When comparing psoriasis vs eczema, there are a few key differences to know.

If you’ve got itchy, discoloured, and flaking patches of skin, it’s natural to be a bit concerned about what’s causing those symptoms. And although it’s always best to book an appointment with a dermatologist when new skin symptoms crop up, it’s inevitable that you’ll be doing a little bit of self-diagnosis (hello internet research rabbit hole), and likely doing a psoriasis versus eczema comparison.

Psoriasis and eczema are two fairly common skin conditions, and both cause symptoms like itching and visible inflammation. These two conditions also share a few other similarities: They’re both chronic, which means symptoms are managed, not cured, and both can be triggered by genetics and environmental factors.

That being said, the treatment options and long-term management of psoriasis and eczema are quite different. So it’s important to know for sure which one you are dealing with. “Both eczema and psoriasis cause inflamed, scaly areas on the skin, and to the untrained eye, they can look similar,” Alan J. Parks, MD, a board-certified dermatologist in Columbus, Ohio, tells SELF.

SELF spoke with several board-certified dermatologists to lay out the difference between eczema and psoriasis.

What are psoriasis and eczema, exactly?
Psoriasis is an autoimmune condition that affects about 7.5 million Americans, according to the American Academy of Dermatology. It happens when your skin cells go through their life cycle more quickly than normal. Typically it takes about a month for skin cells to regenerate, but people with psoriasis, this cell-turnover process happens every three to four days, according to the Cleveland Clinic. The build-up of new skin cells results in flaky scales on the skin’s surface.

Eczema is much more common than psoriasis, affecting between 2 and 10% of all adults.1 Eczema causes patches of dry, itchy skin that tend to turn into a rash when you scratch or rub it. These patches are prone to bacterial, viral, and fungal infections. That’s because, at its core, eczema is tied to a gene variation that affects the skin barrier and its ability to protect your skin from everything from bacteria to irritants and allergens. Eczema flares are triggered by environmental and lifestyle factors, such as irritating skin care products, dry skin, and stress. The main symptom of eczema is itchy, flaky skin, but people who have eczema as children are more likely to develop asthma and environmental allergies.

Why are eczema and psoriasis sometimes mistaken for each other?
Eczema may sometimes be mistaken for psoriasis because it causes a painful, itchy rash that may even appear raised. To the untrained eye (or anxious self-diagnoser), this might make an eczema patch look like a psoriasis plaque.

Psoriasis and eczema aren’t likely to be confused by a trained dermatologist, though, Azeen Sadeghian, MD, FAAD a board-certified dermatologist in Baton Rouge, Louisiana, tells SELF. But she notes that there are some exceptions. “Some cases are challenging because the eczema patches have become thickened enough to resemble psoriasis,” she says. Experts call this thickening “lichenification.”

It’s tempting to think of eczema as “psoriasis light,” which will eventually worsen and become psoriasis. But eczema will not develop into psoriasis. They are two separate conditions, with separate underlying causes. However, it is possible to have both eczema and psoriasis. This condition is called eczematous psoriasis, sometimes known as PsE, according to a 2015 study published in the Journal of Clinical Medicine.2

Both psoriasis and eczema cause redness on lighter skin tones. If you have darker skin, that redness might look more like brown or purple discoloration. These differences can sometimes lead to a misdiagnosis, or a delay in the time it takes to get a proper diagnosis, according to the National Eczema Foundation. “It might be harder to perceive redness or what we call erythema because of the pigment of the skin,” explains Dr. Sadeghian. She also points out that psoriasis can rev up the pigment production in skin of colour, causing darker plaques.

The National Psoriasis Foundation notes that a delay in diagnosis can mean people with darker skin tones aren’t able to take advantage of early treatment options. Research is still underway to understand how to best identify psoriasis in people with darker skin tones.

