Psoriasis
How to Tell the Difference Between Psoriasis and Eczema
Many people do not know the technical differences between psoriasis and eczema, or atopic dermatitis. Recognizing a patch of skin that is inflamed, red, or peeling, as one of these conditions will dictate how you treat it.
This image depicts psoriasis on the belly. The following photos will help give you an idea of the difference in appearances between psoriasis and eczema on different areas of the body.
Getting Familiar with Psoriasis
This image depicts a single patch of plaque psoriasis. The thick patch of white scales is characteristic of psoriasis. Psoriasis is a chronic autoimmune condition that results in the overproduction of skin cells. The dead cells build up into silvery-white scales. The skin becomes inflamed and red, causing serious itching.
There is no cure for psoriasis, but some topical, light-based, and systemic pharmaceutical treatments can put the condition into remission. According to the National Psoriasis Foundation, over 5 million people in the United States have psoriasis (NPF, 2012). The condition is not contagious.
Understanding Eczema
Eczema, or atopic dermatitis, may also be a long-term condition affecting the skin. It occurs because of a hypersensitivity reaction (similar to an allergy), in which the skin reacts to triggers, such as dyes, fabrics, soaps, animals, and other irritants.
Eczema is very common in infants, and many people outgrow the hypersensitivity by childhood or early adulthood. Skin may appear red, inflamed, peeling, cracked, blistered, or pus-filled. Generally it is not covered with scaly dead skin. As with psoriasis, dermatitis can occur anywhere on the body and causes intense itching. Most eczema can be cleared with topical treatment.
Psoriasis on the Face
This image depicts psoriasis on the face. Although psoriasis most commonly occurs on the knees and elbows, it may occur anywhere—including the face, scalp, and neck. Visible psoriasis like this may be a source of embarrassment and social anxiety for affected individuals. With treatment, psoriasis on the face and scalp often resolves, but may recur.
As many as 50 percent of individuals with psoriasis will eventually experience an outbreak of psoriasis patches on the scalp, according to the American Academy of Dermatitis (AAD, 2012). In many cases, scalp psoriasis extends onto the forehead, ears, or neck.
Eczema on the Face
Just as with psoriasis, eczema on the face can cause significant social discomfort. In addition, the patches can be very itchy, causing further skin deterioration. Itching both psoriasis and eczema patches can cause breaks in the skin that allow bleeding or infection. The dryness associated with eczema can also cause cracked skin from general movement.
Because eczema commonly includes pus-filled blisters, scratching can also cause the skin to ooze pus and create crusty and scabbed patches on the skin. Eczema on the face can often be treated topically, but systemic medications may be necessary.
Psoriasis on the Hands
Psoriasis can occur on the hands. Although many people experience attacks of psoriasis on the backs of hands and knuckles, others have outbreaks on the palms. Intense peeling and dry skin on the hands can make even simple actions such as washing hands, picking up a bag, or pulling on clothing very painful and uncomfortable.
Psoriasis on the hands may also include nail psoriasis, a condition in which the overactive skin cells produce too many new cells under the nails. This can look like a fungal infection that discolors the nails and even causes them to fall off.
Eczema on the Hands
Eczema appears on the hands very commonly. This is because soaps, lotions, and contact with certain fabric, animals, and other allergens or irritants that the hands come in contact with can cause a reaction in people with hypersensitive skin.
Frequent washing of the hands can further dry out the skin of someone with eczema on their hands. Eczema on the hands can be difficult to treat because of the constant contact with water and other irritants.
Psoriasis Up and Down the Legs
Psoriasis frequently occurs on the legs and knees. Although some psoriasis may cover significant portions of the legs, other types may appear in isolated patches. The different types of psoriasis have different appearances.
For instance, guttate psoriasis on the legs would appear in many separate, drop-like, small red psoriasis patches. However, plaque psoriasis on the legs often appears in large, shapeless patches with thick red skin or thick white scales.
Eczema Down and Up the Legs
Eczema on the legs may often occur in body “creases,” such as the back of the knee or the front of the ankle. This may be because these areas trap sweat or irritants from clothing and the air. Close contact of irritants with skin and areas of skin rubbing together create a perfect environment for atopic dermatitis to thrive.
