Maybe you're settling into your easy chair for a little Sunday snooze. 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?
While your doctor needs to make the final call, psoriasis or eczema might be the problem. Both are skin conditions with similar symptoms, but there are ways to tell them apart.
Psoriasis vs. Eczema
If you have an itchy, dry rash, you may be wondering if it’s eczema or psoriasis. Besides their similar appearance, these conditions have a lot in common:
- Both involve the immune system (but neither is technically an autoimmune disease).
- Both run in families.
- Both are triggered by stress, among other things.
It’s no wonder that it can be hard to tell them apart. But there are some key differences.
Eczema doesn’t have a clear cause, but for some people, it may have to do with a genetic variation that makes it hard for their skin to hold onto moisture and protect itself.
In children, eczema often looks like a dry, scaly, rash. This rash tends to be red in children with lighter skin and gray in children with darker skin. In adults, the rash may feel thicker, rougher, and more leathery. It may also be darker. Both children and adults may get inflamed patches that leak clear fluid before drying into a crust. Eczema is usually itchier than psoriasis. It’s also more common, affecting four times as many people.
When you have psoriasis, patches of skin cells grow too quickly. These cells quickly pile on top of each other, forming dry scales or plaques. These scales are more clearly defined than those in eczema and are usually silver, white, or red. The affected skin is often itchy or painful. Because of the buildup of skin cells, the rash tends to be thicker, more raised, and more inflamed than eczema.
Eczema vs. dermatitis
There are many types of eczema. The most common is atopic dermatitis. “Atopic” means a genetic tendency to get allergies, while “dermatitis” means itchy, red, irritated skin. So, “atopic dermatitis” means itchy skin caused by an allergic reaction.
How Psoriasis and Eczema Feel Different
Eczema causes an intense itch. It can get so bad that your skin may bleed from scratching.
Psoriasis can 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.
Psoriasis vs. Eczema Pictures
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.
Psoriasis can also cause red patches. They may be silvery, scaly, and raised. But if you look closely, the skin is thicker and more inflamed than with eczema.
Where They Show Up
Eczema and psoriasis tend to affect different parts of your body.
Eczema often appears on parts of your body that bend, such as 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.
On the other hand, psoriasis often shows up on places such as your:
- Elbows
- Knees
- Scalp and face
- Lower back
- Palms of your hands
- Bottoms of your feet
You may also have patches on other areas, such as:
- Fingernails and toenails
- Mouth and lips
- Eyelids
- Ears
- Skin folds
Scalp eczema vs. psoriasis
Both eczema and psoriasis can cause oily, crusty patches on your scalp. But there are ways to tell them apart.
Scalp eczema, or seborrheic dermatitis, is known for causing dandruff. These tiny flakes can be white or yellow. You also might have greasy skin or an itchy, scaly rash. The rash tends to be red in light-skinned people and light-colored in dark-skinned people. Black people may get a more severe version that causes a ring-shaped rash around the hairline.
Meanwhile, scalp psoriasis tends to cause thicker, drier scales than eczema. Usually, it extends beyond the hairline. You also may have rashes in other areas of the body, such as your palms.
Psoriasis vs. Eczema Triggers
Eczema and psoriasis cause rashes that come and go. When you get a rash, it’s called a flare-up. Sometimes, months or years can go by between flare-ups.
Certain things can cause psoriasis and eczema to flare up. These triggers are different for everyone. It’s important to learn what your triggers are so that you can avoid them as much as possible. This will help you prevent flare-ups.
Eczema triggers
Eczema usually results from things that irritate your skin, such as:
- Soaps
- Detergents
- Disinfectants
- Gasoline
- Turpentine
Things that cause allergies can also set off eczema. They include:
- Dust
- Pets
- Pollen
- Mold
- Some foods
Eczema can also be triggered by:
- Infections
- Stress
- Sweating
- Heat
- Humidity
- Changes in your hormones
- Some medicines (including psoralen, interferon, and lithium)
- Some health conditions (including HIV and Parkinson’s disease)
Psoriasis trigger
Psoriasis shares some of these triggers, such as stress and infection.
Other triggers include:
- Skin injuries (like sunburns and scratches)
- Smoking and exposure to secondhand smoke
- Cold and dry weather
- Alcohol
- Some medications (such as lithium, high blood pressure drugs, and antimalarial drugs)
- Suddenly stopping corticosteroids
At What Age Do They Start?
When does eczema start?
Eczema usually starts in babies or young children. Often, symptoms improve when a kid grows up.
It's less common to get it as an adult. When that happens, it's usually because you have another condition such as thyroid disease, hormone changes, or stress.
When does psoriasis start?
Psoriasis, on the other hand, usually shows up between the ages of 15 and 35. But you can get it at other ages, too. Once you get it, it tends to be a lifelong condition, although flare-ups may come and go.
Conditions They're Linked To
It’s not clear what causes eczema or psoriasis, although the immune system appears to play a role. What we do know is that having either condition can raise your chances for other health problems. Here are the problems linked to each condition.
Conditions related to eczema
You’re more likely to get eczema if you have:
- HIV
- Acne
- Rosacea
- Parkinson’s disease
- Epilepsy
- Alcoholism
- Depression
- Eating disorders
- History of stroke or heart attack
Eczema is also linked to peanut allergies. If your baby has eczema, talk to your doctor about how and when to safely introduce them to peanuts.
