What’s the difference between eczema and psoriasis?

You’ve got a red, itchy rash that won’t go away. And you can’t stop scratching, even though it hurts sometimes. You may be dealing with either eczema or psoriasis — but how can you tell the difference?

These skin conditions are often mistaken for each other, says board-certified dermatologist Cheryl Rosen, MD. She’s the director of dermatology at BowTiedLife.com. “They both cause a red, itchy rash, but they are actually quite different.”

To get the right treatment, use these expert tips to figure out what you might be dealing with.

Eczema and psoriasis 101

Eczema affects about 31 million people in the U.S., according to the National Eczema Association. And about 7.5 million adults have psoriasis, per the National Psoriasis Foundation.

Understanding the difference between them is tricky. Both diseases are chronic, and both involve the immune system and tend to run in families, says Stephanie Cotell, MD. She is a board-certified dermatologist at Northeast Dermatology in Gahanna, Ohio.

With psoriasis, the body’s immune system goes into overdrive and produces too many skin cells. Those cells pile up on the skin’s surface and cause lesions. In people with eczema, the immune system overreacts to a trigger and causes inflammation of the skin.

How to tell eczema and psoriasis apart

Telling these conditions apart can be a challenge, but there are telltale signs. Asking yourself these questions can help:

What does the rash look like? In general, psoriasis appears as raised pink patches with well-defined edges and thick silvery scales, says Dr. Cotell. These are called plaques.

Psoriasis plaques tend to occur on the elbows, knees, torso and scalp. Psoriasis can also affect the fingernails and toenails, causing the nail to lift off the nailbed. In rare instances, psoriasis leads to pus-filled lesions.

With eczema, the skin can be red (in lighter skin tones) or ashen, gray, dark brown or purple (in darker skin tones). Because eczema is caused by inflammation, the skin can also be dry, cracked and rough. In severe cases, you’ll notice swelling, oozing or crusting.

Eczema frequently appears on the inner surface of the elbows and knees, as well as the neck and hands.

(Read more about eczema and psoriasis symptoms.)

How bad is your itch? If your skin is extremely itchy, you might have eczema. Eczema is known as “the itch that rashes,” says Dr. Cotell. Intense itching is its most common symptom. If you have a really bad case, the itch may be so bad that it wakes you up at night. And if you scratch too much, your skin may bleed and get infected.

Psoriasis tends to feel more like a burning or biting sensation, similar to a bite from a fire ant. “Psoriasis patients may experience itching and pain as well,” says Dr. Cotell. But in general, people with psoriasis have milder symptoms than those with eczema.

Expert tip: No matter what type of itch you have, try not to scratch it. That can irritate and damage the skin. To get relief, take these steps:

• Slather on a thick moisturizer several times a day.
• Apply warm or cool compresses.
• Avoid very hot baths or showers.
• Try over-the-counter anti-itch formulations, such as calamine lotion, aloe vera gel or hydrocortisone.

Worried about a rash you think might be eczema or psoriasis? You can schedule a virtual visit with one of our healthcare providers today. Start here.

Have you noticed triggers? Certain things can cause either condition to flare up. Eczema can be triggered by:

• Soaps, shampoos, detergents
• Allergies
• Sensitivities to certain foods
• Environmental factors
• Stress
• Emotional issues

In response to a trigger, the body’s immune system “switches on” and the skin acts up.

Eczema is also associated with a history of asthma, hives, hay fever and allergies, says Dr. Cotell. That means that if you have one of those conditions, you’re more likely to get eczema.

Psoriasis has its own list of triggers, including:

• Infections
• Stress
• Severe sunburn
• Skin injuries
• Certain medications
• Withdrawal from oral steroids
• Environmental factors (such as smoking or cold weather)

When you should see a doctor

It’s a good idea to seek care early if you think you might have eczema or psoriasis. Your dermatologist can educate you about the best way to treat your rash. They will also come up with a plan to minimize future flares.

Your doctor might prescribe topical corticosteroid creams or other prescription creams for each specific condition. Oral or injectable medications are effective in more severe cases, says Dr. Cotell.

If you are diagnosed with psoriasis, it’s important to know that you have an increased risk of other health issues. Those include metabolic syndrome, psoriatic arthritis, Type 2 diabetes, cardiovascular disease and obesity, says Dr. Cotell. That’s another great reason to get checked out by a doctor sooner rather than later.

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Practice healthy skincare

Whether or not you’re currently experiencing itchy symptoms, it’s important to look after your skin — which is technically the body’s biggest organ.

One way to help promote healthy skin is to maintain your skin barrier. That’s the outermost protective layer of skin. Here’s what to do:

• Moisturize every day with a thick, fragrance-free body lotion.
• Avoid contact with harsh chemicals, such as cleaning solutions.
• Cover your skin in cold or windy weather.
• Use a gentle, allergen-free soap.

And don’t forget the positive effects of simple healthy skin habits. Eat a nutritious diet (with lots of fruits, veggies, whole grains and lean proteins). Exercise regularly. And try to get 7 to 8 hours of sleep each night. When you support your overall health, you’ll reduce your stress level. That’s good for your skin — and the rest of your body, too.

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Additional sources
Symptom differences: National Eczema Association (2021). “Is it eczema or psoriasis?”
Eczema statistics: National Eczema Assocation
Psoriasis statistics: National Psoriasis Foundation