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What Are the Differences Between Eczema and Psoriasis?

Eczema and psoriasis are skin conditions that have similar symptoms that are difficult to tell apart from one another. Eczema symptoms include itchy, red, inflamed, and scaly skin. Psoriasis symptoms include red, thick, scaly, and flaky skin that often appears as patches.
Eczema and psoriasis are skin conditions that have similar symptoms that are difficult to tell apart from one another. Eczema symptoms include itchy, red, inflamed, and scaly skin. Psoriasis symptoms include red, thick, scaly, and flaky skin that often appears as patches.

Both eczema and psoriasis are chronic dermatologic conditions that can cause red, inflamed, scaly skin and it can be difficult to distinguish between the two.

Eczema refers to a group of skin conditions that cause itchy, red, inflamed, scaly skin, including:

Psoriasis is a chronic autoimmune condition that causes skin to be red, thick, scaly, and flaky. 

Differences between eczema and psoriasis include: 

  • Eczema patches are more vaguely defined, while patches of psoriasis are well-defined and the skin is usually thicker than seen in eczema
  • Eczema commonly occurs in the folds of skin, such as the knees or elbows, while psoriasis is often seen on the face, buttocks, scalp, knees, and elbows
  • Eczema can cause intense itching, while psoriasis may only cause mild itching but may also cause stinging or burning
  • Eczema often first appears in infants or young children and symptoms may improve once a person reaches adulthood, while psoriasis is rare in babies and is often first diagnosed between ages 15 and 35
  • Both eczema and psoriasis may be triggered by stress or infection 
    • Additional triggers for eczema include skin irritants, allergens, sweating, and hormones, while psoriasis flares can also be triggered by skin injury (such as from scratches, burns, or even needle injections from vaccination), and some medications

What Are Symptoms of Eczema and Psoriasis?

Symptoms of eczema include: 

  • Intense skin itching 
    • Itching may be worse at night
    • Scratching can intensify the inflammation and itching
    • Oozing, bleeding, or crusting may occur in places that are scratched open
    • Pustules, blisters, and red, hot skin may occur if a secondary infection occurs
    • Thickened, darkened, and even scarred, skin can occur from repeated scratching
  • Patches of inflamed skin/skin swelling
    • Plugged hair follicles that cause small bumps, usually on the face, upper arms, and thighs
    • Skin flaking 
    • Scaly, rough patches of skin
  • Dry skin
  • Sensitive skin
  • Skin discoloration (especially red or pink)
  • Increased skin creasing on the palms and/or an extra fold of skin under the eye
  • Darkening of the skin around the eyes

Symptoms of psoriasis may include:

  • Patches of skin that are:
  • Thick, dry, and raised (called plaques)
  • Silvery-white scales that itch or burn
  • Red or dark
  • Dry, cracked skin that itches or bleeds
  • Rashes on the genitals and in skin folds (armpits, groin, or under the breasts)
  • Nail changes 
    • Crumbling
    • Differences in color 
    • Pitting
    • Ridges
    • Thickening
  • Psoriatic arthritis occurs in some patients and symptoms include stiff, swollen, painful joints
  • Emotional effects

Symptoms of psoriasis may worsen (flare) for weeks to months and then subside (go into remission).

What Causes Eczema and Psoriasis?

The cause of eczema is not completely understood but people with a family history of eczema are at increased risk of developing the condition so it is believed that genetics play a strong role. 

Triggers for eczema symptoms may include:

  • Skin irritants
    • Hand and dish soap
    • Laundry detergent
    • Shampoo
    • Bubble bath
    • Body wash
    • Surface cleaners and disinfectants
    • Fresh fruit juice 
    • Perfumes and cosmetics
  • Cold or dry environments
  • Sweating
  • Emotional stress or anxiety
  • Rapid temperature changes
  • Wool or synthetic fibers such as polyester 
  • Dust or sand
  • Cigarette smoke
  • Metals (especially nickel)

Psoriasis is caused by an overactive immune system, but the cause of the immune system overactivity is unknown. 

