Eczema and Psoriasis: Which Do You Have?

A red, itchy rash can be confusing, especially when it keeps coming back. You may wonder: What’s causing this? Could it be eczema or psoriasis?

They may look similar at first. But there are clear differences between the two conditions.

Dermatologist Anthony Fernandez, MD, PhD, unearths what makes them different and how to manage symptoms.

Eczema vs. psoriasis

There are several types of eczema. Most are caused by inflammation from an overactive immune system. The most common type, atopic dermatitis, can flare up when you have an infection or your skin touches an allergen, irritant or product that disrupts your skin barrier.

Psoriasis has several different variations, too. It’s largely an autoimmune condition that causes inflammation and speeds up the process of new skin development. With plaque psoriasis — the most common type — skin cells begin to pile up on top of each other to create thick, swollen, discolored scales or plaques.

“Eczema is a condition with inflammation of the skin that makes your skin sensitive and prone to infection,” Dr. Fernandez explains. “Plaque psoriasis is a long-term condition. It can come and go, but you can manage it with home remedies and medication.”

Differences between eczema and psoriasis

Eczema and psoriasis are both chronic conditions with no cure. But they affect your skin in different ways. Here’s how to tell them apart.

Appearance

Psoriasis has thick plaques with sharp edges. These scaly plaques can crack, bleed and feel rough or leathery.

Eczema usually has more poorly defined edges. It may ooze fluid and raise your risk of infection.

“When we see fluid, we usually think about eczema, not psoriasis,” Dr. Fernandez says.

Location

Eczema can appear anywhere, but it often shows up in skin folds. Common areas include:

• Inner elbows
• Behind the knees
• Face (around your eyes and cheeks)
• Neck
• Hands

Psoriasis often affects the outside of your knees and elbows. It can also show up on your:

• Nails
• Scalp
• Lower back
• Genitals
• Palms and feet

Itch

Both eczema and psoriasis cause a burning, painful itch. But itching is usually worse with eczema.

“Low humidity dries out your skin and makes itching worse,” notes Dr. Fernandez. “Heat and high humidity can trigger sweating, which can also make you itch.”

Triggers

Triggers for eczema and psoriasis vary by person.

Eczema is often triggered by things outside your body, like:

• Allergens, like pollen, pet dander and certain foods
• Tobacco smoke and dirty air
• Harsh soaps or skin products
• Some fabrics

Psoriasis triggers are more internal and may include:

• Skin injuries
• Infections
• Sudden changes in body temperature
• Certain medications, like lithium or beta-blockers

Similarities between eczema and psoriasis

Despite their differences, eczema and psoriasis have a lot in common:

• Both are inflammatory skin conditions that cause dry, cracked, scaly skin.
• Both affect your immune system.
• They can run in families.
• Stress is a common trigger.
• They’re not contagious.
• They can affect people of any age.
• Some types, like atopic dermatitis or plaque psoriasis, are common in children.

Treatment options for both

“Even though the causes of eczema and psoriasis are different, treatment is usually similar,” Dr. Fernandez says. “But biologics that work for one often don’t work for the other.”

There may not be a cure, but you can manage symptoms with these strategies:

• Drink water and moisturize daily to protect your skin.
• Try at-home remedies, like colloidal oatmeal baths or cool compresses.
• Eat a healthy diet by including anti-inflammatory foods and avoiding food triggers.
• Exercise and manage stress to boost overall health.
• Follow your provider’s instructions for steroid creams or other treatments.

When to see a doctor

It can be hard to tell eczema and psoriasis apart without a diagnosis. If you have a rash that doesn’t go away with over-the-counter medications, see a healthcare provider.

“We look at the full picture — your symptoms, family history and other conditions — to tell the difference,” Dr. Fernandez says. “Sometimes, we can tell just by looking. But in some cases, we need to do a biopsy.”