OBJECTIVES Severe Chronic Hand Eczema (CHE) or Chronic Hand Dermatitis (CHD), is characterized by thick scaly skin causing painful fissures, erythema, itching, blistering, and oedema. Severe CHE/CHD is often unresponsive to conventional topical corticosteroids and results in substantial occupational, personal, and psychological disability. There is currently a lack of information regarding the economic burden of CHE/CHD in Canada. METHODS A dynamic Excel® model was developed to estimate the cost of treating adults with severe CHE in Canada. Epidemiological/clinical data were derived from systematic literature searches. A Delphi panel of dermatologists provided estimates of resource utilization and validated epidemiological/clinical rates. Given the impact on lost productivity, a pseudo societal perspective was chosen; out of pocket expenses (travel and non-prescription pharmacotherapies) were excluded from the analysis. Unit costs were derived from Ontario standard lists and reported as 2008 Canadian dollars. RESULTS In 2008 the estimated adult population was ~26 million. From the literature it was determined that ~10% of adults may be affected by CHE, and of those 6.7% may have severe CHE/CHD. Assuming 50% of these patients don't adequately respond to topical corticosteroids, an estimated ~87,200 Canadians have severe CHE being refractory to topicals. Treatment cost, including lost productivity, was calculated to be ~$737 million per annum. Even assuming current second-line treatment options are 100% effective, the cost of severe CHE was estimated to be $390 million per annum. CONCLUSIONS This study estimated that the cost of severe CHE/CHD unresponsive to topical corticosteroids in Canada ranges from $390-$737 million per annum. The majority of cost comes from lost productivity due to disease and accessing treatment.