Dyshidrotic dermatitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

A detailed history and physical examination is usually sufficient to diagnose dyshidrotic eczema, however, special tests may be warranted to rule out other processes, if clinical presentation is suspicious.

History

The classic history is of pruritic, sometimes painful, vesicles on the soles, palms, medial and lateral aspects of the fingers and toes. These persist for several weeks then desquamate. Eruptions recur chronically at variable intervals.

Physical examination

On physical examination, there are 1- to 2-mm vesicles on a noninflammatory base which are located on the palms, soles, medial and/or lateral aspects of the fingers and toes. Hyperhidrosis is a frequently reported exacerbating factor and/or comorbidity.[6][15][19] A subset of patients with psoriasis have symptoms limited to the palms and soles, which may be difficult to distinguish from dyshidrotic dermatitis although, most will also have characteristic salmon-colored plaques with overlying silvery scales on other sites, particularly the elbows and knees. Similarly, patients with vesiculo-bullous disease (e.g., pemphigus or pemphigoid) may exhibit vesicles or bullae at acral sites but most commonly exhibit the eruption elsewhere on the body.

Histology

Biopsy is not typically required for diagnosis. It is necessary if there is clinical difficulty distinguishing the condition from psoriasis, palmoplantar pustulosis, or bullous pemphigus. When biopsy is performed, spongiotic dermatitis in acral skin is observed in the case of dyshidrotic dermatitis. Immunofluorescence is negative, ruling out immune-mediated bullous disorders.

Laboratory

Not routinely performed as diagnosis is clinical. However, a potassium hydroxide (KOH) test for bullous tinea, an epidermal scraping with mineral oil to evaluate for scabies infestation, or patch testing to evaluate contact allergy can be performed to rule out differential diagnoses. Possible allergens include personal hygiene products, occupational exposures, and metals.[20]

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