Psoriasis Vs Eczema: Whats The Difference?

You have patches of dry, itchy, inflamed skin — is it eczema or psoriasis? Eczema (also known as atopic dermatitis) is one of the most prevalent skin diseases in the United States. But psoriasis affects many people, too.

To the untrained eye, these skin concerns can look very much the same. The most widespread symptoms — dry, itchy, scaly patches of skin — may show up in either condition, according to the Cleveland Clinic.

But while eczema-and-psoriasis-070914' target='_blank' rel='noopener noreferrer' >eczema and psoriasis may look similar, they are actually different conditions with different causes, says Shilpi Khetarpal, MD, a dermatologist at the Cleveland Clinic.

Psoriasis vs Eczema: Causes

“Psoriasis is an autoimmune disease [that results in] an overproduction of skin cells,” Dr. Khetarpal says.

She explains that in normal skin, it takes around 28 days for a cell to mature, travel to the surface of the epidermis, and be shed along with other dead cells.

In people with psoriasis, however, that process speeds up to just a few days. As a result, live cells can accumulate along with dead ones, which can lead to the formation of scaly lesions.

In eczema, the skin isn’t able to retain water as it needs to, which can make the skin dry and itchy, as well as more sensitive to irritants, says Khetarpal.

Eczema flares are typically set off by “a hypersensitivity, where essentially your skin is reacting to things in the environment, such as fragrances, certain materials, or allergens,” she says.

There may also be an immune component to eczema, says the National Eczema Association (NEA). People with eczema tend to have an overly reactive immune system that, when triggered by a substance outside or inside the body, responds by producing inflammation. This inflammation causes the discolored, itchy, and painful skin symptoms common to eczema.

Psoriasis vs Eczema: Genetics

With psoriasis, “Genetics seems to play a large role,” says Khetarpal. “People with psoriasis often have a family history of psoriasis or psoriatic arthritis.” About 1 in 3 people with psoriasis have a family member who is also affected, according to the Psoriasis and Psoriatic Arthritis Alliance.

Eczema also tends to run in families, suggesting it has a genetic component, too. It’s seen more commonly in people with a personal or family history of asthma, hay fever, or other allergies. “We call it the allergic triad,” says Khetarpal. “Sometimes someone else in the family has one of these conditions, or the patient may have one, two, or even all three of these conditions.”

Psoriasis vs Eczema: Triggers

In both psoriasis and eczema, certain triggers can bring on a flare. While emotional stress is believed to trigger or worsen both psoriasis and eczema, other triggers are more specific to each condition.

Since eczema is a hypersensitivity, environmental factors can cause a flare. According to the NEA, common eczema triggers include:

  • Dry skin
  • Metals (especially nickel)
  • Fragrance
  • Fabrics (like wool and polyester)
  • Soaps
  • Household cleaners
  • Antibacterial ointment (like neomycin and bacitracin)

Psoriasis triggers vary from person to person, according to the American Academy of Dermatology Association, but may include:

  • Cigarette smoke
  • Drinking alcohol frequently or excessively
  • Smoking
  • Skin injury
  • Dry, cold weather
  • Sunburn
  • Infection
  • Tattoos and piercings

Psoriasis vs Eczema: Symptoms

Although a patch of psoriasis or eczema may look similar, there are some differences in how these conditions present themselves, says Khetarpal. These include:

Degree of Itchiness People with eczema tend to experience a lot of itchiness, says Khetarpal. “In our younger patients, the itching can wake them up in the middle of the night — it’s incredibly uncomfortable. People with psoriasis can have some itching but usually not to the same degree as eczema,” she explains.

Location on the Body Both eczema and psoriasis can show up anywhere, but they have their favorite areas, says Khetarpal.

Psoriasis commonly causes troubles on the following body parts:

  • Scalp
  • Elbows
  • Front of the knees
  • Buttocks
  • Lower back
  • Palms
  • Soles of feet

Eczema can occur on those places as well but more typically will affect the following:

  • Insides of the elbows
  • Behind the knees
  • Hands

Dry vs Wet Psoriasis tends to appear drier and flakier, whereas eczema can sometimes be oozy with fluid-filled blisters.

Nail Changes It’s very common to see nail changes in someone who has psoriasis, says Khetarpal. These can include tiny dents; white, yellow, or brown discoloration; crumbling nails; or separation of the nail from the finger or toe. None of this is typically true for eczema. “In eczema, usually the nails are completely normal unless there’s eczema around the cuticle,” Khetarpal adds.

