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Eczema vs. Psoriasis: How to tell which one it is?

Medically reviewed by Sally Chao, MD. Last updated on Sep 1, 2021.

Official answer

by Drugs.com

Both eczema and psoriasis are inflammatory skin conditions. They share some symptoms —namely areas of red, dry, itchy skin—as well as some treatments. Neither is contagious, and both come and go over the course of a lifetime. However, they are not the same condition.

It’s not always easy to tell eczema and psoriasis apart at first.

  • Psoriasis is marked by raised, reddened, thick plaques that can itch and cause a burning sensation. Psoriasis can strike any part of your body, but it is most commonly seen on the knees, elbows, lower back and scalp. These plaques may be covered with silvery scales that can flake off due to your immune system overproducing skin cells that don’t shed normally.
  • Characterized by red and itchy patches of skin, eczema can appear similar to psoriasis, but tends to be more itchy and blotchy in appearance. Exactly where eczema occurs is based on the type and your age. Atopic dermatitis, for example, tends to begin in the folds of the elbows or knees, neck, wrists, ankles, and/or crease between the buttocks and legs, first appearing in very young children.

Understanding psoriasis

Psoriasis affects more than 7.5 million U.S. adults. It occurs when your body’s immune system goes into overdrive and revs up skin cell production. These cells don’t shed. Instead, they build up on skin. There are many types of psoriasis. The most common one is plaque psoriasis.

Other types include:

  • Genital psoriasis. As the name suggests, this form of the disease occurs on and around the genitals.
  • Palmoplantar psoriasis. This form of the disease occurs on the hands and feet.
  • Guttate psoriasis. This less common type of psoriasis is characterized by smaller raised plaques than other forms of the disease.

Psoriasis triggers may include:

  • Stress
  • Skin injury
  • Illness
  • Weather

There is some suggestion that allergies, certain foods, alcohol or environmental factors may trigger psoriasis.

There is no cure for psoriasis, and a growing body of evidence suggests that the inflammation associated with the condition also increases the risk for other diseases down the road, including heart disease. Psoriasis tends to travel with the joint pain and inflammation of psoriatic arthritis. In fact, psoriatic arthritis affects about 30 % of people with psoriasis, according to the National Psoriasis Foundation.

Psoriasis treatment can include topicals p laced on your skin such as steroids to reduce inflammation and/or calcipotriene, a form of vitamin D that slows down skin cell growth.

Light therapy may also be used to slow down the growth of skin cells.

Systemic drugs such as biologics block key proteins that drive the inflammation in psoriasis. Biologics used to treat psoriasis include:

  • Tumor necrosis factor inhibitors (TNF inhibitors), such as Enbrel (etanercept), Cimzia (certolizumab pegol), Humira (adalimumab) and Remicade (infliximab)
  • Interleukin inhibitors, including Cosentyx (secukinumab), Siliq (brodalumab), Taltz (ixekizumab), Ilumya (tildrakizumab-asmn), Skyrizi (risankizumab-rzaa), Tremfya (guselkumab) and Stelara (ustekinumab)

These more powerful drugs may help prevent some of the downstream consequences of psoriasis such as heart disease. Avoiding triggers and taking care of your skin can help keep psoriasis flares at bay.

Understanding eczema

More than 31 million Americans have some form of eczema . Eczema often first appears in early childhood, but it can occur at any age.

Exactly what causes eczema is unknown, but genetics and exposure to certain triggers seem to play a role. It is thought that an overactive immune system comes into contact with a trigger and responds by releasing inflammatory markers that cause symptoms, such as intense itching and inflammation.

There are many different types of eczema, including:

  • Atopic dermatitis. This is the most common type of eczema and typically develops before the age of five.
  • Contact dermatitis. With this type of eczema, the irritation and inflammation follow exposure to a specific substance.
  • Dyshidrotic eczema. This type of eczema occurs on the hands and feet.
  • Nummular eczema. This form of eczema is characterized by coin-shaped patches on the skin.
  • Seborrheic dermatitis. This type of eczema occurs on the scalp and causes dandruff.
  • Stasis dermatitis. This form of eczema occurs when there is pronounced swelling in the lower limbs.

Potential eczema triggers may include:

  • Soap
  • Laundry detergent
  • Shampoo
  • Bubble bath
  • Body wash
  • Fragrances
  • Metals
  • Cigarette smoke
  • Household cleansers
  • Fragrances

Like psoriasis, eczema also travels with other diseases and conditions. Fully one in three children with eczema will develop asthma or allergic rhinitis, and children with atopic dermatitis are six times more likely to develop a food allergy compared to children without this skin condition, according to the National Eczema Association.

The main symptom of eczema is chronic, relentless itch. Scratching only makes it worse and can increase the chances of developing a skin infection. You can try soothing the itch without scratching by taking a bath with oatmeal or baking soda.

Like psoriasis, eczema can have a dramatic effect on quality of life. The itching can interfere with sleep, and can increase the risk of mental health issues such as depression and anxiety.

Eczema is often treated with over-the-counter (OTC) remedies and prescription topical medications, including steroids, calcineurin inhibitors such as Protopic (tacrolimus) and generic options, and Elidel (pimecrolimus) and generic options, which prevent certain cells in the immune system from turning on to cause eczema symptoms.

Another option, Eucrisa (crisaborole), targets phosphodiesterase 4 (PDE4), an enzyme that kickstarts the production of different inflammatory proteins in the immune system linked to eczema.

Dupixent (dupilumab) is a biologic drug that can help treat moderate to severe atopic dermatitis in adults and children. It works by blocking proteins that kickstart the immune system’s overreaction and cause eczema symptoms.

As with psoriasis, prevention also makes a difference. Knowing what triggers an eczema flare and taking steps to avoid them as well as judicious use of moisturizer can help keep eczema flares at bay.

References
  1. National Psoriasis Foundation. About Psoriasis. Available at: https://www.psoriasis.org/about-psoriasis/ . [Accessed August 17, 2021].
  2. American Academy of Dermatology (AAD). What’s the difference between eczema and psoriasis? Available at: https://www.aad.org/public/diseases/eczema/childhood/child-have/difference-psoriasis. [Accessed August 27, 2021].
  3. National Psoriasis Foundation. Causes and Triggers. Available at: https://www.psoriasis.org/causes/ . [Accessed August 17, 2021].
  4. National Psoriasis Foundation. About Psoriatic Arthritis. Available at: https://www.psoriasis.org/about-psoriatic-arthritis/ . [Accessed August 17, 2021].
  5. National Psoriasis Foundation. Phototherapy. Available at: https://www.psoriasis.org/phototherapy . [Accessed August 17, 2021].
  6. National Eczema Association. Eczema Stats. Available at: https://nationaleczema.org/research/eczema-facts/ . [Accessed August 17, 2021].
  7. National Eczema Association. Available at: https://nationaleczema.org/eczema/. [Accessed August 17, 2021].
  8. National Eczema Association. An Overview of the Different Types of Eczema. Available at: https://nationaleczema.org/eczema/types-of-eczema/. [Accessed August 17, 2021].
  9. National Eczema Association. Eczema Causes and Triggers. Available at: https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/. [Accessed August 17, 2021].
  10. National Eczema Association. Managing Itch. Available at: https://nationaleczema.org/eczema/itchy-skin/. [Accessed August 17, 2021].
  11. National Eczema Association. Managing Itch. Available at: https://nationaleczema.org/eczema/treatment/. [Accessed August 17, 2021].

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