Background: Sickness presenteeism (SP, attending work despite being ill) can cause increased health problems and might be associated with sickness absenteeism in the long-term. Also, continuous work impairment due to SP could eventually cause even more aggregate productivity loss than sickness absenteeism. Objective: To examine the extent of and reasons for SP - as measured by the person's own assessment of their state of health - and to investigate the associations between HE severity, work characteristics, demographic factors and SP in patients with HE. Method: Questionnaire-based (postal and on-site), cross-sectional study. The study population consisted of adults (age 20-67) with a dermatologists diagnosis of HE, made in the past 5 years, added to a group of new, on-site recruited patients. Severity was assessed using a self-administered photoguide. Associations were studied using binomial logistic regression. Results: Valid response rate was 40.6% (320/789), 30 additional patients were included on-site. 233 patients proved eligible for analysis (working with HE in the past 12 months). SP was present in 38.6%. It was associated with moderate and severe HE; sickness absenteeism; improvement of HE when away from work; and exposure at work aggravating HE. Not just extrinsic, but also intrinsic reasons were found for SP. Conclusion: SP is common in HE and is significantly associated with work factors. Dermatologists should make patients aware of the risks of this potentially negative behavior (particularly when reasons for SP are intrinsic) and encourage them to contact an occupational physician for implementation of secondary preventive measures.