Many people do not know the technical differences between psoriasis and eczema.
Recognizing a pink, red, or salmon scaly patch of skin as one of these two conditions will hopefully help determine the difference between psoriasis and eczema.
Understanding psoriasis and eczema
Psoriasis is a chronic autoimmune condition that causes the overproduction of skin cells. The dead cells build up into silvery-white or gray scales. Depending on your skin tone, your skin can become inflamed pink, red, salmon, or violet causing serious itching. In addition, on some darker skin tones, it may not be as visible.
Typically, it’s found on the elbows, knees, lower back, and scalp but can be located anywhere on the body.
Eczema is a general term for a group of skin conditions that cause itchy, inflamed, and irritated skin. Atopic dermatitis is a common form of the condition.
It can occur because of a hypersensitivity reaction. This causes the skin to overreact to certain triggers, such as:
- other irritants
Atopic dermatitis is common in infants. Some people outgrow atopic dermatitis, while others continue to experience it into adulthood. There are other individuals who can develop atopic dermatitis after 18 years old, according to the American Academy of Dermatology (AAD).
People with eczema may have periods of time in which they experience no symptoms followed by periods where symptoms flare up.
Skin is very itchy and may appear red, scaly, and thickened, with occasional fluid-filled blisters.
However, on darker skin tones, it can look darker brown, purple, or ashen grey in color. It can also be harder to see. Generally, it is not covered with scaly dead skin.
As with psoriasis, eczema can occur anywhere on the body and cause intense itching.
However, atopic dermatitis tends to occur on a baby’s scalp, face, and cheeks. In children ages 2 years and older, it tends to appear in the creases of the elbows or knees. It can also be found on the neck, wrists, ankles, and the crease between the buttocks and legs. It tends to be chronic dry, itchy skin anywhere but often on the eyelids and hands in adults.
Psoriasis is more likely to appear in areas where the skin rubs on areas like your elbows and knees. It can also occur in other places and affect nails and joints.
Most eczema can be controlled with topical medications and by avoiding triggers.
Comparing psoriasis and eczema
Psoriasis vs. eczema on face
Psoriasis on the face
Although psoriasis most commonly occurs on the knees and elbows, it may occur anywhere. This includes the face, scalp, ears, 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. Typically, it’s treated with oral medications.
Eczema on the face
Just as with psoriasis, eczema on the face can cause discomfort. It tends to be pink, red, dry and itchy, and scaly on light skin. But in brown and Black skin eczema is usually darker brown, purple, or gray in appearance. Sometimes it’s difficult to see which can affect diagnosis.
According to the National Eczema Association, there could be more extensive skin dryness and dark circles around the eyes of African American people. However, in adults with the condition, it can cause dark, scaly circles around the eyes making wrinkles more obvious.
When repeatedly scratched or rubbed in those areas, the skin could become thicker and have raised bumps called prurigo nodules, which can also occur on the trunk, legs, or arms.
Itching leads to scratching, which can lead to thicker skin, bleeding, and possible skin infection.
The dryness associated with eczema can also cause cracked skin from general movement.
Eczema commonly includes fluid-filled vesicles, or blisters, when it occurs on the palms of the hands. This is called dyshidrotic eczema and sometimes requires a course of oral steroids and topical steroids to treat it.
Psoriasis vs. eczema on hands
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 (palmoplantar psoriasis). It tends to be red, dry, and thick, and can have deep painful cracks.
It can also involve the nails and joints and occasionally appear with pustular lesions. Palmoplantar psoriasis is difficult to treat.
- pitting in the nails
- white color
- severely malformed nails
- splitting of the nails
Eczema on the hands
Eczema commonly appears on the hands. This is because the hands often come in contact with soaps, lotions, fabric, animals, and other allergens or irritants.
Frequent handwashing 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 vs. eczema on legs
Psoriasis up and down the legs
Psoriasis frequently occurs on the legs and knees. Although some cases of 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 appears in many separate, drop-like, red, scaly spots all over the body on fair and light skin. On darker skin tones, it can appear as raised, scaly, brownish-gray spots or as lighter scaly papules or spots.
However, plaque psoriasis on the legs often appears in large, shapeless patches of thick red skin or thick white scales on light skin. On skin of color, the plaques may appear thicker and darker with more of a purple or grayish darker brown color.
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 is not quickly and effectively treated, it can become very irritating and painful. Constant contact with clothing can cause significant bleeding, oozing, and infection.
Dry skin in psoriasis vs. eczema
The dry skin of psoriasis
Not all psoriasis patches appear dry or scaly. At times, large 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.
Eczema peeling 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 vs. eczema in inconvenient places of the body
Psoriasis in inconvenient places
Psoriasis can develop in very uncomfortable places.
Inverse psoriasis and other types of psoriasis may develop under the breasts, on the groin, armpits, and skin folds. 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 in infants. Diapers and baby creams may irritate sensitive skin, causing extreme diaper rash. In some cases, eczema covers the entire area that comes into contact with a diaper.
Hypersensitivity to the diaper material or the creams used in washing the area can aggravate the skin. Switching to soft cotton diapers or using a different cleanser may help ease eczema in the genital area in infants.
Adults with eczema in sensitive areas may need to change laundry detergents, cleansers, and fabrics.
Severe psoriasis vs. eczema
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 healthcare professional.
Additionally, there is a rare form of psoriasis called erythrodermic psoriasis. It’s a medical emergency and needs hospitalization to effectively manage the condition. It not only affects your skin but also other areas of your body.
Other types of 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:
- your skin’s sensitivity
- your 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.
Treating psoriasis vs. eczema
Depending on the extent of psoriasis, your dermatologists may start treatment by prescribing topical corticosteroid creams and a topical vitamin D derivative. If these are not enough, some doctors may prescribe a light therapy treatment.
For individuals with more extensive psoriasis, treatment may include either oral medications that suppress the immune system or injectable biologics that target the immune cells that cause inflammation due to psoriasis.
Eczema is often also treated with a topical corticosteroid cream and topical calcineurin inhibitors as well as lifestyle changes. In some cases, doctors may suggest over-the-counter creams.
Other cases of eczema may require antibiotic creams or prescription oral medications.
While there have been several prescription barrier creams prescribed for the condition, they are just as effective as petroleum jelly. It may also be useful to protect skin from irritants and infections, allowing it to heal.
Living with psoriasis vs. eczema
A life with psoriasis
Although psoriasis tends to wax and wane, it’s a lifelong condition. The lack of widespread understanding about psoriasis causes many people with this condition to feel isolated and feeling excluded.
- affect the joints
- cause internal inflammation
- be difficult to treat
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 is not 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 get the right treatment for your condition.
If your provider or dermatologist is unsure of your diagnosis, they may take a biopsy of the skin to determine if it is psoriasis or eczema.