OBJECTIVES: Incidence and burden data for severe Chronic Hand Eczema (sCHE) is limited. In the absence of other means of gathering this data, the study’s primary objective was to generate estimates for global 1-year period prevalence for sCHE. Secondary objectives included an estimate of sufferers whose condition is inadequately managed with topical steroids. METHODS: An online survey, aiming for nationally representative samples, to 34,765 respondents in USA, UK, France, Germany, Japan, India, Brazil, China, recruited via consumer panels. Respondents were classified sufferers of sCHE via questions on length of time experiencing symptoms, frequency and duration of flares, affected hand surface area, and on severity, using the photographic scale developed by Coenraads et al (2005). 147 sufferers meeting the qualifying criteria for sCHE completed questions on diagnosis, treatment and disease burden. RESULTS: We present our results in the form of descriptive statistics. An estimated global1-year period prevalence for sCHE of 0.54% was found, after data adjustment to reflect the population of 18-75 year olds by geographical region, and projection to total population. This is consistent with the range reported by Diepgen et al. (2007) (0.5%-0.7%). Of those classified as sCHE sufferers, 53% reported having received a medical diagnosis of sCHE; of these 80.2% had received treatment during the study period. 47% of those treated were classified as potentially refractory to topical steroids. The impact of the disease on the total sufferer population was greatest in social activities. CONCLUSIONS: Our results indicate a lower than expected diagnosis level of sCHE, given its prevalence and impact on sufferers. We also found that topical steroid treatment is unlikely to adequately control symptoms in significant numbers of cases of sCHE. We believe our methodology is an innovative alternative, consistent with a scientific approach, allowing sizing and understanding of sufferer populations, particularly in under-diagnosed conditions.