The aim of this study was to identify factors of importance for the long-term prognosis of hand eczema in the general population. In a 15-y follow-up, 868 (78%) individuals with hand eczema, diagnosed and clinically examined in a previous population-based study, answered a postal questionnaire with questions concerning persistence of the disease. In a logistic regression model, the extent of eczema involvement at the initial examination was the strongest negative factor for the prognosis, followed by history of childhood eczema and age below 20 y at onset of hand eczema. These factors significantly influenced both the total time with hand eczema during the 15 y follow-up and occurrence of hand eczema the previous year. The predictive factor for hand eczema 15 y later was doubled for an individual with all three risk factors compared with one without them, 72%vs 35%. Contact allergy to any of the standard allergens also related significantly to current hand eczema. In conclusion, the main determinant for a poor long-term prognosis was widespread hand dermatitis at the initial examination. Other important factors were low age at onset of hand eczema, history of childhood eczema, and contact allergy.