Table 4. Perceived psychological, physical, occupational and private consequences of occupational HE.

Sub-Domain	Examples
Psychological	• thinking/worrying about it a lot/everything is about the hands, stress • pressure at work • ‘pulls you down’, feeling bad, crying, depressive mood ‘just because of the hands’, not content/discontent, sad • burden, limitations in everyday life, not able to carry out everyday activities • mockery, feelings of shame (e. g., in intimate interactions), feeling other’s glances, not masculine • feeling excluded, reserved, not going out when skin is itchy • bad life quality, incisions in well-being, unpleasant, sleep deprived • ‘behaving differently than usual’, nervous, oblivious, inattentive, unbalanced • feeling handicapped, helpless • annoyed by other people’s comments (e. g., ‘Is it scabies?’) and protective measures • loss of self-confidence • not in the mood to do something nice/to enjoy, nothing is motivating • uncertainty, frustration, not knowing where it comes from, despair, disappointment
	Example quote: “And when I go shopping, for example, I also started wearing cotton gloves. But I’ve also had to listen to people, also acquaintances, saying: ‘Oh, Michael Jackson.’ Stupid comments. And yeah, and then, of course, there’s also a bit of shame.” (B7)
Physical	• hands do not do what they are supposed to • moving differently • open skin, changed skin milieu, skin is more sensitive than it used to be, wounds take longer to heal, scars • itchiness, pain (one cannot use hands normally), burning • suffering from side effects of medicine/pills (are “like a bomb”, one needs to relax after taking a tablet) • no bending of fingers/making a fist, skin is tense • no fingerprints • stiff, like leather • skin gets stuck (e. g., to fabrics) • pressure sensitivity • not being able to touch anything, to perceive/feel anything with fingers
	Example quote: “But if I say, ‘I’ll use hand sanitizer.’ you’ll hear me screaming in pain all the way down the street.” (B19)
Occupational	• feeling bad about colleagues as they have to overtake tasks • quitting apprenticeship/other jobs in the past because of disease • worried about losing job/being replaced, questions about future career path, thinking about changing jobs (e. g., working in an office), ‘getting through the last years of work before retiring’ • consulting doctor’s during working time and sick leave (probably also in the future): no durable solution, feeling unreliable • not being able to conduct certain tasks or to conduct them differently, esp. when wet/dirty/fine motor activities/tools fall down, slower work pace, less (direct) contact to patients/customers • working with protective gloves, using creams • moral conflict: using disinfectants means pain, not using it is against hygiene rules, using plasters, even though forbidden, also: broken skin cannot be disinfected • questioning if current job is still suitable in context of skin disease • reorganize working procedures/job rotation to avoid skin irritating tasks • glances and comments of colleagues/patients/customers, tips on skin protection are not helpful • socially excluded from activities (e. g., at breakfast table at workplace)
	Example quote: “When the hands are really open, you also get the feeling at some point that you are unreliable, because you just have to call in sick when it’s really bad. (. . .) Then I’m just always afraid that people will think that maybe I’m not reliable or that it could be used against me.” (B2) “Then the others started too, the work colleagues. And they were sitting in a breakfast room and it wasn’t nice. They said, ‘Sit somewhere else. This doesn’t look nice.’ I say, ‘But I can’t do anything about it. It’s just the way it is.’ Then they said, ‘Then put something on.’ And then I started wearing gloves in the breakfast room.” (B34)
Private	• hiding hands from kids, being distant to partner and family (preferring to touch with cotton liners instead of rough/bloody hands) • not being able to do leisure sports, making a sandwich, hold a glass of water properly, no social events to protect hands (becoming an outsider), not touching animals/pets, one has to choose between activities • friends’ glances and comments, family and friends recognize that you / your skin is not alright • everyday tasks are challenging (e. g., cutting vegetables) • always having creams and gloves handy • using gloves (e. g., when washing hair, walking the dog) • asking friends, family, partner for help even if it ‘just’ a skin disease (e. g., gardening, washing dishes), not able to help around the house • talk to friends/family to find solutions • not being able to do something rashly, everything has to be thought through but not always in the mood to conduct protective measures • not wearing what you like (clothes, jewelry) • blood on bedclothes
	Example quote: “I’ve just become a grandmother. It’s just a bit strange when you’re like, ‘Do I touch this child now or not?’ And when it comes to my partner, I sometimes have the feeling- Do I stroke my husband or will he say, ‘Take your rough hands off me?’” (B5)