What Is the Difference Between Psoriasis and Eczema?

Psoriasis and atopic eczema (also known as atopic dermatitis or eczema) are both chronic, inflammatory diseases that affect the skin. They are both somewhat common, but eczema is about four times more common (with eczema affecting 32 million people and psoriasis affecting 7.2 million), according to the National Eczema Association.

Although psoriasis and eczema may initially look the same, slight differences distinguish one condition from the other at a closer glance, says Michele Green, M.D., a board-certified dermatologist in New York City. “Psoriasis is a skin condition characterized by an overactive immune system that causes skin cell growth to speed up,” she says. “While normal skin cells grow and shed over a month, skin cells in psoriasis patients grow and shed over three to four days, leading to a buildup of skin that appears as small or large patches of thick plaques that can appear silvery, red, or white.”

Eczema is also a skin condition characterized by an overactive immune system, but here is one of the main differences, according to Dr. Green: “The over-activity related to eczema weakens the natural skin barrier, leading to decreased moisture retention and heightened sensitivity to irritants and allergens.” The increased inflammation associated with eczema typically appears as red patches of dry and itchy skin, she adds.

How Psoriasis and Eczema Feel Different

It’s not just about appearance: Psoriasis and eczema feel different, too, to those living with the conditions, according to Chris Sayed, M.D., associate professor of dermatology practicing at the University of North Carolina at Chapel Hill.

“The primary symptom reported in eczema is itch, which is the main thing that can make it miserable to live with,” says Dr. Sayed. “The skin can also be sore when scratching leading to breaks in the skin, which can make it sensitive to things like soaps or other irritants.”

Psoriasis can also be itchy, but not to the same extent for most patients, he says. Rather, it’s the pain of cracking and bleeding skin that can cause the greatest discomfort. Flaking is also an issue. “The flaking is often thicker and more substantial in psoriasis, so flaking skin that is visible on clothing or in the environment around patients with psoriasis is a much bigger problem to deal with than in eczema,” explains Dr. Sayed.

How Psoriasis and Eczema Look Different

Both psoriasis and eczema can appear as red patches on the skin, but there are some revealing differences upon further inspection. Eczema usually shows up with poorly demarcated red, dry areas with fine scale on pale skin or gray or ashen-colored patches on darker skin, while depending on your type of psoriasis, it appears with red lesions (called plaques) with heaped-up, white scaling on the skin.

With eczema, both children and adults with eczema may experience weeping of clear fluids from inflamed areas. With psoriasis, skin tends to be raised and thicker. Rarely, there is a chance that someone may have both conditions at the same time: According to a review in the journal Skin Health and Disease, about 2% of the time someone with psoriasis also has eczema, and vice versa.

How Do Symptoms of Eczema and Psoriasis Compare?

Eczema and psoriasis are separate conditions but with some overlapping symptoms:

Eczema Symptoms

While eczema symptoms will be different for each person, the most common ways people experience this condition are:

• Darkening of the skin around the eyes

• Dry or cracked skin

• Itchiness

• Oozing and crusting skin

• Rash on swollen skin that varies in color depending on your skin color

• Raw, sensitive skin from scratching

• Small, raised bumps on brown or black skin

• Thickened skin

Psoriasis Symptoms

Psoriasis symptoms vary by individual, but the most common red flags to look for with this chronic skin condition include:

• Cyclic rashes that may come and go

• Dry cracked skin that may bleed

• Itching, burning or soreness

• Patchy rash in one place, a few places or covering the body

• Thick patches of skin

• Variation in color from purple to pink to red to silver

Where Do Eczema and Psoriasis Occur on the Body?

Both psoriasis and eczema can occur anywhere on the body. At the same time, they also each have tendencies for specific patterns, says Dr. Sayed. In adults and adolescents, the most common locations for eczema are the front of the elbow, behind the knees, on the neck, and around the underarm, explains Dr. Sayed. In infants and children, eczema is usually located on the cheeks, elbows and on the knees.

But like most chronic conditions, there are always exceptions to the rules. Some patients mostly only have eczema on their hands, head, and neck, while others may be covered almost head to toe, says Dr. Sayed. Psoriasis patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places such as the fingernails, toenails, and mouth.

Psoriasis Locations

If you have this chronic skin condition, these are the most likely areas of your body where it will appear:

• Back

• Elbows

• Face

• Feet

• Fingernails

• Genitals

• Hands

• Knees

• Mouth

• Scalp

• Toenails

Eczema Locations

While there is a decent amount of overlap between the areas of the body where psoriasis and eczema appear, there are differences as well. Eczema most commonly occurs on:

• Ankles

• Cheeks

• Folds of arms

• Back of knees

• Neck

• Scalp

• Under the arm

• Wrists

Is Diagnosis Different for Psoriasis and Eczema?

It’s not always easy to tell the difference between psoriasis and eczema. It can be especially confusing because a subset of psoriasis patients may present lesions that look like eczema, and a subset of eczema patients may have plaque-type psoriasis lesions, according to an article in the journal Annals of Translational Medicine. According to the American Academy of Dermatology, at least one study found that most children who had psoriasis were initially diagnosed by their primary care doctor as having another disease, often eczema.

