Psoriasis vs. Eczema: What’s The Difference?

By Irmanie Hemphill, MD, FAAFP
Medically reviewed
October 21, 2021

If you have patches of itchy, inflamed, or red skin, you’re not alone.

Chronic skin conditions like eczema and psoriasis can be uncomfortable but are very common.

Eczema affects up to 15 million Americans, many of whom are infants and young children.

Psoriasis is also widespread, impacting 3% of adults in the United States. 

Although eczema and psoriasis are different conditions that require specific treatment plans, it can be difficult to distinguish between them.

Even general practitioners can misdiagnose patients with psoriasis.

So if you have patches of symptomatic skin and are unsure what is going on, it’s important to make an appointment with a dermatologist to get an accurate diagnosis. 

In the meantime, this article will help you learn more about psoriasis and eczema, including the symptoms, causes, diagnosis, treatment, and risk factors for each.

I’ll also explain the triggers for psoriasis and eczema, as well as how to prevent flare-ups and when to see a doctor about a skin condition.

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Differences Between Psoriasis and Eczema

Psoriasis is a common, chronic autoimmune disease that affects the surface of the skin and sometimes the nails and joints.

Although doctors aren’t sure what causes people to develop psoriasis, they suspect that family history and environmental factors may play a role.

Eczema is another common skin condition that can, in some cases, present similar symptoms to those of psoriasis.

It, too, is an immune-driven disease and can often be triggered by an allergen or irritant.

When someone with eczema comes into contact with something they’re sensitive to, their immune system erupts with an allergic reaction that causes skin inflammation and other uncomfortable symptoms. 

If you have red, scaly skin and aren’t sure whether it’s a form of psoriasis or eczema, there are a few questions that can help distinguish between the two: 

  • What kind of symptoms do I see on the surface of my skin? Both eczema and psoriasis cause red and inflamed skin, but only psoriasis creates raised lesions with silver scales. On the other hand, eczema generates dry patches of skin or blisters that ooze fluid and crust.
  • Where do my symptoms appear? Although different forms of psoriasis target specific areas of the body, generally speaking, it tends to cluster on the elbows, knees, lower back, face, scalp, and nails. Eczema can affect those areas of the body but can also inflame places like the lower legs, back of the knees, hands, feet, and inside the elbows.
  • How itchy do I feel? Psoriasis tends to be mildly itchy or create a sensation that feels more like burning or tingling. Eczema can be severely itchy. In some cases, people with severe eczema scratch their skin so hard that they bleed.
  • Do my symptoms react to sunlight? Ultraviolet light can help heal psoriasis, but eczema tends to get worse after sun exposure. 

Sometimes, even when you account for symptoms, it can be difficult to distinguish between psoriasis and eczema.

The only way to know which condition you have is to see a doctor with extensive experience identifying skin diseases. And even then, you may need a small biopsy for an accurate diagnosis. 

Dermatologists are often the best healthcare providers to see.

They can take a look at your rash, provide an accurate diagnosis, and recommend a course of medical treatment that will help you manage your symptoms and live a higher quality of life.

Symptoms

Psoriasis and eczema can lead to rashes that seem similar, but there are critical differences between the two.

Noting where your rash is located, how it is shaped, and when it appears may help identify whether you have a type of psoriasis, eczema, or something else entirely.

Psoriasis

There are several types of psoriasis, and each presents differently.

The most common include: 

  • Plaque psoriasis: The most common form of psoriasis, plaque psoriasis causes raised, red patches of dry skin with silvery scales or silvery-white scales on the elbows, knees, and back. When people develop plaque psoriasis on their heads, doctors call it scalp psoriasis.
  • Nail psoriasis: When psoriasis affects the fingernails and toenails, it causes pitting, discoloration, and nontypical growth patterns. In cases of severe psoriasis, nails can become loose, separate from the nail beds, or crumble. 
  • Inverse psoriasis: Thought to be triggered by a fungal infection, this form of psoriasis affects different areas of the body prone to sweat, including the groin, under the buttocks, and between the folds of the breasts. Inverse psoriasis produces red patches of skin, but they are smooth, not scaly like those with plaque psoriasis. 
  • Psoriatic arthritis: When psoriasis creates an inflammatory response inside the joints, the condition can be as painful and debilitating as arthritis. Some people with psoriatic arthritis experience joint pain without any skin inflammation or other classic psoriasis symptoms. 

People with a rarer type of psoriasis called erythrodermic psoriasis develop a peeling, red rash that can lead to severe itching or create an intense burning sensation.

Pustular psoriasis, another rarer form of the disease, causes pus-filled blisters on different areas of the body.

