Many people don’t know the technical differences between psoriasis and eczema (atopic dermatitis).
Recognizing a patch of skin that’s inflamed, red, or peeling as one of these conditions will determine how you treat it.
A 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.
Eczema, or atopic dermatitis, may also be a long-term condition affecting the skin.
It occurs because of a hypersensitivity reaction. This causes the skin to overreact to certain triggers, such as dyes, fabrics, soaps, animals, and other irritants.
Eczema is very common in infants. Many people outgrow the hypersensitivity by childhood or early adulthood.
Skin may appear red, inflamed, peeling, cracked, blistered, or pus-filled. Generally, it’s not covered with scaly dead skin.
As with psoriasis, dermatitis can occur anywhere on the body and cause intense itching. Most eczema can be cleared with topical treatment.
Psoriasis on the face
Although psoriasis most commonly occurs on the knees and elbows, it may occur anywhere. This includes the face, scalp, and neck.
With treatment, psoriasis on the face and scalp often resolves, but it may recur.
In many cases, scalp psoriasis extends onto the forehead, ears, or neck. It can be difficult to treat, especially when hair gets in the way.
Eczema on the face
Just as with psoriasis, eczema on the face can cause discomfort. The patches can be very itchy, causing further skin deterioration.
Itching can cause breaks in the skin that allow bleeding or infection.
The dryness associated with eczema can also cause cracked skin from general movement.
Eczema commonly includes pus-filled blisters. Scratching can cause the skin to ooze pus and create crusty and scabbed patches. Eczema on the face can often be treated topically, but systemic medications may be necessary.
Psoriasis on the hands
Although many people have patches of psoriasis on the backs of their 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 or picking up a bag, very painful and uncomfortable.
Psoriasis on the hands may also include nail psoriasis. This condition causes overactive skin cells to 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 the hands often come in contact with soaps, lotions, fabric, animals, and other allergens or irritants.
Frequent washing of the hands can further dry out the skin of people with eczema. 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 up and down 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. These areas may 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 isn’t 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, the patches of psoriasis can build 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 a 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 the feet, and skin creases. Psoriasis in skinfolds or the genital area will appear smooth and shiny, but may resemble eczema.
Affected areas often include larger, more solid patches of smoother skin than typical psoriasis. This is likely because of increased moisture in these areas.
Eczema in 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 the area can aggravate skin. Switching to soft cotton diapers or using a different cleanser may help ease 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
Like 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. This 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 person’s skin
- the skin’s exposure to irritants
- 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 because of the increased chance of broken skin.
Typically, dermatologists start treatment by prescribing topical corticosteroid creams. If these are not enough, many doctors will prescribe a light therapy treatment.
If neither of these improve the psoriasis patches, many dermatologists may prescribe an oral, injectable, or intravenous medication. These medications are the final steps in most treatment plans.
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 psoriasis comes and goes over time, it’s a lifelong condition. A lack of public understanding about psoriasis causes many people with this condition to feel isolated and ostracized.
But most people with psoriasis lead fulfilling, active lives. Here are some tips you can try to avoid psoriasis triggers.
By spreading the word that psoriasis isn’t contagious and that it’s a chronic autoimmune condition, you can help people with psoriasis feel better understood and more welcome in society.
A life with eczema
Just as with psoriasis, people 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 notice their condition.
Understanding the differences between psoriasis and eczema can help you recognize and appropriately treat your condition.