Background Hand eczema (HE) is a fluctuating disease, and an objective assessment of HE severity is coveted. Objectives This study was undertaken to test the association between Hand Eczema Severity Index (HECSI) score and panel scores of photographs taken by dermatologists. Methods A total of 33 patients with mild HE were included. The patients were part of an intervention study, and HECSI scores and standardized photographs were taken at baseline and at follow-up after 5 months. Actual change in HECSI score was compared with rating of change from photographs. A total of 15 dermatologists were engaged in blinded evaluation of photographs. Results The highest correlation coefficients between delta HECSI scores and delta panel scores of photographs in the first and second evaluation rounds were found for moderate improvement and moderate worsening, rs = -0.46 (P = 0.009) and 0.52 (P = 0.003), respectively, and major worsening, r = 0.41 (P = 0.021). With respect to minor changes, no statistically significant correlations were found (P > 0.05). Conclusions In patients with mild HE, photographic assessment was found useful for major and moderate changes only. Further studies would need to be performed in patients with moderate or severe HE, to evaluate whether clinical photographs are able to capture similar changes as HECSI scores.