If eczema on the backs of the knees is not quickly or effectively treated, it can become very irritating and painful. Constant contact from clothing can cause significant bleeding, oozing, and infection.
The Dry Skin of Psoriasis
Not all psoriasis patches appear dry or scaly. At times, large red patches may have no visible scales. However, in this image, the patches of psoriasis have built up from dead skin cells to the point of scaling and peeling.
Removal of large scales should not be forced. Gentle removal will prevent breaking the skin and causing bleeding. Some psoriasis patches may build up a very thick, white layer of dead cells before shedding scales.
The Dry Skin of Eczema
Eczema frequently includes very dry patches of skin. These can make skin so fragile that it cracks very easily. The peeling of eczema may resemble that of sunburn or a peeling blister or callus.
In some cases, the skin may peel without causing raw skin or open wounds. In others, peeling skin reveals broken skin or open blisters. These should be carefully treated to avoid introducing a bacterial or viral infection.
Psoriasis in Inconvenient Places
Psoriasis can develop in very uncomfortable places. Inverse psoriasis and other types of psoriasis may develop on the genitals, armpits, bottoms of feet, and skin creases. The development of psoriasis patches in such places can also make intimate relationships awkward or unpleasant. Psoriasis in skinfolds or the genital area may resemble eczema, but are often large, solid patches of smoother skin than typical psoriasis. This is likely because of increased moisture in these areas.
Eczema in Equally Inconvenient Places
Eczema can occur in many inconvenient places—especially for infants. Diapers and baby creams may irritate sensitive skin, causing extreme diaper rashes. In some cases, the eczema covers the entire area that comes into contact with a diaper.
Hypersensitivity to the material of a diaper or the creams used in washing or prepping the area for changes can aggravate skin. Switching to soft cotton diapers or using a different cleanser may help alleviate eczema in the genital area for infants. Adults with eczema in sensitive areas may need to change laundry detergents, cleansers, and fabrics.
Severe and Pervasive Psoriasis
Just as with most skin conditions, psoriasis can become widespread and very irritating. For instance, plaque psoriasis may cover almost the entire surface of the body. In extreme cases, inflammation can become so severe that it appears and feels like burns.
Extensive, highly painful, burn-like psoriasis can be life threatening and requires immediate attention from a health professional. Other widespread psoriasis may simply require standard treatment to partially heal or resolve.
Severe and Pervasive Eczema
Eczema can also become very serious and cover much of the skin’s surface. The amount of skin affected by eczema will depend on the sensitivity of the individual’s skin, the skin’s exposure to irritants, and the type and effectiveness of treatments.
Severe cracking, oozing, and bleeding in cases of severe eczema can become dangerous. Widespread eczema also makes infection more likely due to the probability of broken skin.
Treating Psoriasis
Typically, dermatologists start treatment by prescribing topical corticosteroid creams. If these are not enough, many doctors will prescribe a light therapy treatment.
If steps one and two do not clear or begin to improve the psoriasis patches, many dermatologists may prescribe an oral medication. These systemic pharmaceuticals are the final steps in most treatment plans. Do not stop using your treatment without approval.
Treating Eczema
Eczema is often also treated with a topical corticosteroid cream. In some cases, doctors may suggest over-the-counter creams. Other cases of eczema may require antibiotic creams or prescription oral medications.
Some barrier creams may also be useful to protect skin from irritants and infections, allowing it to heal.
A Life with Psoriasis
Although the severity of psoriasis waxes and wanes over time, it is a lifelong condition. A lack of public understanding about psoriasis causes many people with this condition to feel isolated and ostracized. However, most people with psoriasis lead fulfilling, active lives.
By spreading the word that psoriasis is not contagious and that it is a chronic autoimmune condition, you can help individuals with psoriasis feel better understood and more welcome in society.
A Life with Eczema
Just as with psoriasis, individuals with eczema often experience off and on symptoms for many years. At times, the condition can be so serious that it restricts activity; at other times, people with eczema hardly even notice their condition. Understanding the differences between psoriasis and eczema can help you recognize and appropriately treat your condition.