What is the age of onset for psoriasis vs. eczema?
One big difference between eczema and psoriasis is the age of diagnosis. Eczema is commonly found in children, many of whom grow out of their symptoms or see a severe reduction in symptoms as they age. That doesn’t really happen with psoriasis.

“Usually, you’ll see eczema in the paediatric population,” says Dr. Sadeghian. Between 15 and 30% of children will have eczema at some point and between 2 and 10% of adults. The average age of diagnosis is one year old.

Psoriasis tends to appear in what doctors call a “bimodal age distribution,” says Dr. Sadeghian. That means that symptoms tend to first appear in two different decades of life. For psoriasis, your diagnosis will most likely be either between the ages of 20 and 30 or ages 50 and 60, according to a 2017 study published in the journal JAMA Dermatology. In about a third of cases, psoriasis begins in early childhood (although those rates have been rising in recent years). However, it may be more likely to be misdiagnosed as eczema in young children, partly because children with psoriasis may have less obvious scaling.

What are the symptoms of psoriasis vs. eczema?
The most common type of psoriasis is plaque psoriasis, per the Mayo Clinic. There are other types of psoriasis as well, but plaque psoriasis is most likely to be misidentified as eczema. The symptoms of plaque psoriasis are most often found on the scalp, elbows, knees, lower back, and genitals and may include:

Raised, inflamed patches of skin
A silvery-white coating of dead skin cells on top of those patches
Itchiness
Pain
Cracking skin and bleeding
Eczema symptoms are similar but do have several important differences.

Eczema is really the collective name for a group of conditions that cause the skin to become red, itchy, and inflamed. The most common form of eczema is atopic dermatitis, which is why “when most people say ‘eczema,’ they usually mean atopic dermatitis,” Todd Minars, MD, an assistant clinical professor of dermatology at the University of Miami School of Medicine, tells SELF. Symptoms of atopic dermatitis can include:

Dry, itchy patches of skin
Small red-to-brownish-grey raised bumps
Cracked or scaly skin

How do psoriasis and eczema affect different areas of the body?
Psoriasis and eczema may look different depending on what part of your body is affected. Here’s a rundown of what you might see:

The hands: Hand eczema is extremely common and is often caused by exposure to irritants like hand soaps, harsh detergents, and touching other chemicals. The skin might itch, feel swollen, and look inflamed and flaky. Hand eczema often appears on the tops of your hands, though it can happen anywhere. Psoriasis that appears only on your hands is palmoplantar psoriasis. You may notice nail ridges or pitting, in addition to inflammation and scaling. The scaling may appear on the palms first.

The face: It’s estimated that 50% of people with psoriasis will have symptoms on their faces, according to the National Psoriasis Foundation. Plaques can show up around your eyes, in and around your mouth, around and behind your ears, and in the ear canal. These scaly plaques can be quite painful and irritating and cause inflamed skin, burning, itching, and bleeding. Facial eczema can sometimes be found on your cheeks, on and around your scalp, and on your mouth and chin.
The legs: Psoriasis on your legs will generally be similar to psoriasis on other parts of your body. It may appear in small patches of inflammation that are then covered by white or grey scales, or it may take the form of scaly patches with small, pus-filled bumps. Eczema on your legs will sometimes appear in the folds of your skin behind your knees.


While eczema and psoriasis can show up just about anywhere on the body, the above areas are generally more common areas for both to appear.

What are the causes of psoriasis and eczema?
“What we know is that psoriasis is immune-mediated, meaning there is some imbalance in the immune system, which leads to inflamed skin,” dermatologist and National Psoriasis Foundation medical board member Jashin J. Wu, MD, tells SELF. “It tends to run in families, but there may not be straightforward patterns of inheritance. One well-known trigger of psoriasis is strep throat infections, but not all new cases of psoriasis result from strep throat.” That doesn’t mean strep throat in and of itself can cause psoriasis in anyone, but it can trigger the condition in someone who is already predisposed to psoriasis.

