Comparing Eczema and Psoriasis: What You Need to Know

Skin conditions affect millions globally. Roughly 1 in 10 people experience eczema, with its peak during early childhood. On a global scale, about 125 million individuals, comprising 2 to 3% of the population, grapple with psoriasis.

Beyond the statistics, these conditions, though sharing similarities, exhibit distinct clinical features.

In this article, you will learn the causes, symptoms, appearance, and treatments, highlighting the subtle yet significant differences between eczema and psoriasis.

1. Causes

Genetics and immune system dysfunction underlie eczema and psoriasis, but environmental triggers often initiate or worsen symptoms. Let’s explore causes in more detail below.

Eczema

Eczema, also known as "atopic dermatitis," is a noncontagious, inflammatory skin condition characterized by severe itching, redness, oozing, and scaly rashes.

Genetics play a significant role in eczema, with a potential genetic component involving the protein "filaggrin," crucial for maintaining skin moisture. Filaggrin deficiency can lead to dry, itchy skin.

Additionally, an overactive immune system contributes to the condition. This immune response can occur throughout the body to certain environmental triggers, such as:

• Exposure to dry air, heat, or cold
• Irritating soaps
• Fabrics like wool or polyester
• Allergens (dust mites, pet dander)
• Stress

Other triggers include substances like fragrances, metals (especially nickel), formaldehyde, and certain chemicals in personal care products. Filaggrin deficiency is a known risk factor, and emotional stress can trigger flare-ups.

Psoriasis

Psoriasis is an immune-mediated disease that causes inflammation in the body, leading to visible signs such as raised plaques and scales on the skin.

Genetics also play a crucial role in psoriasis, with a higher risk for individuals with a family history. The immune system dysfunction, particularly involving T-cells, leads to the attack on the body's skin cells, causing an overproduction of skin cells and characteristic psoriasis symptoms.

Triggers, while not fully understood, include:

• Stress
• Skin injury (cuts or sunburn)
• Infections likestrep throat
• Certain medications (lithium, prednisone)
• Weather conditions (cold, dry weather)
• Lifestyle factors such as tobacco and alcohol consumption

Family history is a significant factor, and psoriasis is not contagious. Triggers can initiate or worsen symptoms, with different people having different triggers.

2. Symptoms

While sharing some similarities, eczema and psoriasis have distinct manifestations that differentiate them. But what are the key symptoms of each condition?

Eczema

Eczema symptoms include:

Red Rash or Patches

• Commonly found inside the folds of elbows and knees.
• In infants, often located on the cheeks, outside of elbows, and knees.
• In older children and adults, typically on hands, feet, arms, and back of knees.

Itching

• Severe itching, interrupting sleep.
• Can lead to scratching, which may result in infection.

Dry Skin

• Skin becomes very dry, prone to cracking and bleeding.
• Skin color changes may occur.

Psoriasis

Psoriasis can manifest in a number of ways, each type with distinct symptoms:

Plaque Psoriasis

• Dry, thick, raised patches (plaques) on the skin.
• Often covered with a silvery-white coating (scale).
• Itching is common.

Guttate Psoriasis

• Small bumps appearing rapidly on the skin
• Bumps are scaly and salmon-colored to pink.
• Temporary clearing in weeks or months.

Inverse Psoriasis

• Smooth, red patches in skin folds.
• Little to no silvery-white coating.
• Sore or painful skin.

Pustular Psoriasis

• Pus-filled bumps on hands and feet.
• Red, swollen skin with extremely sore or painful areas.
• Bumps may resemble an infection but are not infectious.

Generalized Pustular Psoriasis

• Rare and serious type.
• Pus-filled bumps covering most of the skin.
• Cycle of skin dryness, peeling, and recurrence.

Erythrodermic Psoriasis

• Serious and life-threatening.
• Skin looks burnt on most of the body.
• Chills, fever, severe itch, and muscle weakness.

Nail Psoriasis

• Changes in fingernails or toenails.
• Nail pits, discoloration, rough or lifted nails.
• Buildup of skin cells beneath nails.

Psoriatic Arthritis

• Affects joints, causing psoriatic arthritis.
• Swollen and tender joints, heel pain, stiffness.