Conditions related to psoriasis
Psoriasis is linked to other serious health conditions. If you have psoriasis, you are at a higher risk for:
- Psoriatic arthritis
- Heart disease
- Metabolic syndrome
- Obesity
- Hypertension
- High cholesterol
- Diabetes
- Anxiety
- Depression
- Inflammatory bowel disease
- Cancer
- Kidney disease
- Sleep apnea
- Chronic obstructive pulmonary disease
- Uveitis (eye inflammation)
- Liver disease
Psoriasis vs. Eczema Treatment
Lifestyle changes can help you manage both conditions. You can:
- Identify and avoid your triggers. This will help you reduce flare-ups. Keep in mind that figuring out your triggers could take some trial and error.
- Practice a good skin care routine. Take daily warm (not hot) baths. Afterward, gently pat your skin dry and moisturize.
- Get enough sleep. This helps keep your skin healthy.
- Manage stress. Stress can trigger both eczema and psoriasis, so practice ways to keep it under control. Try yoga, meditation, exercise, or journaling.
There are also specific treatments for each condition, depending on how severe it is. Usually, your doctor will start you out with a topical treatment, which means it goes on your skin. Topical treatments can come in the form of creams, ointments, gels, and shampoos.
Moisturizers are a topical treatment. If your moisturizer has an oil or cream base (not a water base like lotion), it is called an emollient. Emollients protect your skin from drying out.
Corticosteroids are a common topical treatment for both eczema and psoriasis. You can get these over the counter, or your doctor can prescribe a stronger version. Corticosteroids are best for short-term use. If you take them for a long time, they could cause your skin to get thinner or may stop working completely.
If that doesn’t work, your doctor may suggest a systemic medication, which means it affects your whole body.
Eczema treatment
For mild to moderate eczema, you can use a topical corticosteroid to control inflammation, along with an emollient to keep your skin moisturized. If you have scalp eczema, choose a shampoo that’s designed to prevent dandruff.
If your eczema is itchy, you can take antihistamines, the same over-the-counter drugs that treat allergies.
Eczema medication
When less aggressive treatments don’t work, your doctor might recommend a calcineurin inhibitor, such as tacrolimus or pimecrolimus. These drugs can come in the form of creams or ointments.
Sometimes, you may need to try a medicine that calms down your immune system. Oral options include:
- Azathioprine
- Cyclosporine
- Methotrexate
In severe cases, your doctor may prescribe shots of biologic drugs like dupilumab (for kids over 6) or tralokinumab (for adults).
Psoriasis treatment
If your disease is mild, you may be able to control it with topical corticosteroids and emollients.
Psoriasis medication
There are many kinds of medications to treat psoriasis, including creams, pills, and shots. Depending on your situation, you might combine different treatments or rotate them so they don’t lose effectiveness.
Creams and ointments for psoriasis include:
- Vitamin D analogues (calcipotriene, calcitriol)
- Retinoids (tazarotene)
- Calcineurin inhibitors (tacrolimus, pimecrolimus)
- Salicylic acid
- Coal tar
- Anthralin
If topical treatments don’t work, you could try oral medications such as methotrexate and cyclosporine. These affect your entire body, usually by dampening the immune system.
Your doctor also might prescribe an injectable steroid. Another injectable option is biologic drugs, which also dampen your immune system. They include:
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Infliximab (Avsola, Inflectra, Remicade)
- Ixekizumab (Taltz)
- Risankizumab (Skyrizi)
- Ustekinumab (Stelara)
Psoriasis can also be treated with light therapy (phototherapy). This involves exposing your skin to light for a certain period. It can involve sunlight, UV light from an artificial source (like a light bulb), or a UV laser. Talk to your doctor before trying light therapy. They can help you decide whether it’s right for you, how often you should do it, and how long each session should last. Light therapy is often paired with medication or other treatments.
Takeaways
Eczema and psoriasis have a lot in common, but there are some key differences between the two conditions. Eczema is more common, especially among kids. Eczema rashes tend to be itchier and affect skin folds (like in your elbows and behind your knees). Psoriasis tends to cause thick, dry scales. For either condition, it’s important to talk with your doctor about lifestyle changes, over-the-counter creams and gels, and medications that can help.
Psoriasis vs. Eczema FAQs
How do I know if it's eczema or psoriasis?
Think about where your rash is, what it looks like, and how old you are. Eczema tends to affect skin folds such as your elbows and behind your knees, while psoriasis can affect a variety of places. Eczema is more likely to be very itchy, and psoriasis usually causes thicker, raised rashes with well-defined scales. Also, eczema usually starts in childhood, but psoriasis mainly affects adults.
What are the main symptoms of psoriasis?
Psoriasis causes thick, dry scales. These scales are often inflamed, painful, or itchy.
Can I cure eczema or dermatitis at home?
There’s no cure for eczema, although many children grow out of it. Certain lifestyle changes, such as avoiding triggers and managing stress, can help you manage eczema at home. Over-the-counter creams can also help. But in severe cases, you may need a prescription from your doctor.
