Psoriasis vs. Eczema: Differences, Images, Treatment

If you have moderate to severe eczema, you may need to try a medicine that affects your immune system like methotrexate, azathioprine, or cyclosporine. If nothing else works, your doctor may prescribe a biologic drug called dupilumab (Dupixent). You might also try light therapy (your doctor will call it phototherapy) using ultraviolet light.

Psoriasis vs. Eczema: How to Tell the Difference

Maybe you’re settling into your easy chair for a little Sunday siesta. Or you’re heading out the door for a day of fun in the sun. Either way, you stop and pause, because you’ve got an itch that just won’t leave you alone — along with blotches of red on your skin. What gives?

Your doctor needs to make the final call, but psoriasis or eczema could be the problem. Both are skin conditions with similar symptoms, but there are ways to tell them apart.

How Psoriasis & Eczema Feel Different

Eczema causes an intense itch. It can get so bad that you scratch enough to make your skin bleed.

Psoriasis could also be itchy, but there’s something extra going on. Your skin may sting or burn. Some people say it feels like you’re getting bitten by fire ants.

The Differences In Appearances

Eczema makes your skin red and inflamed. It may be scaly, oozing, or crusty. You may see rough, leathery patches that are sometimes dark. It can also cause swelling.

In the U.S., healthcare spending accounts for 17.7% of the Gross Domestic Product (GDP), or the total value of goods and services produced by the entire nation for the entire year, according to the Centers for Medicare & Medicaid Services.

Psoriasis can also cause red patches. They may be silvery and scaly — and raised. But if you look closely, the skin is thicker and more inflamed than with eczema.

Where They Show Up

Eczema often appears on parts of your body that bend, like your inner elbow or behind your knees. You can have it on your neck, wrists, and ankles. Babies sometimes get it on their chin, cheeks, scalp, chest, back, arms, and legs.

Psoriasis often shows up on places like your:

• Elbows
• Knees
• Scalp and face
• Lower back
• Palms of your hands
• Soles of your feet

You may also have patches on other areas, such as:

• Fingernails and toenails
• Mouth and lips
• Eyelids
• Ears
• Skin folds

What Triggers Them

Eczema usually results from things that irritate your skin, like:

• Soaps
• Detergents
• Disinfectants
• Juices from produce or meats

Things that cause allergies can also set off eczema, like:

Infections can start up eczema, and so can stress, sweating, heat, humidity, and changes in your hormones.

Psoriasis shares some of these triggers, like stress and infection. But you can also get flare-ups when your skin is injured, for example by:

• Vaccination
• Sunburn
• Scratches

Some medications can also bring on a psoriasis flare, like lithium, which treats bipolar disorder, or drugs for malaria.

At What Age Do They Start?

Eczema usually starts in babies or young children. Often, symptoms improve when a kid becomes a grown-up.

It’s less common, but possible, to get it as an adult. When that happens, it’s usually because you have another condition like thyroid disease, hormone changes, or stress.

Psoriasis, on the other hand, usually shows up between ages 15 and 35. But you can get it at other ages too. It’s rare for a baby to have it.

Conditions They’re Linked To

Eczema usually comes along with dry, sensitive skin. You may have someone in your family who has it or has asthma or hay fever.

Psoriasis is linked to other serious health conditions. If you have it, you may also have diabetes, heart disease, or depression.

Whether it’s psoriasis or eczema, your doctor can recommend ways to get relief for it.

How Is Each Treated

Eczema treatment depends on how severe it is. For mild to moderate cases, you’ll use a topical corticosteroid to control inflammation, and you’ll use an emollient on your skin. This type of moisturizer has an oil or cream base, not a water base, like lotion, which could dry your skin out more.

If you have moderate to severe eczema, you may need to try a medicine that affects your immune system like methotrexate, azathioprine, or cyclosporine. If nothing else works, your doctor may prescribe a biologic drug called dupilumab (Dupixent). You might also try light therapy (your doctor will call it phototherapy) using ultraviolet light.

