Psoriasis vs eczema: how to tell which is which

Most of us consider rashes and dry skin to be relatively minor concerns, but for people who have psoriasis or eczema, those symptoms can seriously impact their quality of life. The two conditions—both of which cause red, inflamed, and peeling skin—can be uncomfortable, conspicuous, and persistent. And they're quite common: About 10.1% of Americans (more than 31 million people) have some form of eczema, and more than 8 million have psoriasis (Silverberg, 2013; NPF, n.d.). If you suspect you may have psoriasis or eczema, here's how to tell them apart.

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Psoriasis is a chronic autoimmune condition in which the immune system causes the overproduction of skin cells—they're produced in days, rather than weeks. This can result in thick, scaly patches forming on the skin, often with intense itching. The different types of psoriasis include (AAD, n.d.):

• Plaque psoriasis: The most common kind of psoriasis, accounting for 80% to 90% of cases, plaque psoriasis, involves thick, scaly patches (or plaques) that can develop anywhere on the body, although they're most often found on the knees, elbows, lower back, and scalp.

• Scalp psoriasis: Thin or thick plaques that develop on the scalp and/or hairline.

• Guttate psoriasis: Small, scaly skin spots that tend to develop in children after a strep infection.

• Inverse psoriasis: Psoriasis that develops where skin touches skin, such as in the armpit or groin. 

• Pustular psoriasis: Small, pus-filled blisters that develop on the hands and feet, often accompanied by thick, cracked skin. 

• Erythrodermic psoriasis: This type causes large areas of skin to look burnt. It can be life-threatening. If you develop it, you should seek medical advice ASAP.

Psoriasis can't be cured; most people who have psoriasis have it for life. But it can be treated, and people with psoriasis can develop healthy lifestyle habits to minimize the condition, such as avoiding triggers like stress, smoking, and alcohol.

Between 10% and 30% of people with psoriasis develop psoriatic arthritis, in which joint pain, stiffness, and swelling accompany scaly patches of skin (NPF, n.d.). 

Treatments for psoriasis include:

• Corticosteroid creams

• Coal tar ointment, shampoo, foam, or bath solution 

• Salicylic acid 

• Synthetic vitamin D creams

• TCIs, or topical calcineurin inhibitors, are immunomodulating creams that are FDA-approved for eczema but may be prescribed off-label for psoriasis (AAD, n.d.)

Eczema refers to a group of skin conditions whose symptoms include red, inflamed, peeling, cracked or blistered skin. It can be caused by allergens, irritants such as certain dyes, fabrics, soaps, and animal dander, or a genetic susceptibility. It often appears in skin folds. Half of people with moderate to severe eczema also have asthma, hay fever, or food allergies (AAAAI, n.d.).

The types of eczema include (NEA, n.d.):

• Atopic dermatitis (AD): The most common form of eczema, it includes red, dry, scaly, and itchy patches of skin. Atopic dermatitis occurs most often in children, but adults can also develop it.

• Contact dermatitis: Caused by contact with an irritant such as soap, detergent, or poison ivy.

• Dyshidrotic eczema: Small blisters that form on the hands.

• Nummular eczema, or discoid eczema: Appears as rounded, coinlike lesions.

• Stasis dermatitis: Scaling or blistering on the lower legs that can be associated with poor circulation.

• Neurodermatitis: Considered a neurological skin disorder because it's fueled by the itch-scratch cycle.

Eczema can be treated, but like psoriasis, it can't be cured. The goal is to manage the condition and decrease your flare-ups and symptoms; for many, it can be a lifelong problem. Treatments include (AAAAI, n.d.):

• Topical treatments like moisturizers and ointments

• Corticosteroid creams

• Light therapy (phototherapy)

• Wet-wrap therapy

• Antihistamines, to reduce itching

• Wearing cotton clothing and avoiding synthetic fabrics and wool

• Avoiding triggers, like stress

Because psoriasis involves the overproduction of skin cells, those cells build up on the skin and cause red plaques that are often covered by silvery-white scales. Eczema is less likely to cause scaling and is more likely to be accompanied by fluids leaking through the skin. Sometimes doctors can't tell the two conditions apart with the naked eye. In those cases, a biopsy may be necessary (Cleveland Clinic, 2020).

Both eczema and psoriasis can't be cured, and they can be lifelong conditions. But several treatments are available, and the conditions can be effectively managed. If you suspect you might have eczema or psoriasis, consult a board-certified dermatologist who can provide a definitive diagnosis and prescribe treatments that can relieve your symptoms.

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Current version

March 05, 2020

Written by

Michael Martin

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.