Persons with atopic dermatitis run a considerable risk of developing hand eczema when exposed to occupational agents that are a burden to the skin. This also pertains to those with a history of skin atopy in childhood. This review presents estimates of the risk of developing hand eczema and examines the evidence for an effect modification by skin atopy on exposure. Skin atopy at least doubles the effects of irritant exposure and, thus, doubles the risk in occupations where hand eczema is a common problem. On the basis of this evidence, guidelines for occupational counseling can be given. Further development of a scale indicating the degree of atopic skin diathesis should facilitate the targeting of this counseling toward specific high-risk groups.