Is it Psoriasis, Eczema or Something Else?

Posted July 11, 2022 by Darla Hadden, PA-C

Are you suffering from a red, dry, itchy rash that just won’t go away? Could it be psoriasis? Eczema? You may be desperate to get relief from symptoms, but it’s important to know what’s causing you trouble first. Psoriasis and eczema are both inflammatory chronic skin diseases that share similar symptoms, but they have very different causes and therefore, can have very different treatments.

Psoriasis is a chronic autoimmune disorder that causes skin cells to grow faster than usual and build up on the skin leaving behind a red, scaly rash. It can lead to systemic inflammation and cause complications.

Eczema, on the other hand, can be caused both by genetic and environmental factors and causes the skin to become inflamed, red, dry and itchy, which makes it more sensitive and prone to infection.

Psoriasis more commonly affects adults beginning around age 20 or 30, whereas eczema typically begins in childhood. However, people of all ages can experience symptoms from these conditions.

Both psoriasis and eczema cause flare-ups repeatedly over time that appear as patches of red, raised, inflamed skin and can appear in some of the same places on the body, such as the elbows, knees and hands. So, how can you differentiate between the two to find the relief you so desperately need?

Summa Health recommends seeing a dermatologist, an expert in hair, skin and nail conditions, to diagnose your rash. Many times, a provider can tell the key differences between the two based on the rash’s appearance, the amount of itch and where the rash is located on your body. While the goal of treatment is the same for both: to reduce inflammation to get relief from symptoms, the best treatment for psoriasis is not always the best treatment for eczema.

Appearance

Both skin conditions cause dry, red rashes, but when looked at more closely, there will be differences in appearance.

Plaque psoriasis, which accounts for the majority of cases, causes thick, red patches of skin (or purple or gray patches on darker skin tones) with well-defined borders that is covered in white scales called plaques. The plaques can be raised and bleed easily when scratched. The scales are a telltale sign of psoriasis.

Eczema, specifically the most common type, atopic dermatitis, typically presents as patches of dry, red or brown leathery skin covered in swollen bumps without well-defined borders. In severe eczema, the small fluid-filled sacs may ooze or crust.

Symptoms and amount of itch

The amount of itching the rash causes is a good differentiator. Typically, people with psoriasis have mild itching, whereas eczema can cause intense itching.

People with psoriasis can feel milder itching with a terrible burning sensation. Some people may even feel soreness or pain due to the cracking skin. People with eczema feel an intense itch that sometimes can be so bad that they can scratch enough to make it bleed.

Common triggers for psoriasis episodes include stress, injury to the skin, medications or infection, whereas environmental factors can trigger eczema flare-ups, such as irritants (soaps, fragrants or cigarette smoke), certain fabrics and stress.

Location on the body

Psoriasis and eczema can appear anywhere, but they tend to show up in different places on the body.

In many cases, eczema appears on creases of skin surfaces, such as inside the elbows and behind the knees, whereas psoriasis tends to appear on the extensor skin surfaces, including elbows and knees.

Psoriasis also can appear on the scalp, buttocks, and the palms of the hands and soles of the feet. Eczema can appear in these places as well, but not as severely as psoriasis.

Could it be something else?

There are other skin conditions that can resemble eczema or psoriasis, including ringworm, athlete’s foot, scabies, herpes and contact dermatitis. Unlike psoriasis and eczema, some of these conditions are highly contagious. That’s why it’s important to see a dermatologist to get to the bottom of what’s causing your discomfort so you can get the most appropriate treatment and find relief.

If you are diagnosed with psoriasis or eczema, unfortunately, there is no cure and patients typically have to manage their symptoms throughout their life. But once you have a diagnosis, you and your healthcare provider can find the best way to manage your symptoms, avoid triggers and develop a good skin care regimen.

Summa Health’s board-certified dermatologists are experts in diagnosing and treating a wide range of dermatological health issues. Call 330.835.9158 to schedule an appointment.

Sources: National Psoriasis Foundation, American Academy of Dermatology Assoc.