3. Appearance And Affected Areas

Visible characteristics and location on the body help differentiate eczema from psoriasis. But which parts of the body are typically affected?

Eczema

Here are some common types of eczema, each distinguished by its unique appearance and the specific areas of the body it affects.

Atopic Dermatitis (AD)

Source: National Eczema

• Appearance: Patches of thick, raised skin known as plaques with a dry, silvery-white coating.
• Affected Areas: Commonly found on the scalp, elbows, knees, or lower back, but can develop anywhere on the skin.

Contact Dermatitis

Source: National Eczema

• Appearance: Inflamed or irritated skin due to contact with a substance.
• Affected Areas: Varies based on the environmental trigger, can occur anywhere.

Dyshidrotic Eczema

Source: National Eczema

• Appearance: Small blisters on hands, feet, fingers, and toes.
• Affected Areas: Primarily on the hands and feet.

Nummular Eczema

Source: National Eczema

• Appearance: Scattered circular patches, may ooze or be very dry and sensitive.
• Affected Areas: Can occur on any part of the body.

Seborrheic Dermatitis

Source: Eczema.org

• Appearance: Usually affects the scalp, with constant itching, rash, and other symptoms.
• Affected Areas: Primarily on the scalp, but can extend to other areas.

Stasis Dermatitis

Source: National Eczema

• Appearance: Itchy skin, redness in lighter skin tones, appearing brown, purple, gray, or ashen in darker skin tones, and dry skin.
• Affected Areas: Predominantly on the legs, especially where circulation is poor.

Neurodermatitis

Source: Medical News Today

• Appearance: Intense itching visible in areas with skin lines, scales, and discoloration.
• Affected Areas: Commonly on the feet, ankles, hands, wrists, elbows, shoulders, neck, and scalp.

Psoriasis

There are different types of psoriasis, each with its own appearance and affected areas across the body.

Plaque Psoriasis

Source: Psoriasis.org

• Appearance: Thick, raised patches of skin with a silvery-white coating.
• Affected Areas: Scalp, elbows, knees, lower back, and can develop anywhere.

Guttate Psoriasis

Source: Stanford Medicine

• Appearance: Tiny, scaly bumps covering torso, legs, arms, and sometimes face.
• Affected Areas: Torso, legs, arms, face.

Inverse Psoriasis

Source: Health Central

• Appearance: Smooth, red patches in areas where skin touches skin.
• Affected Areas: Armpits, genitals, crease of the buttocks.

Pustular Psoriasis

Source: Health Central

• Appearance: Pus-filled bumps on hands and feet, extremely sore or painful skin.
• Affected Areas: Hands and feet.

Generalized Pustular Psoriasis

Source: Rare Disease Advisor

• Appearance: Skin turns dry, red, and tender, followed by pus-filled bumps covering most of the skin.
• Affected Areas: Most of the body.

Erythrodermic Psoriasis

Source: Psoriasis.org

• Appearance: Skin looks burnt on most of the body, accompanied by chills, fever, severe itch.
• Affected Areas: Most of the body.

Nail Psoriasis

Source: Cleveland Clinic

• Appearance: Changes in fingernails or toenails, including pits, discoloration, and roughness.
• Affected Areas: Fingernails, toenails.

Psoriatic Arthritis

Source: Hopkins Medicine

• Appearance: Swollen and tender joints, heel pain, stiffness.
• Affected Areas: Joints, often in fingers, toes, back of the leg above the heel.

4. Treatment

Managing eczema and psoriasis requires a multifaceted approach. So, what are the treatment options for each condition?

Eczema

Eczema treatment varies depending on the type and severity of the condition. Lifestyle changes play a crucial role in managing eczema. This includes:

• Identifying and avoiding triggers
• Establishing a regular bathing and moisturizing routine
• Choosing soft, breathable clothing while avoiding irritating fabrics

Additionally, it's important to avoid known allergens in fabric detergents and manage stress through stress management techniques.