Reaction to Skin Injuries When a person with psoriasis has a skin injury, a flare or new lesion can occur in that area, a response known as the Koebner phenomenon. “A sunburn or a vaccine or any kind of trauma can cause psoriasis to appear in that area — that doesn’t happen in eczema,” says Khetarpal.

Age of Onset “We typically see psoriasis beginning in the teens — the average age is 15 to 30 years old, and so it tends to be later in life compared to eczema,” Khetarpal says. Although people who are older can also develop it, eczema most commonly appears in young children, who often outgrow it in a few years.

Psoriasis vs Eczema: Treatments

There is no cure for either psoriasis or eczema, but the right therapies can often keep skin clear.

Many of the same treatments are used for both eczema and psoriasis. A doctor may recommend:

  • Topical Cortisone Either an over-the-counter or prescription steroid cream is often a first-line treatment for either psoriasis or eczema to help ease itching and inflammation.
  • Immunosuppressive Drugs Medications such as cyclosporine or methotrexate can help control the immune system response, reduce inflammation, and stop the itch-scratch cycle.
  • Biologics These medications target the protein behind the inflammation response. They’re usually given by injection or intravenous infusion.
  • Prescription Phototherapy Also called light therapy, phototherapy uses a machine to safely expose the skin to a controlled amount of ultraviolet light. It can reduce itching and inflammation and boost the skin's ability to fight bacteria. The treatment has been shown to improve both psoriasis and eczema, says Khetarpal, but is more effective in psoriasis.

Eczema may also be treated with:

  • Other Over-the-Counter Treatments These might include oral antihistamines, Tylenol (acetaminophen), nonsteroidal anti-inflammatory drugs, and coal tar or dandruff shampoos for scalp eczema.
  • Other Prescription Topicals Topical calcineurin inhibitors and phosphodiesterase 4 both target the immune system.
  • Oral Steroids These can help fight inflammation.

Psoriasis treatment may also include:

  • Other Over-the-Counter Topicals Lotions and shampoos with salicylic acid or coal tar are approved by the FDA to soothe or help get rid of psoriasis.
  • Other Prescription Topicals Prescription nonsteroidal medications such as vitamin D analogue products, vitamin A, and anthralin may help reduce inflammation and slow down the formation of plaques.

Psoriasis vs Eczema: Self-Care

Liberal use of a thick, nonirritating moisturizer (either a cream, lotion, or ointment) can ease dryness and help restore the skin barrier in both conditions, says Khetarpal.

Avoiding products with dyes and fragrances is important in eczema.

Psoriasis vs Eczema: Complications

Any condition that impacts the skin barrier increases the chance of infection. This can happen with either psoriasis or eczema but tends to be more common in eczema. “In eczema, people are scratching more, so it's common to see the skin superficially infected,” says Khetarpal.

Psoriasis can also lead to more serious complications. About 30 percent of people with psoriasis will develop psoriatic arthritis, a chronic, inflammatory disease of the joints, according to the National Psoriasis Foundation (NPF).

People with psoriasis are also 1.5 to 2 times more likely to develop heart disease than people without the skin condition, says the NPF. “Psoriasis is not just inflammation of the skin; it causes systemic inflammation and can put you at higher risk for cardiovascular conditions, such as heart attack and stroke,” explains Khetarpal.

The Latest in Psoriasis

Picking at Your Psoriasis Scales? Do This Instead

It’s tempting to peel and pick at those itchy scales, but if you can help it, there are better ways to cope.

What Black Patients Need To Know About The Effects of Psoriasis

Psoriasis can look differently on darker skin than on lighter skin — and knowing how to spot the symptoms is an important first step of the treatment ...

Ways to Protect Your Eye Health — and Preserve Your Vision — With Psoriasis

How to keep the skin condition from negatively impacting your vision.

7 Ways to Take the Stress Out of Your Next Hair Salon Visit if You Have Scalp Psoriasis

Scalp psoriasis symptoms can make a routine trip to the hair salon stressful. But with the right approach, you can have an easier visit — and a healthy...

Do You Need a COVID-19 Vaccine Booster if You Have Psoriasis?

Psoriasis drugs that work by suppressing the body’s immune response may raise the risk of COVID-19 complications. If you’re already immunized, can a booster...

Psoriasis Awareness: A 2021 Special Report

Psoriasis flares have been on the rise in 2021, according to a survey of ishonest readers who have the skin condition. Here’s what might be to ...

Psoriasis: How to Deal with Cracked, Bleeding Skin

Take these steps to heal your skin and avoid future fissures.

Your Psoriasis Diet: Best Foods for Spring and Summer

Ready to break out your favorite warm-weather recipes? Here are delicious anti- inflammatory ingredients you should consider using.

Read more on: eczema, psoriasis