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It’s believed that about 7.5 million Americans have psoriasis and another 32 million or so have eczema. That combined population is likely used to experiencing dry and scaly patches, which is why it can be easy for the untrained eye to misidentify the two. “Eczema, or atopic dermatitis, and psoriasis are both very common skin conditions that are often confused by non-dermatologists,” says [Samer Jaber, MD](https://aedit.com/provider/samer-jaber-md-3882), a board certified dermatologist and founder of Washington Square Dermatology in New York City. “They are both red, dry, scaly and often itchy, so they can look similar to non-dermatologists.”

To the trained eye, however, that’s where the similarities between eczema and psoriasis usually end. In order to give your skin the care it needs, a proper diagnosis from a board certified dermatologist is key. To give us non-dermatologists a better understanding of the ins and outs of eczema and psoriasis, we’ve tapped two top physicians for their expert insight.  

## **Eczema & Psoriasis 101**
Both eczema and psoriasis are skin conditions that, in some instances, present similarly. According to [Marisa Garshick, MD](https://aedit.com/provider/marisa-garshick-md-313), a NYC-based board certified dermatologist, they can appear as “red patches and plaques” on the skin, but “the causes, triggers, appearance, and treatment may differ between the two conditions.” In terms of similarities, eczema and psoriasis “are both conditions that reflect inflammation in the skin,” she shares – though “they occur for different reasons and can appear differently on the skin.” In terms of visible differences, Dr. Jaber says “psoriasis is typically more thick and scaly than eczema,” while eczema is often itchier than psoriasis.

With that in mind, let’s take a closer look at each:

### **What Is Eczema?**
Also known as atopic dermatitis, [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter) “describes a condition when the skin becomes red, itchy, dry, and, sometimes, flaky,” Dr. Garshick shares. It is often genetic in etiology (if your parents had eczema, you likely will, too), and it “commonly appears in babies or early childhood,” she adds. While Dr. Jaber says that it “can improve as you get older,” it is “often seen in patients that also have allergies and asthma.” 

Eczema can affect any part of the body, but Dr. Jaber says it is more common “on areas that rub” such as “the inner elbow, behind your knees, neck, and arms, and legs.” Generally speaking, eczema is due to inflammation of the skin and is often triggered by irritants and things that dry out it out like harsh soaps, detergents, chemicals, clothing with a rough texture (think: wool), and stress. While we might think of cold winter climates as a culprit, warmer weather can exacerbate the condition, too. “For some people, intense heat and humidity can also aggravate the skin,” Dr. Garshick says. That includes hot showers.

**Your Eczema Cheat Sheet**

### **Causes & Triggers:**
- Inflammation 
- Genetics
- Environmental factors
- Stress

### **What it looks like:**
- Dry, itchy areas of skin
- Patches of red, gray, brown, or purplish skin 
- Affected areas can also be bumpy or uneven

### **Associated conditions:**
- Seasonal allergies or hayfever
- Asthma
- Family history

### **Common treatments:**
- Moisturizing, fragrance-free beauty routine 
- Lifestyle changes (i.e. shorter showers, humidifiers, etc.)
- Biologic medications

No two eczema experiences are the same. In mild cases, there may be just a bit of redness or flaking. In more severe instances, the skin can thicken, be very red, and peel. At its worst, it can put the skin at risk for superficial infections. Treatment can range from over-the-counter skincare to prescription medication depending on the severity.

### **What Is Psoriasis?** 
[Psoriasis](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-psoriasis) is “an inflammatory skin condition that is characterized by red, scaly, well-demarcated plaques with silvery scales that can occur anywhere on the body,” Dr. Garshick explains. Unlike eczema, “psoriasis usually starts in adulthood and rarely occurs in children,” Dr. Jaber notes. Studies show there may be a hereditary component, and it can be associated with diabetes and heart disease. The average age of onset generally occurs at two different peaks. According to Dr. Garshick, the first is 15 to 35 years old and the second is 55 to 60 years old. 

