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Summary Background Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis. Objectives To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis. Methods Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6-month follow up using a self-administered photographic guide. Additional information was obtained by self-administered questionnaires. Results Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1·5–8·0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1–8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1·11 [95% confidence interval (CI) 1·02–1·21] per month of patient delay and by 1·05 (95% CI 1·00–1·10) per month of healthcare delay. Conclusions A poorer prognosis of hand eczema was associated with longer delay before medical attention.