OBJECTIVES: Hand eczema (HE) is a common inflammatory skin condition of adulthood. Chronic hand eczema (CHE) can be defined as HE persisting longer than three months or re-occurring twice or more within twelve months. We undertook a systematic review of the economic burden of CHE. METHODS: MEDLINE, and 16 other databases/websites were searched in July 2018. Eligible studies were published in English, and provided costs from 1998 or later. Two reviewers undertook record selection and data extraction independently. Data were converted for comparison. RESULTS: 28 mostly European studies reported on monetary costs, or cost burdens such as resource use or work loss. Total costs ranged between $2,279 (€1,745) and $10,002 (€7,450) (5 studies). In terms of resource use, one study reported a mean of 10.6 days in hospital per stay, and another, 0.2 days in hospital per patient per month. The mean number of consultations per month was as high as 3.1, although in other studies it was, on average, less than once a month during a year (4 studies). Sick leave due to CHE ranged from 3% to 57% (17 studies) and increased with disease severity and age (1 study). Women have more prolonged sick leave (>5 weeks annually) in all age groups up to 50 years (1 study). Job loss/job change due to CHE was as high as 25% (based on 10 studies). Mean days of sick leave ranged from 7.2 to 35 per year (2 studies). CHE in workers who handle food (2 studies) or in ‘wet’ occupations (1 study), was strongly associated with sick leave. CONCLUSIONS: This review confirmed the significant cost burden of CHE. Given the paucity of studies estimating the costs of absenteeism and job loss, as well as the lifetime burden of CHE, the true current costs are likely substantially underestimated.