OBJECTIVES: It is assumed broadly that the costs caused by chronic hand eczema (CHE) are significant. However, there is a lack of cost-of-illness studies on CHE. The objective of this study is, therefore, to determine the direct and indirect costs of chronic hand eczema under routine conditions overall and in different treatment stages in Germany. METHODS: The survey was conducted in 24 outpatient practices and clinics across Germany. Patients with CHE refractory to potent topical treatments and insured by statutory health insurances were eligible. Patient characteristics and resource use were directly gathered from patients and physicians. Costs were evaluated from the societal perspective. Four treatment stages were defined: only topical treatments (stage I), additionally photo therapy (II), systemic therapy (III) and inpatient treatment (IV). Bivariate associations between costs and treatment stage were assessed. RESULTS: A total of 223 CHE patients enrolled in the study. The yearly direct and indirect costs per patient are €1742 (SE: €139) and €386 (€83), respectively. A total of 63.2% of patients were treated only with topical treatments; additionally 15.7% with photo therapy, 11.7% with systemic treatments.   A total 9.4% of all patients were admitted to hospitals. The total costs increase with treatment stage I-IV (p<0.001): €1044 (€85), €2307 (€145), €2697 (€461) and €8407 (€991), respectively. Accordingly, costs also correlated with clinical severity. CONCLUSIONS: CHE patients refractory to topical steroids incur marked costs to the society. The costs are increasing disproportionately with escalating treatment stages, especially in patients admitted to hospitals. Hence, new and innovative treatments may help to reduce the societal costs of CHE.