If you're constantly scratching dry, red patches of skin, you may be wondering if you have eczema. Depending on where that angry itch is, however, psoriasis could be your first guess. The two chronic skin conditions are distinctly different to doctors and experts who treat them, but can be very difficult to distinguish for people who are experiencing it firsthand.
“They are often confused,” Frank Wang, M.D., a dermatologist at Michigan Medicine at the University of Michigan, tells Good Housekeeping. “They can look very similar. They both present with red patches and plaques that are scaly and can be itchy, and they can affect similar areas of the body.”
With input from skin care professionals, we're helping you determine whether your skin ailment is eczema or psoriasis — and tips for getting started on treatment.
What are the symptoms of eczema?
Eczema isn't actually one condition all its own; the diagnosis refers to a group of skin conditions that cause itchiness, inflammation and rashes, according to the National Eczema Association (NEA). Your bout of eczema may include one of seven common conditions that affect more than 30 million Americans, including atopic dermatitis, contact dermatitis and others.
Atopic dermatitis is the most common form of eczema, Dr. Wang says. It usually starts in early childhood and features itchy rashes, most routinely on the face and in the soft spot behind the knees, that come and go.
Itchiness is the most common symptom of all types of eczema. Though, it affects people in different ways. Some only have mild itchiness, while others are so itchy that they scratch until their skin bleeds.
Other symptoms, according to the NEA, include:
Dry, sensitive skin
Inflamed, red skin
Rough, scaly patches
Oozing or crusting
What are the symptoms of psoriasis?
Psoriasis affects about 8 million Americans, and like eczema, there are several types. The most common is called plaque psoriasis, according to the American Academy of Dermatology Association (AAD), and symptoms include:
Areas of thick, raised skin, which is referred to as "plaques"
A dry layer covering the plaques that is silvery-white, called "scale"
The plaques, which can be large or small, may appear anywhere on the body but are typically on the scalp, knees, elbows and lower back.
Psoriasis can affect other parts of the body, too, including the joints, causing the condition known as psoriatic arthritis. About 30% of people with psoriasis develop psoriatic arthritis, Dr. Wang says. According to AAD, symptoms include:
Swollen, tender joints, usually in the fingers or toes
Swelling in the back of your legs
What’s the difference between eczema and psoriasis?
Eczema and psoriasis are different chronic conditions, though they both cause red, itchy skin rashes. But for doctors, these rashes have slight differences that the trained eye can usually detect.
“Atopic dermatitis tends to have less well-defined borders, doesn't have as much thick scale as psoriasis and tends to be just a little bit more crusty,” Dr. Wang explains. “Overall, atopic dermatitis tends to be itchier. Both are itchy conditions, but atopic dermatitis is probably more itchy.”
Neither condition is contagious, and eczema and psoriasis can’t be prevented.
What causes eczema and psoriasis?
Scientists aren’t sure exactly what causes eczema, but it’s likely genetic and triggered by allergic reactions to items like soap or fragrance, or could be onset by dry skin, Dr. Wang says. Environmental factors, like cigarette smoke, pollution and stress, could also trigger eczema, per AAD experts.
Research suggests that the immune systems in people with eczema likely overreact, causing inflammation when they come in contact with certain triggers, which makes the skin red and itchy.
Like eczema, there’s no exact known cause for psoriasis, but it too has an immune system link. Psoriasis is caused by an overactive immune system that revs up the production of new skin cells. According to the National Psoriasis Foundation, skin cells typically grow and fall off within a month, but in people with psoriasis, skin cells go through this process in just a few days. Instead of falling off, the cells pile up on the skin, creating thick, scaly patches, which experts call plaques.
Can eczema become psoriasis?
Eczema and psoriasis are completely different conditions. So, eczema can’t turn into psoriasis, and vice versa. But, since the conditions can look so similar, it can be tough to tell the difference even in a clinical setting, especially in children. According to AAD, in these instances, a dermatologist may diagnose the skin condition as “psoriasiform dermatitis.”
There’s some overlap, too. It’s not common, but you can technically get both psoriasis and eczema at the same time, which can be extra confusing. Your dermatologist will usually be able to distinguish between the two.
How can I get started on treatment?
Eczema and psoriasis aren’t entirely curable. But, Dr. Wang says they can be treated and managed to reduce pain, control itching and minimize flare-ups of patches and plaques. Whether you're dealing with one condition or the other (or, both!), managing eczema and psoriasis starts with a skincare specialist best identifying your triggers. You'll work to avoid these irritating events, and you'll also treat any sustained skin injuries that may add to pain or irritation. Mostly, you'll work to stay out of the sun and use solutions to help avoid scratching your skin.
Mild cases of both conditions can be treated at home. Dr. Wang suggests using a mild soap, over-the-counter hydrocortisone and emollients, which are therapeutic moisturizers. There are also lotions and creams for both eczema and psoriasis available to consumers.
If your skin doesn’t respond to at-home treatments, or the eczema or psoriasis exhibit more aggressive symptoms than ever before, it’s time to visit the dermatologist. Always discuss long-term treatment with your care provider when resorting to over-the-counter products.
Treatments will vary based on how severe the condition is and patient preference, Dr. Wang explains, but usually include topical steroids, light therapy and prescription drugs for the inflammation. For severe psoriasis, when patients have 10% to 30% of their body covered in plaques, injectable medications, called biologics, are used.
Since there’s no cure, treatment and management of eczema and psoriasis will often be lifelong, Dr. Wang says. This can impact quality of life, interfere with sleep and even cause anxiety and depression; all issues that you should discuss with your primary care provider, who may refer you to additional specialists for those issues. “Having a skin disorder such as eczema and psoriasis can be very emotionally and physically disabling,” he says. “People can feel extremely self-conscious. It can really hinder their self-confidence, and it can be very stigmatizing.”
But know you're not alone, and that there are treatments that can help you.
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