Eczema vs. Psoriasis: How to Spot the Difference

Eczema and psoriasis are two dermatological conditions that cause patches of inflamed, dry skin. It can be difficult for the untrained eye to tell the two apart because they can look alike, but they stem from different causes and may require different treatments.

At Ross Dermatology, our board-certified dermatologists, Dr. Kim Ross and Dr. Ronald Davis, and their team treat both eczema and psoriasis at their offices in San Antonio, Seguin, and LaVernia, Texas. 

Here ‘s what we’d like you to know about both conditions, their similarities, and their differences.

What is eczema?

Eczema, also called atopic dermatitis, is an inflammatory skin condition that produces a scaly, inflamed, itchy rash. While the exact cause of eczema isn’t known, doctors believe it’s the result of both genetic and environmental factors. 

And since there are no tests that can definitively diagnose the condition, doctors diagnose it based on a physical exam and whether the symptoms meet specific diagnostic criteria.

Symptoms include intensely itchy, flaky, irritated, and red skin. If you have a severe case, it can disrupt your sleep and make it difficult to concentrate at work or in school. In addition, eczema can cause:

• Rashes
• Swelling
• Bumps (papules)
• Fluid-filled pockets (vesicles)
• Areas of darkened, leathery, thickened skin (lichenification)
• Oozing and crusting (in severe eczema)

Eczema most often develops during childhood, though it’s not age-dependent. If it starts during childhood, it often resolves by adulthood. When it starts later in life, it’s usually chronic.

What is psoriasis?

Psoriasis also causes dry, flaky, and red skin, and the skin often piles up in thick patches known as plaques. Unlike eczema, though, psoriasis is an autoimmune condition, meaning the body mistakenly attacks its own cells, believing them to be harmful. 

In this case, the immune system attacks the skin cells, causing an overgrowth that leads to the skin scales and plaques. Psoriasis generally appears in early-to-late adulthood and can affect parts of the body other than the skin.

Eczema vs. psoriasis: differences between them

Though at first glance it may appear that eczema and psoriasis have a lot in common, they are, in fact, two completely different conditions.

Location

Psoriasis and eczema both produce skin rashes, but they show up on different parts of your body.

Eczema most often appears on the flexural surfaces, such as in the crook of the elbows and the backs of the knees. Psoriasis is more often seen on the extensor surfaces, on the outside of the forearms and elbows, or at the fronts of the knees and shins. 

Psoriasis is also more likely to show up on your scalp, face, ears, neck, arms, legs, feet, hands, ankles, and lower back.

Eczema and psoriasis both also cause ridges, discoloration, and thickening of the finger and toenails, but only psoriasis leads to pitting, tiny holes that appear in and around your nails.

Psoriasis can also affect the eyes and the joints. Psoriatic eye inflammation is called uveitis. Psoriatic joint inflammation is called psoriatic arthritis.

Itching

Both psoriasis and eczema lead to itching, but eczema itching tends to be more intense. It also occurs for a different reason than with psoriasis.

With psoriasis, the itching is thought to occur because the skin inflammation irritates nerve receptors called nociceptors that relay the sensation to the brain.

Nociceptors can also get irritated with eczema, but the irritation is compounded by an antibody called immunoglobulin E (IgE) that’s linked to allergies. People with eczema have IgE antibodies in their bloodstream, while people with psoriasis don’t.

Eczema and psoriasis: treatment differences

There’s no cure for eczema or psoriasis, but proper treatment can help relieve symptoms and prevent flare-ups. Common psoriasis treatments include:

• Controlling triggers by avoiding irritants and stressors
• Topical corticosteroid creams to reduce inflammation and itching
• Medicated shampoos
• Topical vitamin D to slow skin cell overgrowth and treat scaly skin
• Topical retinoids to stop skin cell overproduction
• Oral medications such as methotrexate, acitretin, and apremilast (Otezla)
• Light therapy, which uses controlled UV exposure to reduce inflammation and slow the growth of new skin cells
• Injectable medications when topical forms of the medications don’t work
• Biologic medications to target your immune system

Common eczema treatments include:

• Controlling triggers by avoiding irritants and stressors
• Antihistamines to control itching from antibody response
• Topical corticosteroids to reduce inflammation
• Light therapy, which uses controlled UV light to reduce inflammation
• Calcineurin inhibitors to control inflammation
• Biological medications that target your immune system to reduce inflammation

We prescribe the treatment or combination of treatments that addresses your diagnosed condition, the number of symptoms, and their severity.

If you’ve developed itchy, red, scaly patches on your skin, you may have either eczema or psoriasis. Our team at Ross Dermatology can diagnose and treat your symptoms, improving your quality of life.

To learn more or to schedule a consultation, call us at any of our locations, or book online today.