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Background Hand eczema is a common distressing condition aggravated by a number of endogenous and exogenous factors. Various morphological patterns of hand eczema have been described. Aims To study the morphological patterns of hand eczema and identification of contact sensitizers of hand eczema by patch test. Methods Hundred consecutive patients of hand eczema attending the outpatient department of the institute were recruited over a period of one year from 2013-2014. All the patients were patch tested using Indian standard series. Results Pompholyx was the most common morphological pattern seen in 25% of patients followed by hyperkeratotic palmar eczema in 22%. Positive patch test to one or more allergen was present in 61% of patients. Nickel sulphate was found to be the most common allergens seen in 16%. This was followed by potassium dichromate, parthenium, fragrance mix in 11%, 8%, 8% respectively. The females (57%) were out-numbered by males (43%) with sex ratio of 1.32:1. Housewives (29%) were the most commonly affected. Conclusion Patch testing is a very useful investigative procedure for allergic contact dermatitis (ACD) of hands. The Indian Standard Series is useful but insufficient. Hence, testing with vegetables and other personal care products are suggested especially in housewives along with Standard Series. Thus, a specific patch test series for hand eczema is suggested. [ABSTRACT FROM AUTHOR]