Hives and psoriasis are skin conditions that may be confused with one another.

Both can result in itchy patches of red skin, though they have different causes. Both hives and psoriasis can spread to multiple locations on your body or can be confined to one area of inflammation.

However, each condition has its own unique symptoms that can help you tell them apart.

Hives, also known as urticaria, is a sudden-onset skin reaction resulting in red or white welts of varying sizes. As the reaction progresses, the welts appear and diminish. The welts are also known as wheals.

On darker skin tones hives are often the same color as your skin, or slightly darker or lighter than your natural skin color. People who have a light or medium complexion see red or pink hives. Also, just as darker skin tones can vary in pigmentation, so can the appearance of hives and other rashes.

Hives is a relatively common condition. A total of 15 to 25 percent of people experience it at least once in their lives, according to the American Academy of Dermatology.

Hives is not contagious.

Hives may be a reaction that happens once, or it can be a chronic condition. Chronic hives is defined as welts that last more than 6 weeks or welts that persist over a period of months or years. They may be caused by:

Or, there may be no apparent reason for an outbreak.

Psoriasis is an autoimmune disease that causes skin cells to build up at an increased rate, resulting in thick skin lesions, or plaques.

Psoriasis comes in different forms. On light and fair skin tones, symptoms include raised, red or pink patches of skin that are occasionally paired with a silvery scale. On medium skin tones, it tends to be salmon-colored with silvery-white scales. On darker skin tones, the patches are more likely to appear as violet or dark brown patches.

It’s unclear what causes psoriasis, although the immune system is involved. Psoriasis is not contagious.

Psoriasis triggers include:

  • stress
  • skin injury
  • certain medications, including lithium and medications for high blood pressure
  • infections, such as strep throat
  • dietary triggers, such as dairy and red meat
  • environmental factors, such as extreme cold

Hives are generally not life threatening, although they may be associated with life threatening allergic reactions, such as anaphylaxis. Hives are uncomfortable and may affect your quality of life. The symptoms of hives vary in severity and may include:

  • raised welts on the skin that are flat and smooth
  • welts that may be small or as large as a grapefruit
  • welts that appear quickly
  • swelling
  • burning pain

Psoriasis symptoms may be severe or mild. The symptoms may include:

  • red, scaly lesions
  • dry, cracked skin that may bleed
  • itching
  • burning
  • soreness
  • thickened, ridged, or pitted nails
  • swollen, stiff joints

The first course of treatment for acute hives is often an antihistamine, such as diphenhydramine (Benadryl). If you have chronic hives, your doctor will work with you to identify your triggers and treat your reaction.

Your doctor might suggest that you go on a long-term medication regimen. This treatment may include:

  • an antihistamine
  • a histamine blocker
  • an anti-inflammatory steroid
  • an antidepressant or antianxiety medication

Lifestyle remedies such as wearing loose clothing, cooling the skin, and avoiding itching may also help.

Psoriasis treatments are meant to slow the growth of skin cells and help smooth the skin. Topical treatments include:

  • corticosteroids
  • retinoids
  • salicylic acid
  • coal tar, which is a black, liquid by-product of coal
  • moisturizers

Another effective treatment is phototherapy using ultraviolet light. Oral medications such as cyclosporine (Neoral, Restasis, Sandimmune, Gengraf) or drugs that alter your immune system may also be used in severe cases.

Biologics are another class of medications used for psoriasis. They’re given intravenously or by injection. Biologics target specific sections of the immune system instead of the whole system. They work by blocking certain proteins that contribute to psoriasis triggers and psoriatic arthritis.

Lifestyle changes can help manage psoriasis as well. These include:

  • drinking alcoholic beverages only in moderation
  • managing stress through exercise, meditation, or other techniques
  • eating a nutrient-dense, balanced diet free from foods that serve as triggers

Hives and psoriasis share some characteristics, such as redness, itching, and burning, but there are also differences between the two conditions.

slightly raised and smoothbumpy, scaly, and may have a silvery coating
comes on suddenlyappears more gradually
comes and goes, and often vanishes within several hours to a few daysusually lasts at least a few weeks or months at a time
seldom bleeds, unless due to excessive itchingmay bleed

Anyone can get hives or psoriasis. Both conditions impact children as well as adults of all ages.

If you have food allergies, sensitive skin, or you’re under a lot of stress, you have an increased chance of developing hives.

You have a higher chance of developing psoriasis if you:

  • have a family history of psoriasis
  • have HIV
  • have a compromised immune system
  • develop infections regularly
  • chronically experience high levels of stress
  • have obesity
  • are a smoker

To treat either hives or psoriasis, you first need to learn which condition is affecting you.

When you see a doctor for a diagnosis, they start by examining the rash. Depending on your other symptoms and your family history, the doctor may be able to diagnose your condition simply by inspecting your skin.

During your visit, they may ask about:

  • allergies and allergic reactions
  • your family history of skin conditions
  • changes in your environment (including new soaps, detergents, etc.)

If your doctor is uncertain and wants more information before providing a diagnosis, they may also:

  • order blood tests to rule out underlying conditions
  • order allergy tests, particularly in the case of chronic hives
  • order skin biopsies if they suspect you might have psoriasis

You should contact a doctor if you:

  • are experiencing symptoms such as skin rash and itching.
  • have hives and they last more than a few days or are severe.
  • have psoriasis and your symptoms worsen.

If you have difficulty breathing or your throat begins to swell, seek emergency medical attention or call 911 or local emergency services.

People with hives or psoriasis face similar symptoms, but the similarities end when it comes to treatment.

If you have any doubts about whether you have hives or psoriasis, consult a doctor for an accurate diagnosis and to start proper treatment.