Psoriasis vs. Eczema: Understanding the Differences

DWorking with dry, itchy skin is uncomfortable at best and can even affect the quality of your life. After all, you can’t just tell your rash to take a break while you’re doing other things.

But dermatologists say the best way to improve your symptoms is to find out what might be behind your skin problems. Do you suffer from psoriasis, eczema or something completely different? Dermatologists explain how to know the difference between psoriasis and eczema and how to get help.

What is psoriasis?

Psoriasis is an autoimmune disease that occurs when your body produces skin cells too quickly American Academy of Dermatology (AAD) explains. This causes the skin cells to pile up and form visible spots or spots on the skin. Fortunately, a psoriasis rash is not contagious, according to the AAD.

What is eczema?

Eczema is a common skin condition that usually starts in childhood and causes itchy, dry and inflamed skin. AAD say. Like psoriasis, eczema is not contagious.

How do the symptoms of psoriasis compare to eczema?

“Psoriasis and eczema are both chronic skin conditions, but there are clear differences,” says a board-certified dermatologist Ife J. Rodney, MD, founder and director of Eternal dermatological aesthetics. “While they share some similar symptoms, such as redness and itching, their underlying causes and the appearance of the affected skin differ.”

These are the main symptoms of psoriasis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):

• Patches of thick, red skin with silvery-white scales that itch or burn and usually appear on the elbows, knees, scalp, trunk, palms, and soles of the feet
• Dry, cracked skin that itches or bleeds
• Thick, ridged, pitted nails
• Poor sleep quality

And these are the main signs of eczema: NIAMS say:

• Red, dry, extremely itchy spots on the skin
• Rash that may ooze or weep clear fluid, or bleed if scratched
• Thickening and hardening of the skin

How do I know if it is eczema or psoriasis?

Although both conditions cause rashes, they appear differently, he says Cindy Wassef, MD, an assistant professor at Rutgers Robert Wood Johnson Medical School. Psoriasis often causes a rash that has a salmon pink, dark purple or gray hue, depending on a person’s skin tone, she says, adding that the patches tend to have a silvery tint. “It can be associated with nail findings, such as pitting,” she says.

“Eczema is more of a pale pink to brown color, with a fine white peel,” says Dr. Wassef.

Location also matters when trying to determine whether you are dealing with psoriasis versus eczema. While you can technically have signs of both conditions anywhere you have skin (whether that’s eczema on your scalp or psoriasis on your face), they tend to show up in different places. “Psoriasis lesions are most common on the scalp, elbows, and knees,” says Gary Goldenberg, MD, a board-certified dermatologist practicing in New York City. “Eczema is most common on the backs of the knees and the fronts of the elbows.”

What causes these conditions?

There is a difference in the cause of psoriasis versus eczema. “The exact cause of psoriasis is not yet fully understood, but it is thought to involve a malfunction of the immune system,” says Dr. Rodney. “Genetics also plays an important role in psoriasis.” (This means that if you have a family history of psoriasis, there is a good chance you will develop the condition higher than average¹.)

“Eczema is often linked to a combination of genetic and environmental factors,” says Dr. Rodney. “Triggers for eczema can include irritants such as soaps and detergents, allergens such as pollen or pet dander, infections and stress.”

But “both conditions can be caused by environmental factors, stress, illness, diet and other factors we may not understand,” says Dr. Goldenberg.

How does the treatment differ?

Treatment can vary for psoriasis versus eczema depending on how severe the symptoms are. “For mild eczema and psoriasis, initial treatment with topical steroids is very similar,” says Dr. Wassef. “For more severe cases, however, injectable medications that act on the immune system target different areas of eczema and psoriasis. It would be important to know what result you have.’

In general, psoriasis treatments may include topical corticosteroids, vitamin D ointments or creams, immunosuppressive medications, and light therapy, says Dr. Rodney. (In the meantime, you should avoid exfoliants.) On the other hand, most types of eczema are usually “treated with moisturizers to keep the skin hydrated, along with topical corticosteroids or immunomodulators to reduce inflammation,” she says. “Avoiding triggers and allergens is crucial for managing eczema.”

How can you prevent psoriasis and eczema?

It can be difficult to completely prevent psoriasis and eczema because of their genetic components, says Dr. Rodney. But she says flares and symptoms can usually be managed through lifestyle changes.

“For psoriasis, managing stress, avoiding skin injuries, and following prescribed treatments can help prevent exacerbations,” says Dr. Rodney. “For eczema, maintaining good skin hydration through regular use of moisturizers, identifying and avoiding triggers, and practicing good skin care routines can prevent flare-ups and reduce the severity of symptoms.” Seasonal eczema care is also critical.

If you have a skin rash and you’re not sure what’s behind it, talk to your dermatologist. They are well-versed in both skin conditions and can usually give you a diagnosis after examining your skin, says Dr. Wassef. From there, you can create a care plan together to find the soothing relief you’re looking for.