Eczema

Just as there are different types of psoriasis, there are also different types of eczema, each with its own symptoms and triggers. They include:

  • Atopic dermatitis: More than 26 million people, including more than 9 million babies and young children, have atopic dermatitis, making it the country’s most common form of eczema. Most of the time, people with atopic dermatitis experience itchy, dry skin. Those with lighter skin tones may see their eczema present as red patches on their body, while those with darker skin tones may experience brown or gray patches.
  • Contact dermatitis: People with contact dermatitis have sensitive skin. They experience symptoms when they touch substances or materials that irritate them or cause an allergic reaction. The resulting itchy, burning, or blistering skin can negatively impact their quality of life if left untreated.
  • Neurodermatitis: People with neurodermatitis experience itchy, scaly patches on their necks, limbs, and anal region. Stress, anxiety, or environmental irritants can cause symptom flare-ups at any time.
  • Seborrheic dermatitis: People with this common skin condition develop dry, scaly patches on their scalp and sometimes on the sides of their nose, their eyebrows, eyelids, and chest. It often affects people with oily skin and hair or who have weakened immune systems.
  • Stasis dermatitis: People with stasis dermatitis experience itching, discoloration, thick patches of skin, and open sores on their lower legs. The condition is caused by fluid buildup when abnormal blood flow prevents oxygen from reaching the skin.

Causes

Although researchers are still trying to identify the causes behind psoriasis and eczema, they know that family history and environmental conditions play a role in both diseases. 

Psoriasis 

Genetics play a significant role in whether someone develops psoriasis.

If you have a family history of psoriasis, you are more likely to develop psoriasis younger and to experience joint inflammation. 

Individuals who have psoriasis experience symptoms that cycle through periods of remission and exacerbation.

When people become stressed or come into contact with a triggering substance, their immune system goes into overdrive, causing psoriasis symptoms to flare.

Eczema

A combination of genes and triggers ultimately determines whether someone develops eczema.

Some people with eczema, though not all, have a gene mutation that harms their ability to form a protective skin barrier, leading to dry and easily infected skin. 

For those with eczema, symptoms flare when they come in contact with irritants, allergens, and other triggers.

Learning how to avoid situations and materials that exacerbate eczema is a crucial part of managing the condition.

Diagnosis

If you are concerned about an itchy, red, or raised patch of skin, make an appointment with your dermatologist to get it evaluated and accurately diagnosed. 

Psoriasis 

When your doctor evaluates you for psoriasis, they will interview you about your health and whether any family members have had psoriasis in the past.

They will examine your skin, scalp, and nails and may take a small biopsy (a skin sample to examine) to help determine what kind of psoriasis you have.

Be sure to tell the doctor if you experience any joint stiffness, swelling, or pain, or any other symptoms that you believe might be related to psoriasis.

Eczema

If your doctor believes you may have eczema, they will ask about your health history and whether anyone in your family has the condition.

In addition, they will look at your rash and ask you whether you’ve been in contact with any substance that might trigger your immune system.

They may also run a few tests to rule out any other skin condition. 

Be sure to let your doctor know if you or anyone in your immediate family suffers from hay fever or asthma, as those conditions can put you in a higher-risk category for developing eczema as well.

Treatment

There are no cures for psoriasis or eczema, but you manage either condition with the right treatment plan.

Because everyone is different, some people respond better to specific therapies than others.

It’s essential to work with your healthcare provider to find one or more treatments that reduce your symptoms and improve your quality of life.

Psoriasis

Different types of psoriasis may respond to different kinds of therapies.

Doctors may recommend: 

  • Topical creams and ointments: Over-the-counter (OTC) and prescription topical steroids (corticosteroids) can help control inflammation and reduce redness.
  • Light therapy (phototherapy): When used in controlled settings like the doctor’s office or with a home-care kit, ultraviolet light B (UVB light) can soothe inflamed skin and relieve symptoms.
  • Oral medications: Doctors often prescribe oral medication to people with moderate to severe psoriasis who don’t respond well to topicals or light therapy.
  • Injectable medications: Biologics, or injectable medications, are administered by shot or via IV infusion.

Your doctor might suggest that you augment your medication with complementary lifestyle changes.

For example, improving your diet, becoming more physically active, learning how to reduce your stress, and getting acupuncture.

While these may help alleviate your symptoms, they are not appropriate replacements for pharmaceutical medication.

Eczema 

Depending on the type of eczema and severity of the symptoms, doctors may recommend one or more treatments to help alleviate the condition.

These might include:

  • Bathing and moisturizing: Using gentle cleansers, bathing or showering in lukewarm (not hot) water, and applying oils and moisturizers to the skin before getting dressed may help reduce flare-ups and protect the skin’s natural barrier.
  • Over-the-counter medications: Low-potency steroid creams, antifungal or dandruff shampoos, and oral medications like antihistamines and pain medications may help reduce irritation, itch, and inflammation. 
  • Light therapy: Controlled treatments with different wavelengths of UV light can soothe itchy skin and alleviate irritation for people who do not respond to topical treatments.
  • Prescription creams and ointments: Non-steroidal topical calcineurin inhibitors (TCIs), topical phosphodiesterase four inhibitors, and topical corticosteroids can be applied to affected areas to help calm the skin and send symptoms into remission.
  • Oral medications: Immunosuppressant systemic medications and steroids may help control some cases of moderate to severe eczema.
  • Injectable medications: Biologic medications can be administered through the skin or through the vein to suppress the immune system’s response to triggers.