Common areas that are affected by psoriasis include the scalp, elbows, knees, lower back, nails, hands, and feet. “Psoriasis tends to affect the extensor surfaces, such as the knee and elbow, and can be associated with joint pains and psoriatic arthritis,” Dr. Garshick shares. Flare-ups can be brought on by a variety of factors. “Psoriasis is often triggered by changes in the season, stress, alcohol, and skin trauma,” Dr. Jaber says. It can also be exacerbated in the aftermath of infections like strep throat, he adds. 

**Your Psoriasis Cheat Sheet**

### **Causes & Triggers:**
- Injury (think: insect bites, sunburn)
- Certain illnesses & medications
- Temperature changes
- Smoking & alcohol consumption 

### **What it looks like:**
- Red or pink plaques
- Raised rash with scales
- Clearly defined patches

### **Associated conditions:**
- Psoriatic arthritis
- Certain autoimmune conditions, including Crohn’s disease
- Type 2 diabetes

### **Common treatments:**
- Topical steroids
- Vitamin D analogs
- Narrowband phototherapy
- Lifestyle changes (i.e. diet, stress, etc.)

Eczema and psoriasis are similar in that every case is different. The condition usually manifests in unpredictable cycles that alternate between periods of few to no symptoms and more intense flare-ups. For some, psoriasis is a mostly cosmetic concern. But, for others, it can cause discomfort (physical and mental) and impact quality of life.

## **Diagnosing Eczema & Psoriasis**
If you are experiencing patches of scaly skin, the best way to determine whether you have eczema, psoriasis, or another skin condition is to schedule an appointment with your dermatologist. “In addition to the locations involved, associated symptoms, and the characteristic appearance, the most definitive way to distinguish the two is with a skin biopsy,” Dr. Garshick says. While the latter may be the most definitive, it’s not foolproof. “There are scenarios when even that is not conclusive to differentiate the two,” she admits.

When it comes to the physical exam, there are some specific indicators to keep an eye out for. “Eczema tends to be more ill-defined in the edges, while psoriasis is more well-demarcated,” Dr. Garshick explains. “Psoriasis is also known to experience the Koebner phenomenon, which is the appearance of new skin lesions in areas of skin trauma or injury in otherwise healthy appearing skin.”

Diagnosis may, however, be a little more nuanced on the face. Dr. Garshick says that it can sometimes be “challenging” to distinguish between eczema and psoriasis on the face – though “there are some hints based on location.” Because people with eczema tend to have more [sensitive skin](https://aedit.com/aedition/difference-between-sensitive-vs-sensitized-skin) in general, it “tends to favor the area around the eyes and mouth” and can be “more pronounced in areas of the face where the skin is thinner,” Dr. Garshick shares. This is not usually true of psoriasis. “On the face and scalp, some individuals can experience an overlap of psoriasis and seborrheic dermatitis (dandruff), which can affect the hairline, forehead, and eyebrows,” she adds.

## **Treating Eczema & Psoriasis**
Not only can a dermatologist diagnose your skin condition, but they can develop a treatment plan for it, too. “A dermatologist can help guide you on how to distinguish psoriasis from eczema as well as the specific treatment course,” Dr. Garshick says. This may include over-the-counter and prescription skincare, oral and injectable medications, and in-office procedures. “While the types of treatments may be similar – as both can be treated with topical creams as well as light therapy and oral or injectable medications – the specific ways and medications to treat the conditions can differ,” she notes. “It is always important to see a dermatologist to determine the best treatment options for you.”

### **How to Treat Eczema**
There are many ways to treat atopic dermatitis, and many of them require little to no professional intervention. “I always recommend starting out with simple lifestyle changes,” Dr. Jaber says. These modifications include:

- Using a [fragrance-free](https://aedit.com/aedition/fragrance-free-beauty-skincare-for-sensitive-skin) soap
- Taking shorter, cooler showers
- Patting (not rubbing) your skin dry
- [Moisturizing](https://aedit.com/aedition/best-body-creams-lotions-balms-for-every-skin-concern) twice a day 
- Running a [humidifier](https://aedit.com/aedition/humidifiers-facial-steamers-for-skincare-dry-skin-acne) at home
- Avoiding fragrance & skin irritants 