Over-the-counter (OTC) treatments are available for managing eczema symptoms. These include:

• Antihistamines (oral) for itching and allergies
• Pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs for pain and inflammation
• Topical hydrocortisone for temporary relief of itching and rashes

Prescription topicals offer more targeted solutions. These include topical corticosteroids in varying strengths, topical calcineurin inhibitors (TCIs) like tacrolimus and pimecrolimus, and topical phosphodiesterase 4 (PDE4) inhibitors like crisaborole. Additionally, topical Janus kinase (JAK) inhibitors, such as Opzelura (ruxolitinib 1.5%) cream, specifically target the JAK-STAT pathway to reduce inflammation.

For more severe cases, prescription injectable biologics like Dupixent (dupilumab) and Adbry (tralokinumab-ldrm) can be used to block specific interleukins, calming the immune system and reducing inflammation in moderate to severe atopic dermatitis.

Prescription oral immunosuppressants, including JAK inhibitors like Cibinqo (abrocitinib) and Rinvoq (upadacitinib), as well as traditional systemic medications like azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil, are prescribed for moderate to severe eczema to control or suppress the immune system.

Psoriasis

Psoriasis treatment options encompass various approaches, ranging from topical therapies to oral or injected medications and light therapy. The choice of treatment depends on the severity of the condition and its responsiveness to previous interventions.

The first line of defense often involves topical therapies, which include:

• Corticosteroids
• Vitamin D analogues
• Retinoids
• Calcineurin inhibitors
• Salicylic acid
• Coal tar
• Anthralin

Corticosteroids, available in different forms, are commonly prescribed for mild to moderate psoriasis. Vitamin D analogues, such as calcipotriene and calcitriol, slow skin cell growth and can be used alone or with corticosteroids. Retinoids, like Tazarotene, reduce skin cell growth but require caution during pregnancy. Calcineurin inhibitors, such as tacrolimus and pimecrolimus, are useful in sensitive areas where other treatments may be irritating.

Light therapy, or phototherapy, is another treatment avenue. This involves controlled exposure to natural or artificial light. Options include:

• Sunlight (Heliotherapy)
• Goeckerman therapy (combining coal tar with light)
• UVB broadband and narrowband
• PUVA (psoralen plus ultraviolet A)
• Excimer laser therapy

For more severe cases or when other treatments prove ineffective, oral or injected medications may be considered. These include:

• Steroids (injected directly into psoriasis patches)
• Retinoids like acitretin
• Biologics altering the immune system
• Methotrexate
• Cyclosporine

However, these systemic medications carry potential side effects and must be used cautiously.

Additionally, alternative therapies, while not strongly supported by evidence, may provide relief for some individuals. These include:

• Aloe extract cream
• Fish oil supplements (combined with UVB therapy)
• Application of Oregon grape to the skin

Alongside medical interventions, lifestyle and home remedies play a crucial role in managing psoriasis. Self-care measures involve daily baths, moisturizing, avoiding triggers, and lifestyle adjustments such as maintaining a healthy weight and limiting alcohol consumption.

Wrap Up

Eczema and psoriasis are common inflammatory skin conditions with genetic components. While sharing some similarities, they each have distinct symptoms, affected areas, and treatment approaches.

Eczema involves itchy, red rashes often in skin folds, while psoriasis causes raised, scaly plaques. Multifaceted treatment is required, including topical therapies, light therapy, oral or injected medications, and lifestyle adjustments.

Overall, eczema and psoriasis are manageable chronic conditions requiring an individualized treatment plan to minimize symptoms and flare-ups.

Is eczema the same as psoriasis?

No, although both conditions can cause burning or itching, eczema patients often complain more about itching, while psoriasis patients commonly experience soreness or pain due to cracked skin, along with joint pain.

Does eczema go away?

While eczema can spontaneously resolve in some cases, for most people, it is a lifelong skin condition that typically develops in early childhood. While there's no cure, various treatments and management strategies can minimize flare-ups and control symptoms.

What is the best soap for eczema?

For bar soaps, opt for gentle, moisturizing options without fragrances or harsh chemicals. Recommended choices include CeraVe Hydrating Cleanser Bar, Vanicream Cleansing Bar, and Dove Sensitive Skin Unscented Beauty Bar.

What is the fastest way to heal eczema?

An effective and intensive treatment for severe eczema involves applying a corticosteroid ointment and sealing it with a wrap of wet gauze, topped with a layer of dry gauze.