Psoriasis can also occur at the site of skin trauma. As the cut or scrape heals, psoriasis lesions develop.4 This is called Koebner’s phenomenon, says Dr. Sadeghian.

People with eczema have certain genes that are responsible for impairing the skin’s ability to act as a barrier to irritation. Dr. Sadeghian says that having a family history of eczema means that it’s more likely you’ll develop the condition. Neither eczema nor psoriasis is contagious.

Are psoriasis and eczema diagnosed differently?
Psoriasis and eczema are both diagnosed by a comprehensive examination from your dermatologist. There’s no lab test necessary to diagnose either condition. According to the American Academy of Dermatology, eczema and psoriasis tend to look quite different to someone with dermatological training. Eczema can typically be established with a simple visual assessment.

A psoriasis diagnosis could be slightly more involved. For one, if your dermatologist suspects that you have psoriasis, they may take a small sample of your skin cells (called a biopsy) to be analyzed in a lab. This is to determine which type of psoriasis you’re dealing with. Then, they’ll do a detailed calculation—taking into account your symptoms and how much of your body is affected—to figure out the severity of your psoriasis. The result of this calculation is called your PASI Score.

Can stress trigger psoriasis and eczema?
Eczema and psoriasis have some similar triggers. In both cases, flare-ups can occur because of environmental factors, changes in climate, and viral or bacterial infections. Eczema triggers tend to be things that dry out your skin, but psoriasis triggers are often linked to the immune system (like strep throat). One trigger they both have in common? Stress.

“Whenever the body is under a stressful situation or is fighting off an infection, it increases inflammation in the body. If you’re already predisposed genetically to develop a condition, then the stress can kind of unmask it. If you’ve already been diagnosed, stress or infection can cause a flare,” says Dr. Sadeghian. Of course, living with a chronic condition itself is stressful, which can create a stress-flare cycle that’s hard to break.

When it comes to the research about stress and skin conditions, the results are mixed. A 2017 study published in the British Journal of Dermatology evaluated 39 studies with more than 32,500 patients and concluded that there was no convincing evidence that stress could exacerbate psoriasis.5 However, a 2016 study published in the Journal of Aesthetic and Clinical Dermatology found that stress and other mental health conditions do cause flare-ups.6 As for eczema, a 2017 study published in the International Journal of Molecular Sciences did find evidence that psychological stress may exacerbate atopic dermatitis.

Just because science hasn’t fully clarified the role stress plays in these conditions doesn’t mean the link doesn’t exist. Dr. Wu says he’s seen a number of patients who experience stress-related psoriasis or eczema flare-ups in his practice.

What are the treatments for psoriasis vs. eczema?
Though psoriasis and eczema are different conditions, first-line treatments for the two are often similar, according to Penn Medicine. If you’re diagnosed with psoriasis or eczema, your doctor may recommend:

Over-the-counter moisturizers to soothe irritated skin
Topical medications to reduce inflammation, like corticosteroids, and calcineurin inhibitors (immunosuppressants)
Oral steroids, like prednisone, which can be used for a short period of time to help calm a severe case
Wet dressings, which involve wrapping the area with a wet bandage to soothe the itchiness
Phototherapy, in which a special machine emits a very filtered, narrow wavelength of ultraviolet light onto the skin to help reduce itching and inflammation
If your psoriasis or eczema doesn't respond to the above treatment methods, or if it is already considered moderate to severe, your doctor may recommend that you start with a class of treatment called biologics, which are injectable medications that target a specific part of your immune system to interrupt the immune response and quell inflammation. There are a number of biologics available to treat psoriasis and far fewer for eczema, but it may take some trial and error to figure out which one is best for you. Interesting new research published in the Archives of Dermatological Research suggests that your ethnicity may even play a role in which biologic medication will work best for your psoriasis treatment.

Both psoriasis and eczema can have a pretty tangible impact on your quality of life. If you’re struggling with managing your psoriasis or eczema, see a board-certified dermatologist, who can help determine the best treatment plan for you.

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