With your skincare routine, it’s all about preventing [dry skin](https://aedit.com/aedition/how-to-treat-prevent-dry-skin-face-body-hands) and irritation, but know that these changes may not be enough for everyone. “If, despite this, you still struggle with eczema, see a dermatologist for topical prescription medications,” Dr. Jaber says. “There are both steroid and non-steroid topical medications that work very well for mild to moderate eczema.” From a prescription perspective, Dr. Garshick points to non-steroid anti-inflammatory creams like Eucrisa® (crisaborole) and Elidel® (pimecrolimus) and injectable Dupixent® (dupilumab). For some patients, light therapy may also be effective. In the most severe cases, Dr. Jaber says there have been “some amazing advancements” in the treatment of eczema with biologic medications. 

### **How to Treat Psoriasis**
Psoriasis flare-ups can be unpredictable, and, as Dr. Garshick shares, “treatments do not provide a permanent cure” and “there’s always the chance it can come back.” Even so, there are some lifestyle adjustments that can help manage and maybe even prevent relapses. They include eating a [well-balanced diet](https://aedit.com/aedition/best-diet-for-healthy-beautiful-skin), maintaining a healthy body weight, keeping stress levels in check as much as possible, and many of the eczema-prevention tips outlined above. “Since psoriasis has been found to be associated with other medical conditions, such as an increased risk of heart disease, certain lifestyle modifications, such as weight loss and exercise, can be helpful for those with psoriasis and has been shown to improve psoriasis skin severity,” she notes.

From there, a multi-modal treatment plan often works best. Both of our experts agree that topical steroids and/or topical [vitamin D](https://aedit.com/aedition/guide-to-vitamin-d-in-skincare-wellness) analogs, like calcipotriene, can be effective – especially in the treatment of mild psoriasis. For moderate to severe cases, narrowband phototherapy and biologic medications are often a solution. As Dr. Garshick explains, the latter are “injections that target the immune system” and “have been a great advance” in the treatment of psoriasis because they allow patients to see results and clearer skin “relatively quickly.”

In terms of at-home skincare, Dr. Garshick says exfoliating acids can help to smooth scaly skin. “As some of the plaques can be thick, it can be helpful to use [salicylic acid](https://aedit.com/aedition/guide-to-beta-hydroxy-acids-salicylic-acid-in-skincare)-based creams on the plaques to help exfoliate and eliminate the dead skin cells,” she shares. Oh, and then there is this piece of advice that is true of psoriasis and pretty much every other skin concern: Don’t touch it. “You don’t want to manually pick off the scales in psoriasis, as that can trigger more scales,” she warns.

## **The Takeaway**
If you have red, rough patches of skin that are not responding to your usual hydrating skincare routine, it’s time to visit the experts to figure out the root cause. Even an article as comprehensive as this one cannot replace the expert eye of a [board certified dermatologist](https://aedit.com/aedition/skin-care-questions-for-your-dermatologist) when it comes to diagnosing and subsequently treating both eczema and psoriasis. Once you know what skin condition you are dealing with, you’ll be able to establish a treatment plan – including the necessary lifestyle adjustments – accordingly.

Expert Opinion

To the untrained eye, it can be difficult to distinguish between the red, scaly patches of skin. Here’s what you need to know about the common skin conditions.

Eczema vs. Psoriasis: What's The Difference Between The Skin Conditions?

Eczema vs. Psoriasis: What’s The Difference?

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Psoriasis is a chronic skin condition that is believed to impact two to three percent of the population. It causes patches of inflamed, red, and flaky skin on the face and body that tend to have a silvery appearance. These symptoms are caused by the overproduction of skin cells, and, for those who suffer from psoriatic arthritis, it can also lead to joint pain and stiffness. What causes someone to develop psoriasis remains somewhat of a mystery, and there is currently no cure. Treatments are highly personalized in nature and often require quite a bit of trial and error to determine what works best.

In honor of World Psoriasis Day, we spoke to New York City-based board certified dermatologist [Morgan Rabach, MD](https://lmmedicalnyc.com/dr-morgan-rabach/), and two psoriasis patients to better understand the skin condition and how to manage it.

