Eczema vs Psoriasis: What’s the Difference?

Maybe you first noticed patches of skin that are dry, scaly, or cracked. Or perhaps you detected a rash, or felt a burning or itchy skin irritation. While these symptoms could be caused by a number of conditions, eczema and psoriasis are likely culprits.  

“Eczema and psoriasis are two common inflammatory skin diseases. They can both present as red rashes on the skin that can be itchy or painful,” says Alexandra K. Golant, MD, FAAD, dermatologist and Medical Director, Faculty Practice, Mount Sinai Health System in New York. “However, in some patients there is not as clear a distinction, which can make a clear diagnosis more difficult,” says Golant.  

Though eczema and psoriasis share some common traits, they’re actually very different and have different treatments, so it’s helpful to know the difference between eczema and psoriasis, what causes each condition, and how they are managed. 

Eczema affects about 31.6 million people in the United States, or roughly 10 percent of the population, according to the National Eczema Association. It can take many different forms, but the type of eczema that dermatologists see most often is atopic dermatitis, which is common among people who have a personal or family history of allergies or asthma.  

Other types of eczema include: 

• Contact dermatitis 
• Seborrheic dermatitis 
• Dyshidrotic eczema 
• Stasis dermatitis 
• Nummular eczema 

Location and Appearance 

All these different forms of eczema can cause your skin to develop a rash or become itchy, inflamed, or scaly. It often shows up inside the bend in your elbow or knee, though eczema can also appear around your eyes, neck, hands, feet, or ankles. Sometimes, in cases of “weeping eczema,” fluid can ooze from the affected skin area, which is typical for eczema (but not for psoriasis). 

With psoriasis — which affects about 7.2 million people in the United States, making it much less common than eczema — skin plaques or patches are usually red or raised, with silvery scales. The skin itself is thicker, denser, and more inflamed than normal, and it’s unlikely to cause oozing or weeping. Among people with darker skin, psoriasis usually appears as purple or discolored skin. 

Psoriasis also tends to affects areas like the outside of elbows and knees (not inside the crease, which is more common in eczema), as well as the torso, palms, soles of the feet, buttocks, scalp, hairline, or fingernails and toenails. Patches or plaques of psoriasis usually have well-defined borders (unlike eczema, in which the edges of affected areas are not well defined). 

Causes

Despite the fact that both eczema and psoriasis cause red, inflamed, and irritated skin, the two diseases have very different causes. Eczema is widely believed to have environmental and genetic causes: Most often, your immune system will be triggered by an allergen or skin irritant, such as detergent, disinfectants, soaps, dust, pet dander, pollen, mold, pollution, or certain foods.  

Additionally, researchers have found that in some people with eczema, a gene responsible for creating a protective layer on the skin has mutated. Known as filaggrin, this protein helps your body maintain a protective barrier on the top layer of your skin. When this gene has mutated, less filaggrin is available to protect your skin, leaving it vulnerable to infection and to the skin flares that are common in eczema. 

Psoriasis, on the other hand, is an autoimmune disorder that’s caused when your immune system becomes overactive. Inflammatory cells cause your body to make too many skin cells too quickly, causing patches or plaques on your skin that are raised, red, and scaly. Psoriasis is also a chronic condition, meaning it’s usually with someone their entire life — eczema, meanwhile, can sometimes show up in childhood and disappear when a person reaches adulthood.  

While psoriasis, like eczema, can sometimes be triggered by stress or weather extremes like very dry or very humid conditions, psoriasis skin flares are also triggered by injuries, sunburn, scratches, and vaccinations. Some infections, such as strep throat, and medications like lithium or beta-blockers, will also trigger a psoriasis flare.  

Treating Psoriasis vs Treating Eczema

While there are no cures for either disease, both eczema and psoriasis can fortunately be successfully treated with medication and other therapies. And some of the treatments work well for both conditions.  

“There is considerate overlap in how we treat eczema and psoriasis when it comes to topical treatments,” says Golant. “However, we have recently seen the FDA approval of a few novel, more targeted non-steroidal agents approved for both conditions, which is a very exciting development.” 

Corticosteroids, for example, have been used successfully to manage both eczema and psoriasis. These medications — prescription or over-the-counter (OTC) topical creams that are applied directly to the skin — can suppress the immune system and ease the inflammation and irritation common to both diseases. And many OTC ointments and creams can be used by people with eczema and psoriasis to keep skin moisturized and healthy. 

Other prescription medications, known as biologics or systemics, are specifically targeted to the causes of eczema and psoriasis. These may be pills taken orally, or they may be injections or intravenous (IV) infusions. Some, such as methotrexate, azathioprine, or cyclosporine, can be used for both diseases, but many of the newer medications are designed to target individual proteins involved in the immune response and are therefore specific to one disease or the other, but not both. 

Other helpful treatments and home remedies, such as following a healthy diet (like the Mediterranean diet), getting plenty of sleep, exercising regularly, taking colloidal oatmeal baths, managing stress, and moderating your alcohol consumption, will help to address both psoriasis and eczema.  

But whichever therapies you choose, make sure you get a proper diagnosis first and work with your doctor or health care provider to come up with a treatment plan that works specifically for you and your condition. 

Getting Clear on Psoriasis

Having psoriasis isn’t easy. It can be physically and mentally challenging, causing uncomfortable symptoms and making you feel disconnected from loved ones and daily activities. But the right information, treatment plan, and support can make a big difference in your health and happiness.

Our podcast, “Getting Clear on Psoriasis,” is here to help. Host and psoriasis patient David Brandt guides listeners through important topics about living better with psoriasis. Each episode includes relatable insights from fellow patients and key information from leading dermatologists and other experts. Listen now.

If you enjoyed reading this article, you’ll love what our video has to offer.