Psoriasis treatment is either systemic, which means it affects your entire body, or topical, which goes on your skin. If your disease is limited, or mild, you may be able to control it with topical corticosteroids and emollients.

Light therapy paired with acitretin, apremilast, cyclosporine, d eucravacitinib, methotrexate, or a biologic is also an option for more severe cases. Or you could use just a biologic drug, which includes:

Show Sources

American Academy of Dermatology: “Atopic dermatitis: Who gets and causes.”

National Eczema Association: “Eczema,” “Symptoms of Eczema,” “Causes & Triggers,” “Treatment.”

National Psoriasis Foundation: “About Psoriasis,” “Life with Psoriasis,” “Causes and Known Triggers,” “Psoriasis Treatments.”

O’Neill, J. Acta Dermato-Venereologica, April 2011.

UpToDate: “Treatment of psoriasis in adults,” “Treatment of atopic dermatitis (eczema).”

Psoriasis vs. Eczema: Differences, Images, Treatment

To the untrained eye, psoriasis and eczema are quite similar in appearance. Patches of red, dry skin develop which can cause itching, embarrassment, and have an impact on quality of life.

And while they share some of the same characteristics and treatment options, the underlying cause of these two common skin conditions differs and determines the best approach to reducing future flare-ups.

Why Is Eczema Confused With Psoriasis?

Mistaking eczema for psoriasis is common, as both are inflammatory skin conditions and are similar in appearance. The two not only share similar symptoms, but they frequently develop in the same areas of the body, such as the scalp or hands.

While those are two of the more common sites for flare-ups, both conditions can form anywhere on the body. They also share some common triggers, including cold, dry air and allergens in the environment.

Can you have both at the same time?

Yes, you can. This is known as a condition called eczematous psoriasis. This typically presents as an eczema rash and psoriatic lesions in specific areas such as behind the knee, the crook of the elbow, or other folds in the skin – areas where sweat and moisture can get trapped and irritate the skin. This overlapping condition also tends to cause more itching than psoriasis alone due to increased inflammation.

Understanding Psoriasis

Psoriasis is an autoimmune disease – a condition in which the body’s immune system mistakenly attacks healthy cells. Plaque psoriasis is one of several types of psoriasis and affects 80–90% of people who develop psoriasis.

In this condition, the body produces skin cells at an accelerated rate. Normally, it takes weeks for new skin cells to form under the skin and migrate up to the skin’s surface, but in plaque psoriasis, the entire process occurs over just a few days.

As a result, skin cells accumulate and form thick, red patches, called plaques. These plaques are often covered with silvery scales that cause itching and pain.

Small, scaly bumps develop in mild cases; dry skin cracks and bleeds in severe cases. Other psoriasis symptoms include ridged fingernails and toenails, as well as stiff, swollen joints.

Science hasn’t developed a deep understanding of why some people develop psoriasis. Research suggests that having psoriasis means you are more likely to have other autoimmune diseases. While this is a lifelong condition, an individual can be symptom-free for years.

Environmental factors or lifestyle choices can trigger psoriasis flare-ups. Among the more common triggers are:

• Allergies
• Cold, dry air
• Drugs
• Heavy alcohol use
• Infection (particularly strep throat)
• Injury to the skin (such as sunburn or a bad cut)
• Stress
• Tobacco

Where on the body is psoriasis likely to appear?

Psoriasis can affect any part of the body, but especially in those areas where skin rubs against clothing, such as:

• Elbows
• Knees
• Lower back
• Soles of the feet

The hands are also common sites for psoriasis flare-ups as a result of frequent hand washing and because of the wear and tear on busy hands throughout the day. Anything that puts stress on the hands or causes dryness raises the risk. Psoriasis that forms on the scalp is associated with psoriatic arthritis, a type of psoriasis that causes inflammation of the joints.

Understanding Eczema

Just as there are different types of psoriasis, there are also several kinds of eczema. The most common is called atopic dermatitis, and it usually first appears in young children, although symptoms can show up at any age.