## **What Is Psoriasis?**
Not to be confused with [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter) or [rosacea](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-rosacea), psoriasis is a chronic skin condition that causes patches of red, dry, flaky skin. It most commonly appears on the elbows, knees, lower back, and scalp, but the patches can show up anywhere on the body. No two psoriasis cases are the same, and the condition usually manifests in unpredictable cycles that alternate between periods of no (or minor) symptoms and more intense flare-ups. During these relapses, the patches of irritated skin can be large, itchy, burning, and even painful.

The severity of the condition varies by patient. For many, psoriasis patches are more of a cosmetic concern than anything else. But, for others, the discomfort and appearance of large areas of irritation can affect their quality of life — causing physical pain and discomfort.

## **Who Does Psoriasis Affect?**
According to the World Health Organization’s [2016 Global Report on Psoriasis](https://apps.who.int/iris/handle/10665/204417), the condition affects men and women equally. It is thought that some 100 million people worldwide have been diagnosed with the condition, and it would appear that it is gradually becoming more common.

There are slightly higher numbers of cases of recorded cases in Caucasian patients compared to other ethnicities, but this disparity may be due to differences in the number of people seeking treatment in different demographics. There are no clear factors that make one group more susceptible to the condition than others, though there is often a misconception that psoriasis is a contagious skin condition. Psoriasis is not contagious, and it is thought to be triggered by certain infections, genetics, and injuries to the skin.

## **What Causes Psoriasis Flare-Ups?**
Psoriasis flare-ups can be caused by a variety of triggers, Dr. Rabach says. She lists medications, stress, illness, changes in weather, alcohol consumption, and smoking as some potential culprits. There are no specific irritants (such as ingredients in foods, cosmetics, or detergents) that are known to trigger psoriasis relapses. As a result, treatment plans for patients with psoriasis may include lifestyle changes that help manage and prevent future relapses. Dr. Rabach advises that people eat a [well-balanced diet](https://aedit.com/aedition/best-diet-for-healthy-beautiful-skin), [maintain a healthy body weight](https://aedit.com/aedition/best-fitness-classes-workouts-exercises-to-try-at-home), and [destress](https://aedit.com/aedition/impact-of-stress-on-skin-acne-wrinkles-dryness) whenever possible to stay on top of symptoms. 

### **The Relationship Between Psoriasis & Arthritis**
Around a third of people who have psoriasis will develop psoriatic arthritis. The condition can develop up to 10 years after a person first experiences skin complaints linked to psoriasis, and experts believe it happens because the immune system begins to attack healthy tissue by mistake. Not everyone who has dermatological symptoms will go on to develop arthritis, but it’s not clear why some people do while others don’t.

To treat psoriatic arthritis, patients are advised to first consult with their primary care physician before being referred to an internist or rheumatologist to manage the condition moving forward. Treatment usually includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and disease-modifying anti-rheumatic drugs (DMARDs), which can be particularly effective when taken early on in the degenerative process.  

## **How Is Psoriasis Treated?**
Courses of treatment for psoriasis often involve a combination of topical creams, [light therapy](https://aedit.com/aedition/everything-you-need-to-know-about-the-benefits-of-light-therapy), and lifestyle modifications. “The standard of care for patients with psoriasis are topicals consisting of different strengths of steroids and vitamin D cream,” Dr. Rabach explains. “Depending on how much of the body’s surface area is affected, we use light therapy — usually narrowband UVB.” For smaller areas, she uses an excimer laser. 

There is more recent research into whether biological medications, which alter the immune system, can help treat psoriasis, but Dr. Rabach cautions that there is a lack of long-term data to support such options.

## **Patient Perspective**
We spoke to two people who have different experiences of living with psoriasis. Joey is managing an increasing number of relapses, while Sue is experiencing the onset of psoriatic arthritis. 