However, age can help to differentiate between the two conditions, says Dr. Green. “Psoriasis typically affects adults, with symptoms often appearing around early adulthood, though individuals at any age may be affected,” she explains Eczema, meanwhile, is seen in roughly 20% of children but also affects around 1% to 3% of adults.

The level of itch may also be an indicator. Even though psoriasis can be itchy, with eczema the level of itch can be intense. A genetic connection may also hold clues to a diagnosis. Both psoriasis and eczema tend to run in families.

The best way to figure out which one you might have? See your dermatologist, who is trained to distinguish between the two conditions.

Difference in Triggers for Psoriasis and Eczema

Although the exact causes of psoriasis and eczema are unknown, researchers agree there is a complex relationship between genetics, the immune system, in both of these skin conditions, says Dr. Green. Both psoriasis and eczema can both come and go, getting better and then worse again. When symptoms get worse, this is known as a flare in the condition. What causes the symptoms to get worse is known as a trigger. “Triggers such as stress, illness, weather, or skin injury can all result in the onset or exacerbation of psoriasis symptoms,” says Dr. Green. “Although these factors can trigger eczema, more common triggers include dander, pollen, mold, food allergies, harsh soaps, and detergents.”

Psoriasis Triggers

These are among the most common instigators of a flare with psoriasis:

• Allergens

• Certain foods

• Illness such as a virus

• Injury to skin

• Weather

Eczema Triggers

What sets this skin condition off? The biggest trigger offenders include:

• Certain foods

• Dry skin

• Environmental allergens (cigarette smoke, pet dander, pollen)

• Household products (soaps, detergents, disinfectants)

• Irritating clothes material (wool, latex, polyester)

• Mold

• Perfumes or lotions

• Stress

Common Comorbidities for Psoriasis and Eczema

A comorbidity is a condition that is related to your disease. Because psoriasis causes whole body inflammation, high blood pressure, cardiovascular disease, and type 2 diabetes are all comorbidities of psoriasis, according to the National Psoriasis Foundation. Psoriatic arthritis is also a comorbidity related to psoriasis, with approximately one in three people who live with psoriasis going on to develop psoriatic arthritis.

Eczema can also result in comorbidities, according to Dr. Green. “Eczema is part of a group of allergic conditions known as the ‘allergy march,’ with the onset of one of these conditions increasing the likelihood of developing another,” she says. “These conditions include asthma, food allergies, skin infections, and allergic rhinitis, commonly known as ‘hay fever.’”

You may be surprised to find out that roughly 20% of adults with eczema are also affected by asthma, and up to 15% of children with eczema (from three to 18 months old) have an allergy to one or more food types, adds Dr. Green.

Infections are another complication related to eczema, she says: “Since eczema results from a weakened skin barrier, you are at an increased risk for colonizing bacteria on the skin, leading to infections such as staph and herpes.”

How Psoriasis and Eczema Are Treated

According to Dr. Sayed, there are both similarities and differences when it comes to treating the two conditions. “Many of the topical steroids like hydrocortisone and triamcinolone might be used for both conditions and can be very effective,” he says. “There are certain newer prescription creams that might be better for one condition than the other, but they can cross over some.”

But the more advanced treatments are usually specifically designed to treat either psoriasis or eczema, says Dr. Sayed. “The newer biologic or other similar medicines that reduce certain types of inflammation as pills or injections are usually more targeted for either psoriasis or eczema since the underlying cause for each condition is different.”

Another difference: While psoriasis is driven by an auto-inflammatory process, with eczema, it’s sometimes possible that removing an environmental offender can improve your symptoms. “Triggers like allergens can occasionally be modified for eczema,” says Dr. Sayed. For severe cases, though, “they will need management beyond that.”

Here’s a look at how each condition is typically treated.

Psoriasis Treatment

Depending on the severity of your symptoms and the degree of spread on your skin, your doctor will talk to you about one of these approaches (alphabetized for convenience):

• Cyclosporine

• Immune therapies (biologics and small molecule inhibitors)

• Light therapy

• Medication to slow skin cell production (anthralin)

• Medicated lotions or shampoos

• Methotrexate

• Moisturizers for dry skin

• Oral steroids

• PDE4 inhibitors

• Retinoids

• Salicylic acid products (Neutrogena T/Sal, Salicyn and Keralyt)

• Steroid creams (hydrocortisone)

• Vitamin A or retinol creams

• Vitamin D3 ointment

Eczema Treatment

While eczema in children can sometimes disappear in its own as they age, in adults, this skin condition typically requires treatment. Options, in alphabetical order for convenience, are:

• Immune therapies (Dupixent and Opzelura)

• Light therapy

• Medicated shampoos

• Moisturizers for the skin

• Oral steroids

• PDE4 inhibitors (Eucrisa)

• Steroid creams (hydrocortisone or clobetasone butyrate)

• Topical calcineurin inhibitors (Elidel and Protopic)

Takeaways

Despite the differences in eczema and psoriasis, both conditions can be more successfully managed today than they were in the past. Treatment for psoriasis and eczema have come a long way, says Dr. Green, but becoming symptom-free still takes some trial, error, and teamwork with your dermatologist.

“Although there is no cure-all, an incredible amount of advancement has been made in treatments to alleviate inflammation, itchiness, and redness in [eczema and psoriasis] patients,” she says. Still, medications do not come without side effects, “so it is essential to consult your dermatologist to determine which treatments may be right for you.”