Factors that can increase a person’s chances of developing psoriasis include:

Triggers for psoriasis flares include:

How Are Eczema and Psoriasis Diagnosed?

The diagnosis of eczema and psoriasis is based on a patient’s medical history, clinical symptoms, and a physical examination of the skin, nails, and scalp.

A small sample of skin may be taken (a biopsy) to help confirm a diagnosis.

What Are the Treatments for Eczema and Psoriasis?

Eczema is a chronic condition that worsens (flares) periodically in between times of mild to no symptoms. Eczema cannot be cured but it may be managed with home care and medications. 

Home remedies to reduce or relieve symptoms of eczema include: 

  • Identifying and eliminating triggers 
  • Keeping the skin hydrated
    • Emollients
      • Use thick creams (for example, Eucerin, Cetaphil, and Nutraderm) or ointments (such as petroleum jelly, Aquaphor, and Vaseline) that contain little to no water
      • Apply immediately after bathing for the best results
      • Apply twice daily or more frequently as needed
  • Bathing
    • Lukewarm baths or showers can hydrate and cool the skin and may help relieve itching
    • Use unscented, mild soap or non-soap cleanser (such as Cetaphil) sparingly
    • Apply an emollient immediately after bathing or showering 
    • Avoid hot baths or showers, or those lasting more than 10 to 15 minutes because they can dry the skin
    • Dilute bleach baths may be recommended decrease the number of bacteria on the skin that can cause infections or worsen symptoms 
      • Use one-fourth to one-half cup of bleach in a full bathtub (about 40 gallons) of water and bathe 5 to 10 minutes twice weekly, followed by application of an emollient
  • Wet dressings (wet wraps) may be used to help soothe and hydrate skin, reduce itching and redness, loosen crusted areas, and prevent skin injury due to scratching

Medications used to treat eczema include:

  • Over-the-counter (OTC) or prescription topical steroid creams or ointments 
  • Over-the-counter (OTC) or prescription oral antihistamines for itching 
  • Tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel)
  • Oral steroids (e.g., prednisone) may be used for short periods to treat severe flares
  • Injectable “biologics” such as dupilumab (Dupixent) for adults with moderate to severe eczema that has not responded to other treatments
  • Immunosuppressive drugs may be recommended for patients with severe eczema who do not improve with other treatments

Ultraviolet light therapy (phototherapy) is another treatment used to help control eczema. The treatment is reserved for patients with severe eczema who do not respond to other treatments because it is expensive and can increase the risk of developing skin cancer.

There is no cure for psoriasis, but treatments are aimed at relieving symptoms. Treatments for psoriasis include: 

  • Topical treatments, such as creams and ointments
    • Over-the-counter (OTC) topical treatments
      • Salicylic acid
      • Coal tar
      • Bath solutions such as oil, oatmeal, Epsom salts or Dead Sea salts
      • Fragrance-free moisturizers and soaps
      • Scale lifters (keratolytics) with an active ingredient of salicylic acid, lactic acid, urea, or phenol 
      • Anti-itch treatments such as calamine, hydrocortisone, camphor, diphenhydramine hydrochloride (HCl), benzocaine, and menthol (may increase irritation and dryness)
      • Aloe vera, jojoba, zinc pyrithione, and capsaicin may help moisturize, soothe, remove scale, or relieve itching 
      • Castederm may be used for inverse psoriasis to help dry moist plaques in the folds of the body
      • Coverings may be applied over some topical treatments such as cellophane, plastic wrap, waterproof dressing, cotton socks, or a nylon suit
  • Prescription topical treatments
  • Phototherapy (light therapy)
    • Ultraviolet light B (UVB): broad band and narrow band
    • Psoralen + UVA (PUVA) 
  • Systemic treatments

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References
https://www.uptodate.com/contents/eczema-atopic-dermatitis-beyond-the-basics?search=Eczema&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

https://nationaleczema.org/eczema/

https://www.uptodate.com/contents/psoriasis-the-basics?search=psoriasis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.psoriasis.org/

https://www.aad.org/public/diseases/eczema/childhood/child-have/difference-psoriasis