### **Joey, 32, New York City**
*Joey was diagnosed with psoriasis three years ago. Her first flare-up occurred during a stressful period when she was completing her PhD. Relapses have become increasingly frequent, but she is able to keep symptoms under control working closely with a dermatologist.*

<Dialogue>
  <Question party={The AEDITION}>
    What does psoriasis look like for you?
  </Question>
  <Response party={Joey}>
    My psoriasis symptoms are mostly patchy red rashes that tend to be pretty flakey and sore. I usually get them on my hands, forearms, and back. The ones on my knuckles, in particular, get very painful. It’s something I have lived with for a little while now, so I can spot the very first signs that a relapse is on its way. Because we still haven’t found a treatment that works well for me, I have to see my dermatologist regularly. It also has an impact on me emotionally. It’s a condition that’s not really severe enough for me to consider myself ‘ill,’ but I don’t feel like a completely healthy 30-something anymore, which can be tough at times.
  </Response>
  <Question party={The AEDITION}>
    What treatments have you tried?
  </Question>
  <Response party={Joey}>
    So far, we’ve managed to find some creams that make me more comfortable, but they do not seem to shorten the length of time my flare-ups last. Each time I have a flare-up, we decide whether to stick with what kept me comfortable last time or if we should try something new. It’s quite experimental, but I’m pleased I’m able to manage the discomfort now. On the other hand, the fact that my particular case affects my hands and forearms means that I am self-conscious a lot of the time. It’s something I am working on with a therapist as well as with my dermatologist to approach things from both perspectives.
  </Response>
  <Question party={The AEDITION}>
    How does psoriasis impact your daily life?
  </Question>
  <Response party={Joey}>
    Initially, the impact showed through in my confidence levels. I went from wearing sleeveless tops and dresses to wanting to wear long sleeves all the time. I would dread hot summer days when I’d have to show my skin. These days, it means I spend a lot of time taking care of myself. I have overhauled my diet to eat clean and unprocessed foods. I practice yoga and meditation to manage stress. It isn’t always easy, but I’m finding it easier the longer I live with it. It’s like anything: It’s a shock and quite strenuous to begin with, but, over time, you adapt.
  </Response>
</Dialogue>

### **Sue, 45, Denver, CO**
*Sue was dealing with dermatological symptoms of psoriasis for close to a decade before she began experiencing joint pain. She received a diagnosis of psoriatic arthritis after a series of tests and has been adapting her lifestyle and adjusting medication ever since.*

<Dialogue>
  <Question party={The AEDITION}>
    What does psoriasis look like for you?
  </Question>
  <Response party={Sue}>
    Psoriasis has been a part of my life for quite some time, and it’s something I knew I may be at risk of developing because I have a family history of the condition. In the beginning, it was mostly just a few flakey patches of skin from time to time. Gradually, it developed into a more significant problem for me, with the patches getting larger during flare-ups. More recently, joint pain is something I have to live with.
  </Response>
  <Question party={The AEDITION}>
    What treatments have you tried?
  </Question>
  <Response party={Sue}>
    The treatment is two-fold. I see a dermatologist who has found great solutions for the dermatological side of the issue. I have light therapy and also apply a couple of steroid creams that appear to work very well. The joint pain is managed with some relatively mild anti-inflammatory drugs for now, but I have a treatment plan set out in case things get worse.
  </Response>
  <Question party={The AEDITION}>
    How does psoriasis impact your daily life?
  </Question>
  <Response party={Sue}>
    It’s quite a variable thing. I can be fine on some days and in a lot of pain on others. That’s probably the most difficult aspect — not knowing when I’m going to feel alright or not. I have already adapted my lifestyle significantly to prepare for the bad days to become more frequent. I now work for myself so I can set my own pace. When I recently moved, I opted for a single-story house as opposed to one with stairs. On good days, there is no difference between my abilities and anyone else’s, but it’s something that is there in the background that I have to be aware of.
  </Response>
</Dialogue> 

## **The Takeaway**
Like so many skin conditions, living with and treating psoriasis is a very personal experience. Some patients only experience mild dermatological symptoms, while others have more severe flare ups and develop psoriatic arthritis. If you think you might be experiencing skin concerns related to psoriasis, it is important to consult with a board certified dermatologist to create the best treatment plan for your needs.

Patient Perspective

In honor of World Psoriasis Day, The AEDITION speaks with a board certified dermatologist and patients about their experiences living with and treating the chronic skin condition.