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Eczema or Psoriasis – How to Tell the Difference

Understand the difference between eczema and psoriasis

If you often have rashes, scales or other itchy skin conditions, you might wonder whether you have eczema or psoriasis. It can often be difficult to distinguish between these two conditions, but getting a proper diagnosis is key to knowing what treatment you need for your specific issue. That's why it's important to discuss your skin condition with your doctor and see a dermatologist if necessary.

What do eczema and psoriasis look like?

At first glance, it’s easy to see why eczema (also known as atopic dermatitis) and psoriasis are so easy to confuse. Both feature rashes with dry and itchy skin that often appears red and scaly. The American Academy of Dermatology notes that both conditions tend to affect the the elbows and the knees. Both conditions are also chronic diseases, meaning they won’t go away or they may come back after clearing up.

However, the two conditions are actually quite different. As the academy notes, the rash related to eczema appears mainly in the crooks of the elbows and knees and is intensely itchy. Psoriasis, however, generally appears on the outside of the elbows and knees, according to the National Psoriasis Foundation. It also may affect the scalp, face and buttocks.

While both conditions can be itchy, the academy notes that eczema is often the itchier condition of the two. The rashes related to plaque psoriasis, however, can sometimes be painful, as well.

The major difference between eczema and psoriasis though, is the cause of each disease according to the Cleveland Clinic. Eczema is triggered by your skin’s response to an outside element, often an allergen of some kind. People with seasonal allergies (sometimes called hay fever), asthma, or those who've been exposed to chemicals may develop eczema. Psoriasis results from an immune system dysfunction (called immune-mediated disease).

Another complicating factor is that sometimes it's possible to develop eczema and psoriasis simultaneously, though the American Academy of Dermatology notes that this is uncommon. Neither eczema nor psoriasis is contagious, though the conditions can run in families.

If you notice any possible symptoms of either condition, particularly the rashes, check in with your doctor and ask if a consultation with a dermatologist might be appropriate.

How to treat eczema

According to the Mayo Clinic, the primary treatments for eczema include regular use of moisturizer, as well as topical creams and ointments, including corticosteroid creams that are applied as directed after moisturizing. In some cases, your doctor may recommend stronger topical drugs, such as tacrolimus (Protopic) or pimecrolimus (Elidel).

Oral treatments for eczema may be recommended as well. Oral corticosteroids, such as prednisone, can help you manage severe outbreaks in the short term, while antibiotics might be needed if an infection develops.

Other possible treatments for eczema include wet dressings and light therapy.

For very severe eczema, the injectable drug dupilumab (Dupixent) may help some when other treatments are ineffective.

How to treat psoriasis

Because psoriasis is primarily an immune system disorder that mainly affects the skin, the Mayo Clinic notes that treatments for this condition can be somewhat different than the treatments for eczema.

Light therapy is especially useful for managing psoriasis, and the types available include UVB phototherapy, narrow-band UVB phototherapy as well as brief daily exposure to sunlight. These therapies may reduce scaling and inflammation and slow down the turnover of skin cells.

Topical creams, moisturizers other treatments are also standard options for psoriasis. Your doctor may recommend:

  • Topical corticosteroids
  • Synthetic forms of vitamin D
  • Topical retinoids
  • Anthralin (Dritho-Scalp)
  • Coal tar
  • Salicylic acid

Oral or injectable medications may also help manage psoriasis symptoms.

The bottom line

Managing eczema or psoriasis can be challenging, and it may take some trial and error to come up with the medication or combination of medications that work best for you. Work closely with your health care team to come up with a treatment plan that's right for your particular situation.

Article references

  1. Itchy Rash? How to Tell If It’s Eczema or Psoriasis, Cleveland Clinic, 2018, https://health.clevelandclinic.org/itchy-rash-how-to-tell-if-its-eczema-or-psoriasis/
  2. What’s the Difference Between Eczema and Psoriasis?, American Academy of Dermatology, 2019, https://www.aad.org/public/diseases/eczema/eczema-resource-center/controlling-eczema/eczema-vs-psoriasis
  3. Atopic Dermatitis (Eczema), Mayo Clinic, 2019, https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/diagnosis-treatment/drc-20353279
  4. Psoriasis, Mayo Clinic, 2019, https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845
  5. About Psoriasis, National Psoriasis Foundation, 2019, https://www.psoriasis.org/about-psoriasis