A patient with an otherwise recalcitrant chronic vesicular hand eczema responded with a dramatical improvement within 2 weeks of cyclosporin A (CsA) therapy 5.0 mg/kg daily. The patient was still free of eczema in spite of reducing the CsA dose to 2.5 mg/kg daily. CsA therapy was finally stopped due to a moderate increase in blood pressure, resulting in rapid recurrence of the hand eczema. The case report clearly demonstrates that oral CsA should be considered in patients with severe hand eczema that cannot be controlled on conventional immunosuppressive treatments.