An atopic dermatitis flare-up produces dry, itchy skin and brownish or red patches. Small, fluid-filled bumps often develop that become crusty when scratched.

Researchers have identified several factors that contribute to the development of atopic dermatitis. Among potential contributing factors are:

• Genetic mutations that affect skin health
• Unhealthy response of the immune system
• Low levels of certain bacteria in the microbiome that protect the skin
• Inflammation that affects the nerves in the skin

Where on the body is eczema likely to appear?

Atopic dermatitis flare-ups usually appear where the limbs bend and skin folds trap moisture, causing irritation. Typical spots for eczema flare-ups include:

• Behind the knee
• Crook of the elbow
• Neck
• Wrist and hand

Eczema, which can be triggered through contact with an allergen or other irritant in the environment, can produce a rash anywhere on the body.

How to Tell the Difference Between Psoriasis and Eczema

To determine whether a rash is a sign of psoriasis or eczema, it is advised to see a dermatologist. They will consider the number of flare-ups, the thickness of the plaques, the patchiness of the rash and determine if fluid-filled blisters are present.

Scaly skin

A strong indication of psoriasis is the presence of well-defined patches of red and silver scales. While this symptom is also seen with eczema, eczemic rashes tend to appear as a scattering of bumps.

Bumps or flakes

Staphylococcus bacteria is normally present on the skin of most healthy people, but if it penetrates deep into the skin and enters the bloodstream, a staph infection can develop.

Eczema flare-ups are therefore commonly associated with yellow-colored crusts caused by this staph bacteria. Bumps containing the bacteria break open and crust over quickly.

Psoriasis flare-ups don’t contain fluid-filled or crusty little bumps. Instead, it produces dry flakes that sheds off the body.

One flare-up or two?

Psoriasis and eczema also differ in the number of rashes that appear at one time. Psoriasis tends to appear symmetrically on the body such as on both knees or both elbows.

Eczema, however, can show up on just one arm or leg. And unlike psoriasis outbreaks, eczema tends to migrate, clearing in one area, and developing elsewhere.

Itchy skin

The degree of itchiness also offers clues about the cause of your flare-up. Psoriasis tends to be much less itchy than eczema. Rare types of psoriasis, however, can cause a burning sensation.

Over-the-Counter vs. Prescription Treatments

Certain commercial and prescription treatments are effective in treating both skin conditions. For more serious cases, however, doctor-prescribed medications and other therapies specific to each condition will be necessary.

Over-the-counter treatment options include:

• Topical corticosteroid creams, such as Cortizone-10, reduce mild inflammation and symptoms
• Moisturizing creams and ointments, which ease symptoms and lower the risk of future flare-ups on areas of dry skin

Prescription medications and therapies include:

• Immunosuppressive drugs, such as cyclosporine and methotrexate tamp down the body’s immune system response. They are prescribed for moderate to severe cases of psoriasis and severe cases of eczema that cover widespread areas of skin
• Phototherapy, also known as light therapy, emits various wavelengths of ultraviolet light to target specific areas or the entire body
• For psoriasis in particular, anthralin is commonly prescribed to slow the growth of new skin cells. Synthetic versions of vitamin D, including calcipotriene and calcitriol, also effectively slow skin cell growth and are often combined with topical corticosteroids.

For severe cases, an FDA-approved injectable drug, dupilumab, controls the inflammatory response responsible for eczema flare-ups. Two prescription-strength topical creams – tacrolimus and pimecrolimus also reduce inflammation associated with eczema. Antibiotics are also used to address bacterial infections.

Researchers are also finding encouraging results, including clearer skin and less itching, with JAK-STAT inhibitors and PDE-4 inhibitors.

Takeaway

Psoriasis and eczema are both inflammatory skin conditions that result in red patches of scaly skin. Psoriasis flare-ups are usually less itchy than eczema rashes, but they produce thicker scales. Psoriasis is an autoimmune disease, like rheumatoid arthritis, while eczema is caused by genetic or environmental factors, as well as abnormal responses of the body’s immune system.

