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 the body or can be confined to one area of inflammation.

Each condition, however, 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.

Hives is a relatively common occurrence. A total of 15 to 25 percent of people experience it at least once in their lives. Hives isn’t 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 six 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, also called plaques.

It’s unclear what causes psoriasis, although the immune system is involved. Psoriasis isn’t 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 medication used for psoriasis, and they are 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 manage psoriasis as well. These include:

  • drinking only in moderation
  • managing stress through exercise, meditation, or other techniques
  • eating a healthy, 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.

HivesPsoriasis
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 men and women of all ages.

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

You have a higher risk of developing psoriasis if any of the following apply:

  • you have a family history of psoriasis
  • you have HIV
  • you have a compromised immune system
  • you get a lot of infections
  • you chronically experience high levels of stress
  • you’re obese
  • you’re a smoker

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

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

During your visit, your doctor 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:

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

You should contact your doctor if:

  • You’re experiencing symptoms such as skin rash and itching.
  • You have hives and they last more than a few days or are severe.
  • You 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 your doctor for an accurate diagnosis and to start proper treatment.