventive behaviour, necessary to avoid relapses of the disease. Yet, evidence related to self-management of hand eczema is poor. In chronic illness generally, interventions that aim at increasing medication adherence, and thus indirectly the patient’s self-management, are most effective when intervening in several dimensions[
14,
15]. Better methods to support self-management of patients with chronic hand eczema may potentially improve the prognosis of a disease that is both a burden to the individual and to society. Hand eczema is often caused or aggravated by occupational exposures such as wet work, food handling, cutting oils etc. In several studies, interventions aiming at secondary prevention of occupational irritant hand eczema have been examined[
16]. Comparisons have been made regarding the usage of protective equipment versus the usage of skin care products[
17]. Also, the efficiency of skin care programmes including an educational element has been examined. Both skin protection behaviour and objectively assessed symptoms were beneficially impacted in a group of health care personnel[
18,
19] and among employees in the food care industry[
20,
21]. However in general, interventional prevention trials have had methodological weaknesses and insufficient dimensions in terms of power[
16,
18] and only few studies have investigated skin protection programmes as a tertiary preventive measure. In Germany, a combined health educational and health psychological intervention i.e. Tertiary Individual Prevention has been found to significantly increase important factors related to skin protection behaviour[
22]. This programme requires three weeks of hospitalisation based upon employer-funded health insurance. Hence, these results are not easily transferred to a Danish health care system in which chronic hand eczema is predominantly treated in an outpatient setting. The current randomised controlled trial evaluates the effectiveness of a newly developed nurse-led counselling programme, based upon individual needs and resources, compared to conventional patient information given at medical consultations.