While there is no cure for either condition, there are several prescription and OTC treatments designed to ease symptoms and reduce the intensity of future flare-ups.

Sources

• Siegfried, E. C., & Hebert, A. A. (2015). Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications. Journal of clinical medicine, 4(5), 884–917. https://doi.org/10.3390/jcm4050884
• Wu, J. J., Nguyen, T. U., Poon, K. Y., & Herrinton, L. J. (2012). The association of psoriasis with autoimmune diseases. Journal of the American Academy of Dermatology, 67(5), 924–930. https://doi.org/10.1016/j.jaad.2012.04.039
• Xhaja, A., Shkodrani, E., Frangaj, S., Kuneshka, L., & Vasili, E. (2014). An epidemiological study on trigger factors and quality of life in psoriatic patients. Materia socio-medica, 26(3), 168–171. https://doi.org/10.5455/msm.2014.26.168-171
• Kim, J., Kim, B. E., & Leung, D. (2019). Pathophysiology of atopic dermatitis: Clinical implications. Allergy and asthma proceedings, 40(2), 84–92. https://doi.org/10.2500/aap.2019.40.4202
• e Vlam K, Szumski A, Mallbris L, et alSAT0395 Scalp Psoriasis as A Surrogate Marker for Psoriatic Arthritis Severity and Treatment Response. Annals of the Rheumatic Diseases 2014;73:737. DOI:10.1136/annrheumdis-2014-eular.2949
• Psomadakis, C. E., & Han, G. (2019). New and Emerging Topical Therapies for Psoriasis and Atopic Dermatitis. The Journal of clinical and aesthetic dermatology, 12(12), 28–34. ncbi.nlm.nih.gov/pmc/articles/PMC7002051/

Last modified: January 5, 2023

Is it Eczema or Psoriasis?

Ever wonder about the differences between eczema and psoriasis? Or have you tried to explain the two conditions to someone and found yourself getting confused? You’re not alone. Even the most skin-savvy of us can sometimes get these common skin conditions mixed up. So, with Psoriasis Awareness Month happening every year in September, we’ve outlined some key details to clarify things and hopefully help more people get the accurate diagnosis and treatment they need.

Causes of the Diseases

Eczema and psoriasis, while two distinct conditions, have something key in common. Both these diseases, says Dr. Amy Paller, Professor of Dermatology and Pediatrics at the Northwestern Feinberg School of Medicine, involve the human immune system, just in different ways. Neither is classified as strictly an autoimmune disease, however, since there can be other causes for both.

With psoriasis, the immune system is overactive in a manner that leads to the growth of too many new skin cells, too fast. These cells pile up on the surface of the skin, causing thick scales or plaques that can be dry, flaky and painful. Most types of psoriasis can be triggered or worsened by stress, skin injury, cold/dry weather, medications or infections. Genetics also seem to play a role with psoriasis risks “running” in families.

While experts don’t completely know what causes eczema, a combination of genes, immune system tendencies and triggers are believed to be involved. People with eczema tend to have overly-reactive immune systems that, when triggered by a substance outside or inside the body, respond by causing inflammation. Researchers have also found that some people with eczema have a mutation in a gene that plays an important role in the skin barrier — leaving the skin more vulnerable to dryness, irritants (like soaps, detergents, fragrances and certain fabrics) and allergens (like dust, pet dander and pollen). Similar to psoriasis, stress can also trigger eczema and family history can increase eczema risks.

Probability

While eczema and psoriasis are both somewhat common, according to the University of Pennsylvania Medical School, eczema is about four times more common (with eczema affecting 32 million people and psoriasis affecting 7.2 million). It is also possible to have both conditions but that’s relatively uncommon. One study found that just 1.4% of children with eczema also had psoriasis.

There are also different types of psoriasis and eczema and some are more common than others. Plaque psoriasis is the most common type of psoriasis while atopic dermatitis is the most common type of eczema. Contact dermatitis is another form of eczema which is quite common, but not as prevalent as atopic eczema.