Risk Factors

Anyone can develop psoriasis or eczema at any time, though some people are more prone to skin conditions than others. 

Psoriasis

Those at higher risk of psoriasis include: 

  • People who experience chronic stress 
  • People who have a weakened immune system due to HIV or other conditions
  • People with a family history of the disease 
  • White people

Eczema

Those at higher risk of eczema include: 

  • Black people
  • Infants and young children
  • People who are exposed to irritants in their environment 
  • People who experience chronic stress 
  • People who have a family history of the disease, asthma, or food or environmental allergies
  • People who have asthma or hay fever
  • Women 

Neither eczema nor psoriasis is contagious, meaning that it can’t be passed from one infected person to another through close contact.

Triggers

Both psoriasis and eczema can be triggered by certain materials, substances, and events.

Different people react differently to triggers, so if you have one of the conditions, it’s important to note when you experience symptom flare-ups so that you can avoid the things that exacerbate your condition.

Psoriasis

Common triggers for psoriasis include:

  • Dry or cold weather 
  • Environmental allergies 
  • Food allergies
  • Illness
  • Injury
  • Stress

Eczema

Common triggers for eczema include: 

  • Allergens like pet dander, pollen, smoke, dust mites, and insect bites
  • Certain chemicals found in household cleaners, shampoos, and cosmetics
  • Changes in seasons
  • Cold or dry weather 
  • Hot weather
  • Dry skin 
  • Fragrances
  • Hormonal changes
  • Yeast or bacterial infections
  • Latex
  • Long, hot baths 
  • Metals like copper, gold, and nickel
  • Sweat
  • Wool 

Some people with eczema experience lag time between their exposure to a trigger and the onset of their symptoms.

Taking detailed notes of your experiences can help you determine your triggers and how to avoid them.

Prevention Tips

You can’t prevent eczema or psoriasis, but you can take steps to avoid the environments and experiences that trigger your symptoms and make them worse.

  • Avoid exposure to extreme weather or temperature fluctuations
  • Avoid injuring your skin 
  • Eat a healthy, nutritious diet 
  • Be physically active
  • Manage stress 
  • Avoid chemicals, allergens, and other irritants
  • Avoid scratching your skin, even when it itches 
  • Breastfeed your infant 

If you have eczema or psoriasis symptoms, you might consider seeking counseling or attending a support group specializing in helping people with skin conditions.

These resources can share tips, offer support, and help you navigate your condition. 

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When to See a Doctor 

If you suspect that you have psoriasis or eczema, it’s vital to make an appointment with a dermatologist so they can diagnose you and recommend a treatment plan.

With the proper medication, you can manage your condition and get your itch and inflammation under control. 

Make an appointment with your dermatologist if you are experiencing: 

  • An itchy rash that doesn’t get better with moisturizer or OTC creams 
  • A rash or blisters that are oozing, full of pus, or bleeding 
  • A rash that is accompanied by a fever, dizziness, increased weight gain, or rapid heart rate 
  • Deep grooves or pockets in your fingernails or toenails 
  • Pain or tenderness in your back, hands, or feet 
  • Skin itch or pain that’s new worsening or spreading
  • Stiffness in your joints 
  • Swelling or skin that is hot to the touch

If you are experiencing severe or rapid swelling in your skin, tongue, lips, or face; skin that is painful to touch; wheezing; and shortness of breath, you may require emergency care.

Call 911 or go to your nearest emergency room immediately.

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Frequently Asked Questions

Is eczema and psoriasis the same thing?
Although eczema and psoriasis are both chronic conditions that produce red, swollen, and itchy skin, they are distinct diseases with different causes, symptoms, and treatment options.
Which is worse, eczema or psoriasis?
It’s hard to say overall if eczema or psoriasis is worse because every person is different and some people experience more severe symptoms than others. If you are concerned about a skin rash or any other sign you believe might be related to eczema or psoriasis, make an appointment with your dermatologist to have your skin examined.
What is the root cause of psoriasis?
Although researchers are still studying the root cause of psoriasis, they believe it is related to genetic and environmental factors. People with a family history of the disease are more likely to develop it.
Can eczema or psoriasis be cured?
Although there is no cure for eczema or psoriasis, people successfully manage them with the right combination of treatments. Working with your doctor to identify the medication and lifestyle changes that keep your symptoms in remission is the best way to live well with either disease.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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Irmanie Hemphill, MD, FAAFP

Dr. Hemphill is an award winning primary care physician with an MD from Florida State University College of Medicine. She completed her residency at Halifax Medical Center.