How to Tell the Difference Between Psoriasis and Eczema

Pop quiz: Can you tell the difference between psoriasis and eczema? As if these chronic skin issues weren’t frustrating enough, they can also be incredibly confusing. “Both eczema and psoriasis cause red, scaly areas on the skin, and to the untrained eye, they can look similar,” board-certified dermatologist Alan J. Parks, M.D., tells SELF. Here’s how to figure out which is which, along with the best ways to actually treat these annoying skin conditions.

These are the most common psoriasis symptoms:

The most common type of psoriasis is plaque psoriasis, per the Mayo Clinic. The symptoms of plaque psoriasis are most often found on the scalp, elbows, knees, lower back, and genitals and may include:

  • Raised, red patches of skin

  • A silvery white coating of dead skin cells on top of those patches

  • Itchiness

  • Pain

  • Cracking skin and bleeding

There are other, less common forms of psoriasis. Guttate psoriasis, which often begins in childhood or young adulthood and can be triggered by a strep infection, appears as small, droplike lesions. Inverse psoriasis shows up as a smooth, shiny, red rash in body folds, such as under the arms or breasts. Pustular psoriasis, which can present on the palms of the hands and soles of the feet, is characterized by noninfectious, pus-filled blisters, according to John Hopkins Medicine. The most severe, and rarest, type of psoriasis is erythrodermic psoriasis, which results in widespread, fiery redness over most of the body. It can cause severe itching and pain, and if you think you’re having an erythrodermic psoriasis flare-up, you should seek medical attention immediately. (FYI: You can find more information and photos of each type from the Mayo Clinic here.)

Eczema symptoms, on the other hand, are similar but different.

Eczema is really the collective name for a group of conditions that cause the skin to become red, itchy, and inflamed. The most common form of eczema is atopic dermatitis, which is why “when most people say ‘eczema,’ they usually mean atopic dermatitis,” Todd Minars, M.D., an assistant clinical professor of dermatology at University of Miami School of Medicine, tells SELF.

The American Academy of Dermatology (AAD) calls atopic dermatitis “the itch that rashes” to emphasize how uncomfortable this condition’s characteristic dry, red, scaly patches can be.

Symptoms of atopic dermatitis can include:

  • Dry, itchy patches of skin

  • Small red-to-brownish-gray raised bumps

  • Cracked or scaly skin

Contact dermatitis is another kind of eczema, which can be caused by coming into contact with an allergen or an irritating substance, such as solvents, poison ivy, and detergents, the AAD says. The reaction typically affects the part of the body that touched the irritant, according to the Mayo Clinic. Its symptoms are redness or rash, burning or swelling, and blisters that may weep or crust over.

Dyshidrotic eczema is yet another form of this condition. It appears as small, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet, and may be triggered by stress, allergies, or exposure to metals like nickel and cobalt, according to the Mayo Clinic. Symptoms include pain, itching, redness, flaking, and scaly, cracked skin. (FYI: You can find more information and photos of eczema from the Mayo Clinic here.)

What causes psoriasis vs. eczema?

These two skin problems have different causes and can appear in different stages of your life. Psoriasis is an autoimmune condition that affects about 7.5 million Americans, according to the AAD. It happens when the skin cells go through their life cycle more quickly than normal. Typically, it takes about a month for skin cells to regenerate, but in people with psoriasis, this process happens every three to four days, according to the Cleveland Clinic.

Psoriasis typically strikes when someone is between the ages of 15 and 35, according to the U.S. National Library of Medicine, but it can affect anyone at any age. “What we do know is that psoriasis is immune-mediated, meaning there is some imbalance in the immune system, which leads to inflamed skin,” dermatologist and National Psoriasis Foundation medical board member Jashin Wu, M.D., tells SELF. “It tends to run in families, but there may not be straightforward patterns of inheritance. One well-known trigger is strep throat infections, but not all new cases of psoriasis result from strep throat.”

Eczema is much more common than psoriasis. According to the most recent estimate available, more than 30 million Americans have some form of eczema.

A textbook case of eczema begins during infancy or early childhood, Dr. Minars says. “There are some controversies as to whether eczema is primarily an immune-mediated disease or a skin-barrier-defect disease,” Dr. Wu says. “Like psoriasis, it also tends to run in families,” suggesting that there may also be a hereditary component.

Can stress exacerbate psoriasis or eczema?

There’s no doubt that living with psoriasis and eczema can be stressful, and their connection to stress has been widely discussed in the dermatology community.

Although experts often advise people with psoriasis and eczema to avoid stressful situations, a lot remains to be proven about exactly how stress can influence these conditions. A November 2017 meta-analysis in the British Journal of Dermatology evaluated 39 studies with more than 32,500 patients, concluding that “no convincing evidence exists that preceding stress is strongly associated with psoriasis exacerbation/onset.” As for eczema, an October 2017 study in the International Journal of Molecular Sciences reported that psychological stress may exacerbate atopic dermatitis, and it might be mediated by the hypothalamic-pituitary-adrenal (HPA) axis.

Just because science hasn’t fully clarified the role stress plays in these conditions doesn’t mean the link doesn’t exist. Dr. Wu says he’s seen patients experience stress-related psoriasis or eczema flare-ups in the past, and the AAD mentions stress when discussing both psoriasis and eczema.

Though psoriasis and eczema are different conditions, treatment for the two is often similar.

While there’s no cure for either condition, they can be treated. If you’re diagnosed with psoriasis or eczema, your doctor may recommend:

  • Over-the-counter moisturizers

  • Topical medications to reduce inflammation, like corticosteroids, calcineurin inhibitors, and retinoids

  • Oral steroids, like prednisone, which can help calm a severe case when used for a short period of time

  • Wet dressings, which involve wrapping the area with a wet bandage to soothe the itchiness

  • Phototherapy, in which a special machine emits ultraviolet light onto the skin to help reduce itching and inflammation

Although psoriasis and eczema are both frustrating, irritating conditions, they shouldn’t be life-ruiners. If you’re struggling with managing your psoriasis or eczema, see a dermatologist, who can help determine the best treatment plan for you.


Originally Appeared on SELF