How to tell the difference between eczema and psoriasis and get the right treatment

• Eczema is a common skin condition that can cause swelling and thick, scaly skin.
• Psoriasis is less common than eczema and causes a dry, itchy rash with scaly patches of skin.
• Treatment for mild cases of both conditions is similar but more severe cases require unique care.

Eczema and psoriasis are common inflammatory skin conditions. They both can cause itchy rashes and appear on the same parts of the body — to an untrained eye they are easy to mix up.

Treatments for mild and moderate cases of these conditions are similar, but severe cases may require more specific medications.

Here are the causes, symptoms, and treatment of eczema and psoriasis and what makes them different.

What is eczema?

Eczema, aka atopic dermatitis, is a common skin condition affecting up to 10% of people in the US.

Its tell-tale symptoms include a dry, itchy rash that can range from minor patches to severe flare ups that cause intense itching and sometimes pain due to scratching.

"Eczema is most commonly seen in kids — 95% of cases by 5 years of age — and much less in adults," says Anar Mikailov, MD, a dermatologist and the founder of KP Away.

Eczema is associated with allergic conditions like asthma, hay fever, and food allergies. More than half of children under age 13 with eczema will go on to develop these other conditions.

You are more likely to have eczema if members of your family also have asthma or environmental allergies. Black children tend to develop it more frequently than white or Asian children — 19% vs. 16% and 8%, respectively.

Causes

The exact cause of eczema is difficult to pinpoint as there are multiple factors that influence it:

Genetics

The latest research shows that there is a genetic basis to eczema. Certain gene variations  contribute to an impaired skin barrier, which causes skin cells to lose moisture and develop gaps between them, triggering dry, irritated, and itchy skin.

Immune system

When you have an impaired skin barrier your skin is more vulnerable to environmental irritants. Your immune system sees these irritants as dangerous and responds with inflammation, which creates itching and a rash.

 Environment

Flare ups of eczema symptoms can be caused by many different environmental irritants. Some of the more common triggers include:

• Household cleaning and bath products
• Cosmetic products with artificial scents
• Dust and pollen
• Pet dander
• Cigarette smoke
• Climatic factors — change in seasons or extreme weather

Other factors that may increase the risk of developing eczema include where you live. It is more common if you live:

• In a city
• In high-income country like the US
• Around weather that is cold and damp 

Stress

High levels of stress impact the immune system and skin and increase the inflammatory response that causes eczema.

Symptoms

The main symptom of eczema is itching, which can be very intense and is often worse at night. 

"The itch starts before the rash, and it shows up in symmetric areas on your body. In kids, symmetric rash with itching occurs near the elbows, knees, around the eyes, forehead, and nose," says Mikailov.

 Eczema can also cause:

• A discolored rash — on light colored skin it will be red, on darker skin it can look darker brown, purple, or gray
• Thickened and scaly skin due to frequent scratching
• Swelling
• Oozing or crusting areas of skin 

Treatment 

"Treatment of mild eczema starts with avoiding environmental triggers, frequent applications of proper moisturizers, and topical anti-inflammatory medications. In severe cases, oral medications and injections can be very effective, with rapid results in days to weeks," says Jeffrey Hsu, MD, a dermatologist and founder of Oak Dermatology.

Hsu says that although often effective, these medications are not cures — eczema is a chronic condition and occasional flares are to be expected if not properly managed by a dermatologist.

What is psoriasis?

Psoriasis causes a dry, itchy rash characterized by scaly patches of skin. It is fairly common, affecting about 3% of adults in the US — or almost eight million people. 

Psoriasis is a chronic, incurable condition that tends to have intermittent flare ups with worsening symptoms.

"Unlike eczema, psoriasis can be seen in childhood as often as adulthood, and affects men and women equally," says Mikailov.

Causes

Psoriasis is an autoimmune condition — the body's defense system sees normal, healthy cells as dangerous and release antibodies to attack them — so the cause of psoriasis is a mechanism similar to other autoimmune diseases like rheumatoid arthritis, lupus, and Hashimoto's thyroiditis.

In the case of psoriasis, T-cells from the immune system attack healthy skin cells. This causes the body to accelerate the creation of new skin cells — these new cells build up on the surface of the skin, creating psoriasis' distinctive scaly appearance.

Psoriasis tends to run in families, and has some common triggers, both for its first incidence as well as flare ups once it's established. Common triggers include:

• Stress
• Infections — of the skin and especially strep throat
• Injury to the skin, like scrapes or cuts
• Weather, especially when it's cold and dry
• Tobacco use
• Heavy alcohol use
• Illness

Psoriasis can affect people in different ways. Minor cases might be just a few spots of flaky scaling skin, while some cases can affect large portions of the body. The most common places psoriasis appears are the scalp and face, elbows, knees, feet, and the low back.

Symptoms

In addition to a scaly rash, symptoms of psoriasis include:

• Dry and cracked skin that can itch and bleed when scratched
• Pitted or cracked nails
• Burning or sore skin
• Joint pain

About one in four people with psoriasis will develop a condition called psoriatic arthritis, which usually occurs years after psoriasis on the skin begins. Psoriatic arthritis shares similarities with rheumatoid arthritis — both cause joint pain, swelling, and, in some cases, deformity of joints.

 People with psoriasis are more likely to develop other conditions such as:

• Cardiovascular disease
• Type 2 diabetes
• High blood pressure
• Depression
• Inflammatory bowel disease or other autoimmune conditions

Treatment

"Treatment for psoriasis involves corticosteroid creams, vitamin D cream, phototherapy, and sometimes injection or ingested medicine. Fortunately, due to the new medicines, psoriasis can be essentially cured," says Mikailov.

You can expect to see improvement in one to two months with injection medicine. Creams and phototherapy can require two to three months before improvement, says Mikailov.

Eczema vs. psoriasis

"These two common conditions can look similar to the untrained eye — they both appear to be red scaly rashes initially, and in mild cases, the treatments can be very similar," says Hsu. 

Both conditions are caused by immune system dysfunction. In eczema the immune system is overactive, whereas in psoriasis the immune system attacks healthy cells — so in severe cases medications for each will differ, says Hsu.

Psoriasis, being an autoimmune condition, has more complications than eczema. "While some cases of eczema can be severe, causing much discomfort and itch, psoriasis tends to have more serious and wide ranging multi-systemic consequences, including arthritis, heart disease, and diabetes," says Hsu.

The main differentiation between eczema and psoriasis is itching: Eczema is always itchy, sometimes intensely so, but itching with psoriasis is more mild and tends to be accompanied by a burning or stinging sensation.

Here are some differences between the two:

Eczema	Psoriasis
Very common —10% in US have it	Less common — 3% of people in US have it
Immune system overreacting causing inflammation and rashes	Immune system attacking healthy skin cells causes rashes
Most common in children	Can occur in children or adults
Associated with asthma, allergies, and environmental sensitivity	Associated with psoriatic arthritis and can cause other health problems
Very itchy	Mild itching, burning, or stinging
Most often appears on back of knee, inside elbows, or on face	Appears most often on scalp and face, elbows, knees, feet, and low back

Insider's takeaway

Eczema and psoriasis are both common skin conditions that can be hard to tell apart. However, they can usually be treated similarly with topical medications. 

For moderate and severe cases, a trained dermatologist will be able to differentiate the two and give you the best recommendations for treatment.