AbstractBackgroundHand eczema is a disease with large variation in clinical presentation and severity. Scoring systems for quantitative severity assessment exist. However, they are observer‐dependent. An objective quantitative tool for scoring of hand eczema would improve categorization of hand eczema.ObjectiveTo investigate the usefulness of multispectral imaging in assessing severity of hand eczema with respect to extent and the different morphological features.MethodsPatients with hand eczema (n = 60) and healthy controls (n = 28) were included. The severity of hand eczema was assessed by a dermatologist using the Hand Eczema Severity Index (HECSI) and a global assessment (Physician Global Assessment [PGA]). Multispectral imaging of the hand was performed on all patients and controls using the VideometerLab Instrument.ResultsAreas of the morphological elements identified by multispectral imaging were statistically significantly correlated with the PGA scores. Analyzed by Cohen's kappa, a moderate agreement between imaging‐based severity assessment and PGA was found. The imaging‐based severity assessment was also correlated with HECSI (Spearman rho 0.683, P < .001). Still, the imaging‐based algorithm was not capable of differentiating hand eczema patients from controls.ConclusionsMultispectral imaging allows quantitative measurements of different skin parameters to be performed. In its present form, multispectral imaging cannot replace the clinical assessment of a dermatologist. However, after refinement, this or similar technologies could prove useful.