Age of Onset

Both eczema and psoriasis can affect people of all ages, but eczema typically first appears in babies and children, while psoriasis tends to manifest later, often between the ages of 15 and 35. Indeed, “eczema is much more common in children than psoriasis,” said Dr. Stuart A. Cohen, Assistant Professor with the University of California San Diego, Department of Pediatrics. The American Academy of Dermatology reports that only 1% of children have psoriasis and other experts indicate psoriasis is rare in babies. Children with eczema may find that their symptoms go away or improve as they get older, while psoriasis tends to be more of a lifetime condition.

Appearance

At first glance, the dry rashes of eczema and psoriasis can look similar. When you look closer, there are often telltale differences between the similar symptoms of these two conditions.

Dr. Paller explained that eczema is usually “characterized by poorly demarcated red, dry areas with fine scale,” while psoriasis appears as “red, well-circumscribed lesions (called plaques) with heaped-up, white scaling.”

Eczema: In children: dry skin, scaly skin, red patches on pale skin or rash, grey or ashen colored patches on Black or brown skin with eczema. In adults: there may also be patches of thicker, rougher, darker, leathery skin. Both children and adults may experience oozing and weeping of clear fluids from inflamed areas, with resulting crustiness. Eczema causes the skin to sometimes become inflamed or swollen.

Psoriasis: Well-defined, layered, scaly patches overlying redness. Scaling or “plaques” can be silvery, white, or red. Skin tends to be thicker, raised, and more inflamed than with eczema because psoriasis symptoms cause an excess buildup of skin cells that the body can’t shed quickly enough.

Location

The location of rashes on the body is often a differentiator between these skin diseases.

With eczema, especially in children, symptoms most often appear in the skin folds or “crooks” of the body, particularly along the creases of the elbows, knees, wrists, neck, and ankles. Babies may also get eczema on the chin, cheeks, scalp, chest, arms, and legs. Adults are more likely to have symptoms on patches of skin on their faces or hands.

Psoriasis, while potentially appearing anywhere on the body, is more likely on the outer edges of the elbows, knees, scalp, palms, lower back, soles of the feet, ears, mouth, eyelids, buttocks, or nails.

Itch

Both eczema and psoriasis can cause itchy skin, but eczema, said Dr. Cohen, “may cause an intense itch while psoriasis causes more of a burning or stinging sensation or mild itch.” Indeed while eczema is typically very itchy, especially at night and in children — to the point of disrupting sleep — psoriasis may not cause itchiness at all.

Treatments

There are no cures for eczema or psoriasis, but various treatments can be used to provide symptom relief and to help to prevent flare-ups of either condition.

Working with your dermatologist is the best way to find the treatment options that can bring your skin symptoms under control. This may involve a combination of over-the-counter skin products (like moisturizing emollients and topical corticosteroids), prescription skin products, avoiding triggers, and having a good skin care regimen and healthy lifestyle. Skin products are particularly good for calming eczema or psoriasis flares.

For psoriasis treatment, phototherapy (light therapy with ultraviolet or UVB light) may be recommended. And, if either condition is severe, biologics or systemic (oral) treatments to reduce inflammation may be recommended.

“Topical steroids have been the workhorse treatment for both psoriasis and eczema,” said Dr. Paller. “Other medications that broadly suppress the immune system, whether oral or to be applied to the skin, can work for both. However, newer agents that are more ‘targeted’ to the now-known underlying cause of these two inflammatory disorders are more specific for psoriasis or eczema by suppressing specific arms of the immune system.”

In severe cases, psoriasis can turn into psoriatic arthritis. When this is the case, a medicine such as methotrexate or cyclosporine may be recommended by a doctor to help manage symptoms. Be sure to ask about all potential ointments and creams available to help your skin rashes.

Clearly, there’s a lot more to the psoriasis vs. eczema question than meets the eye. But regardless of which condition you have, or think you have, we know that the challenges of both conditions can run deep on patients and their caregivers. We hope that this article inspires you to talk to a knowledgeable healthcare provider to find the best treatment plan for you.