Eczema or Psoriasis? How To Tell the Difference

Do you have persistent patches of red, dry, itchy skin that won’t go away? If so, you may have eczema or psoriasis.

These skin conditions have similar symptoms, so it’s often difficult to tell them apart. But you’ll typically find that doctors treat them similarly. Dermatologist Anthony Fernandez, MD, PhD, explains the difference between these two skin conditions, including how they’re diagnosed and managed.

Eczema and psoriasis: A quick overview

Both conditions show up as skin inflammation, meaning they look like rashes. Dr. Fernandez says their differences lie in their cellular and molecular makeup. He explains both of them.

What is eczema?

“Eczema is an inflammation of the skin that makes your skin more sensitive and more prone to infection,” Dr. Fernandez explains. It causes skin rashes, which may be well- or ill-defined, and dry, red, itchy and bumpy and/or scaly.

There are multiple kinds of eczema, but often, when you hear someone talk about eczema, they’re talking about the most common type, atopic dermatitis. (Other types of eczema are usually called by their full medical names.)

Atopic dermatitis usually occurs in people with a personal or family history of asthma, hay fever or other allergies. And though an estimated 10%–20% of infants have eczema, about half will grow out of it as they get older.

What is psoriasis?

Psoriasis is a chronic, immune-mediated disease. This means that your immune system becomes dysfunctional and chronically activated, which results in skin changes. It causes raised, red, scaly patches on your skin.

There are many types of psoriasis, but the most common is plaque psoriasis, which accounts for nearly 80%–90% of psoriasis cases.

“Plaque psoriasis is a chronic condition, meaning there is no cure,” Dr. Fernandez says. “It can, however, be better and worse at varying points throughout your life, and you can manage it with at-home remedies and medications.”

What do eczema and psoriasis have in common?

Atopic dermatitis and plaque psoriasis are different conditions, but they do have some similarities.

• They look similar. The conditions can be difficult to tell apart when they appear on your skin because they both cause dry, cracked and scaly skin.
• They’re not infectious. “Neither psoriasis nor eczema is contagious,” Dr. Fernandez says. “You can’t pass them from person to person.”
• They may be genetic. You can be genetically predisposed to either or both conditions, which means they may run in your family.
• They can impact anyone. Both conditions can impact people of any age, gender/sex or race. (You are, however, more likely to have eczema if you’re Black and/or assigned female at birth. It’s also common in children.)

Differences between eczema and psoriasis

Visually, it can be difficult to tell atopic dermatitis and plaque psoriasis apart.

“You have to look at all the clinical aspects of a rash to distinguish between eczema and psoriasis, including the history and the patient’s other medical problems,” Dr. Fernandez notes. “We can often visually distinguish psoriasis lesions from eczema lesions, but there are definitely times when we cannot tell the difference. In those cases, we perform biopsies.”

He explains some of the differences between the two diseases.

When they first occur

Psoriasis usually starts in early adulthood but may develop later in life. And though atopic dermatitis is often seen in children, you can develop it at any time, whether from dry skin or from contact with chemicals that trigger irritation or an allergic reaction.

Appearance

Eczema and psoriasis look similar on the skin. Their most common presentations include:

• Bumps.
• Dryness.
• Cracking.
• Leathery patches.
• Redness.
• Scales.

If you have plaque psoriasis, though, you’ll typically have patches of skin that are red and covered with silvery scales. These are known as plaques, and they’re usually sharply defined, raised, itchy and painful.

With psoriasis, plaques are likely to be thicker and have drier scaling than eczema. “Still, sometimes that’s not enough to tell the difference between the two with the naked eye,” Dr. Fernandez cautions.

Fluid

An obvious clue pointing to eczema is fluid that leaks through your skin, known as a serous exudate. “When we see that, we definitely think about eczema instead of psoriasis,” Dr. Fernandez says.

This is called weeping eczema, and it’s the result of inflammation in your skin. It can increase your risk of infection, so it should be treated by a doctor as soon as possible.

Location

In adults, eczema most often appears behind your knees and inside your elbows. But it’s also commonly found:

• Around your eyes.
• On your neck.
• On your hands, feet and ankles.

Psoriasis most commonly appears on your elbows and knees, too, but plaques can occur anywhere.

Some other common locations are:

• Face and scalp.
• Fingernails and toenails.
• Genitals.
• Lower back.
• Palms and feet.

Triggers

If you have atopic dermatitis, it’s important to figure out your personal triggers: things that aggravate the condition. Common ones include:

• Allergens like pollen, pet dander and foods.
• Exposure to tobacco smoke and other air pollutants.
• Harsh soaps and other skin products.
• Some fabrics, like wool.
• Stress.
• Weather, especially very high or low humidity.

Doctors aren’t sure exactly what triggers psoriasis flare-ups, and they seem to vary per individual. But some common triggers seem to be:

• Skin injuries, like cuts scrapes of surgery.
• Stress.
• Infections, like strep throat.
• Some prescription medications, including lithium and beta-blockers.
• Weather, especially cold, dry air.

Itchiness

“Eczema typically causes more intense itching than psoriasis,” Dr. Fernandez says. It can be made worse by low humidity, which dries out your skin and causes itchiness, as well as by heat and high humidity, which cause sweating that then leads to itchiness.

Treatment options for both

“Though the underlying causes are different, treatment is generally similar,” Dr. Fernandez says. “However, biologics that are effective for eczema will not be effective for psoriasis, and vice versa.”

He explains some of the ways to manage each of them.

1. Keep your skin hydrated

“There is no cure for psoriasis and multiple types of eczema, including atopic dermatitis, but you can help limit the symptoms by getting proper treatment and taking good care of your skin,” Dr. Fernandez assures.

Dry skin is itchy skin, so one of the keys to managing these conditions is to try to keep your skin moist and hydrated. Dr. Fernandez recommends using a moisturizing cream or ointment, regardless of the need for prescription medications, if you have either eczema or psoriasis.

2. Try safe at-home remedies

“Remedy” is a bit of a misnomer, as you can’t remedy either of these conditions. But you can manage them with a few at-home tips and tricks.

Make sure you know the do’s and don’ts of treating eczema at home and which home treatments can help when you’re in the midst of a psoriasis flare-up. Colloidal oatmeal baths, for example, can be helpful for both conditions.

3. Take care of yourself

Your skin also benefits from your overall health, so follow these general health tips to keep yourself and your skin in the best shape possible:

• Drink alcohol only in moderation.
• Drink more water.
• Get plenty of exercise.

4. Follow a healthy diet

Eating well is another tenet of overall health, and it can impact your skin, too. The Mediterranean Diet, which is thought to be the heart-healthiest diet, is sometimes recommended for people with eczema and psoriasis because of its anti-inflammatory focus.

What you eat can help reduce the symptoms and impact of psoriasis flare-ups, so ask your doctor for recommendations about the best diets for people with psoriasis. And while no foods or eating styles will cure your eczema, you can modify your diet to try to keep symptoms at bay.

When to see your doctor

“You should always see a dermatologist for a rash that doesn’t go away with over-the-counter medicine.” Dr. Fernandez stresses. Typical treatments include:

• Topical cortisone, especially if you have a mild case.
• Immunosuppressive drugs (such as cyclosporine, methotrexate, or biologics) for more moderate to severe cases.
• Phototherapy or ultraviolet light treatment for severe cases.

It’s also important to know that eczema can prompt a secondary infection. To prevent this, your doctor may use topical and systemic antibiotics to remove bacteria and calm the inflammation.