Psoriasis vs. Eczema: Similarities, Differences, and the Most Effective Treatments

Psoriasis vs. Eczema: Similarities, Differences, and the Most Effective Treatments

So you’ve got patches of flaky, reddish, or dry skin with an itch that just won’t quit. Sure, you should probably make a doctor’s appointment to figure out exactly what’s causing it, but being a typical human, you decide to do a quick consult with Dr. Google first. It would be easy to reach the conclusion that you have eczema, after viewing some online pics, and there’s a good chance you’d be right: This common condition causes chronic skin drama for more than 10 percent of the U.S. population, or 31.6 million people. That’s a lot of people with itchy skin reaching for cortisone cream. 

However, it’s important to note that eczema—also called atopic dermatitis—isn’t the only leading culprit to consider when your skin regularly flares up with feisty rashes. You could also be dealing with psoriasis. Less prevalent than eczema but still affecting a very significant 7.5 million people in the U.S. alone, psoriasis is also an inflammatory skin condition that can at times produce very similar symptoms. Yet eczema and psoriasis are completely different diagnoses that frequently require different treatment. 

Ready to figure out whether psoriasis vs. eczema is your issue? Here’s one of the most helpful indicators of which skin disease you have: Eczema usually appears during infancy or childhood—some people outgrow it, while some people find it gets worse, but it’s rare to see it for the very first time when you’re an adult. So if you know your inner elbows have been prone to red patches since you were in grade school, there’s a good chance eczema is the cause. Psoriasis, on the other hand, most commonly surfaces between the ages of 15 and 25, but can also appear later. 

While both eczema and psoriasis each have a genetic component—if your parent or sibling has one, there’s a good chance you do too—their root causes and symptoms have some notable differences. Psoriasis is a chronic autoimmune condition that results from skin cells multiplying too quickly, which leads to thickened patches of skin that look red (if you have light skin) or purple, gray or dark (if you have darker skin). Those patches are often cracked and/or covered in silvery scales, a result of those rapidly multiplying skin cells. Psoriasis also involves systemic inflammation throughout the entire body; 30 percent of people eventually experience psoriatic arthritis in addition to skin symptoms. Eczema, on the other hand, seems to occur because the skin’s protective barrier is weakened, due to genetic and/or environmental factors, including living in a very dry or polluted climate. Its rashes—which can be red or darkened along the same spectrum as psoriasis “plaques”—can feel dry and flaky, sometimes oozy or with small bumps, but have no silvery scales. 

Another key difference between eczema and psoriasis is where rashes are located. Eczema loves to crop up in places where skin bends, like the crooks of elbows and the backs of knees, as well as the wrists, ankles and neck. Plaque psoriasis—by far the most common among the five different types of psoriasis—prefers the kneecaps and outside of elbows, as well as the scalp, ears, lower back, buttocks, palms, soles, and face. 

Another clue to the eczema vs. psoriasis question lies in where you’d rate your itchiness on a scale of 1 through 10. Eczema tends to be intensely itchy—to the point where some people scratch until they bleed—while the must-scratch urge produced by psoriasis tends to be milder, and sometimes can also burn. Then there are differences in what causes flare-ups of each condition. While both eczema and psoriasis can be exacerbated by environmental factors like cold, dry winter air, psoriasis flare-ups can be triggered by common viral infections like strep, while eczema often appears in response to common allergens like dust mites (regular cleaning and anti-dust mite mattress/pillow covers can make a big difference) or fragranced laundry detergent and skincare products. 

One helpful factor is that many medications, treatments, and mitigation strategies work equally well for different types of eczema and types of psoriasis. Management of both conditions centers around calming skin inflammation and identifying/avoiding triggers. Diligent moisturization is key, as it helps keep the skin’s protective barrier healthy, to help avoid irritants and triggers. Using lukewarm shower water instead of steaming hot avoids drying the skin out, and using a humidifier overnight offsets dryness and itching. Also worth noting, with an eye toward psychology instead of dermatology: Efficiently managing stress is also crucial for preventing flare-ups of both eczema and psoriasis, as it encourages inflammation.

Taking oral antihistamines and applying a topical steroid cream like cortisone can counter the itching associated with both eczema and psoriasis. People with both eczema and psoriasis also often find relief from over-the-counter ointments that use coal tar, an ingredient that reduces swelling and scaling. For moderate to severe eczema and psoriasis, your healthcare provider may recommend incorporating phototherapy (a.k.a. light therapy, or exposing lesions to ultraviolet light), where you visit a light booth (it looks like a tanning booth) to soak up a controlled dose of UVB light up to a few times a week. The specific wavelengths used help break the cycle of skin inflammation. Other effective treatment options for moderate to severe cases: systemic corticosteroids or biologics, which are injectable medications or IV infusions that disrupt the body’s inflammatory response. 

Still, it’s important to establish which condition you have, since some very effective psoriasis treatments that target the skin disease more specifically. These include oral prescription medications as well as topical medications that treat scaly skin by slowing the accelerated growth of skin cells, including topical corticosteroids, retinoids, prescription Vitamin D creams, and anthralin. Medicated shampoos, soaps, washes, ointments, and moisturizers for psoriasis often employ salicylic acid to help fight its specific type of scaly patches. Sometimes, doctors will prescribe immunosuppressants (which as the name indicates, suppress the immune system) to combat stubborn cases of psoriasis. 

With either eczema or psoriasis, the last thing you want to do is randomly experiment with a bunch of over-the-counter remedies and potentially end up making your skin condition flare up worse. The best thing to do if you’re not sure if you’re dealing with eczema or psoriasis: Go ahead and call your doctor, or ideally, a dermatologist, who is the most trained to pinpoint the sometimes-subtle differences between eczema and psoriasis and recommend the most effective treatment plan for you. 

Petra Guglielmetti is a health, wellness, and beauty journalist who taps into a broad network of doctors, scientists, and medical experts to write in-depth service articles for leading publications like Glamour, Health, Real Simple, and Parents.

More on psoriasis and the treatment of psoriasis:

For more information on the treatment of psoriasis, visit the National Psoriasis Foundation.

Originally Appeared on Glamour