History and exam

Key diagnostic factors

common

skin lesions

Nonerythematous 1- to 2-mm vesicles located on the palms, soles, medial and/or lateral aspects of the fingers and toes.

pruritus

Dyshidrotic dermatitis is characteristically highly pruritic. A prodrome of pruritus is common.

Other diagnostic factors

common

hyperhidrosis

This is a frequently reported exacerbating factor and/or comorbidity in patients with dyshidrotic dermatitis.[6][19]

recurrent eruptions

May recur over weeks to months.

uncommon

pain

Some patients complain of pain more than pruritus.

Risk factors

strong

exposure to irritants

Exposure to irritants, such as water, detergents, and solvents, may be an exacerbating factor in some patients with dyshidrotic dermatitis.[15]​[18]​​​​

weak

atopy

Some investigators have found an association between atopy and dyshidrotic dermatitis, while others have reported no correlation.[6][7]

metal allergy

There is conflicting evidence of an association between dyshidrotic dermatitis and metal allergy.[8][9] Exposure to the offending metal in allergic patients may cause a flare and these patients should avoid such contact. Nickel is the most commonly implicated metal, but other metals such as chromium and cobalt are also possible exacerbating factors.

hyperhidrosis

Hyperhidrosis may be an aggravating factor for a subset of patients with this condition as there are reports of improved dyshidrotic dermatitis after treating hyperhidrosis.[6][13]

emotional stress

Emotional stress can trigger outbreaks of dyshidrotic dermatitis.[16]

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