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Understand your skin condition: Eczema vs psoriasis

Close-up of eczema rash on hand
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Eczema and psoriasis are skin conditions that can cause similar symptoms – read on to find out how to tell the difference.

What is eczema?

Eczema, or dermatitis, is a common, non-contagious skin condition that affects children and adults. There are lots of different types of eczema, which vary in severity, but the basic symptoms are always similar: dry and very itchy skin which may also become red and sore.

The most common type of eczema is atopic eczema, which tends to affect people who have allergic conditions like asthma and hay fever. Other types include contact dermatitis, where the skin reacts to an irritant or allergen, and seborrheic dermatitis, which tends to affect the face and scalp.

Symptoms of eczema

People with eczema tend to have skin that is chronically dry and unable to retain moisture, making it more sensitive to infections and irritation.

If you have atopic eczema, you’ll have areas of skin that are itchy, dry, cracked and sore. Eczema normally develops on the hands, the insides of the elbows, and the backs of the knees, although it can affect any area of the body. Eczema in children commonly affects the face and scalp.

A complication of eczema is a skin infection. If this happens you might notice the following symptoms, in which case you should see a doctor as soon as possible:

  • Your eczema gets worse
  • A yellow crust or yellow-white spots appear on the surface of the affected skin
  • Fluid is oozing from the skin
  • Your skin is sore and swollen
  • You feel feverish and unwell

Atopic eczema doesn’t cause bad symptoms all the time – instead you’ll have flare-ups, during which your symptoms get worse, followed by periods when your symptoms improve. These flare-ups are usually triggered by exposure to an allergen or irritant, hormonal changes, or environmental factors.

Other types of eczema may cause slightly different symptoms. Seborrheic dermatitis, for instance, causes dandruff when it affects the scalp.

Who can be affected by eczema?

Eczema is a really common condition, especially atopic eczema – this type is thought to affect one in five British children, and one in ten British adults. You’re more likely to develop atopic eczema if you have one or more close family members with eczema.

What is psoriasis?

Psoriasis is a condition that causes patches of red, crusty and flaky skin to develop on the body. The most common type is known as plaque psoriasis – this is where affected areas of skin develop in large patches marked by a clear outline.

Psoriasis is caused by the body producing too many skin cells. Normally skin cells are replaced every three to four weeks, but in people with psoriasis this process happens every three to seven days. The build-up of skin cells is what causes plaques to form.

Symptoms of psoriasis

Plaque psoriasis causes areas of red and crusty skin to develop across the body – normally on the elbows, knees, scalp and lower back. Often these plaques are covered in silvery scales, and sometimes they might be itchy and sore. In more severe cases, plaques can crack and bleed.

Other types of psoriasis affect specific areas of the body, such as the nails, or cause slightly different skin symptoms. Guttate psoriasis causes small drop-shaped sores, while pustular psoriasis causes pus-filled blisters.

Who can be affected by psoriasis?

Psoriasis is thought to affect around 2% of Brits. It can begin at any age, but it’s more likely to develop in adults under the age of 35.

It isn’t clear why some people are more susceptible to psoriasis than others, but we do know that it can run in families.

Know the difference between eczema and psoriasis

If you think you have either eczema or psoriasis, you should make an appointment with your GP so they can take a look at your symptoms. In other words, you don’t need to self-diagnose!

However, it can be helpful to understand the general differences and similarities between psoriasis and eczema if you’re affected by either of them.

Appearance

Eczema usually appears as areas of dry skin, which may also be itchy, dry, cracked or sore. Depending on your skin colour your eczema may be red, dark brown or grey.

Psoriasis usually causes distinct areas of dry and crusty skin, which are often red with a ragged but clearly defined border. Plaques are often coated in silvery scales.

Itching

Eczema is characterised by very itchy skin, which leads to constant scratching. This scratching can in turn cause inflammation and bleeding, and make your skin more vulnerable to infection.

Psoriasis can also cause itching and soreness, but this isn’t the case for everyone.

Location

Eczema can occur anywhere but tends to develop on the fingers, inside the elbows, and behind the knees. It can also develop on the face and scalp in children.

Psoriasis tends to develop in similar areas to eczema, such as the elbows and knees. It’s also quite common for it to affect the lower back and the scalp.

Treating eczema

Eczema can’t be cured but it can be managed with the daily use of emollients (moisturisers) and the occasional use of topical corticosteroids when symptoms worsen. Emollients are particularly important as they help to keep the skin properly moisturised, which helps protect it from irritants, allergens and infections.

In addition, you can take preventative action by working out your eczema triggers and trying to avoid them wherever possible.

Other treatments include:

  • Calcineurin inhibitors like pimecrolimus or tacrolimus for use in sensitive areas
  • Antihistamines to combat severe itching
  • Bandages or wet wraps to prevent scratching, and moisturise and heal the skin

If your eczema is very severe, you’ll need to be referred to a dermatologist for specialist treatment like very strong topical corticosteroids or immunosuppressant tablets.

To learn more, read this article: Eczema cream.

Treating psoriasis

Like eczema, psoriasis can’t be cured, but the symptoms can be managed with the right treatment.

The main treatments for psoriasis are emollients (for use all over the body) and topical corticosteroids (for use on affected areas). You might also be prescribed:

  • Vitamin D analogues, which can be used alongside steroids
  • Calcineurin inhibitors like pimecrolimus and tacrolimus for use in sensitive areas
  • Coal tar, which may be used in combination with phototherapy
  • Dithranol

Other than topical treatments, psoriasis can be treated with phototherapy, where natural and artificial light is directed at affected skin. Another option for severe psoriasis is a systemic treatment like methotrexate.

To learn more, read this article: Psoriasis treatment.

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References:

https://eczema.org/information-and-advice/types-of-eczema
https://eczema.org/information-and-advice/types-of-eczema/atopic-eczema/
https://www.nhs.uk/conditions/atopic-eczema/symptoms/
https://www.nhs.uk/conditions/atopic-eczema/causes/
https://eczema.org/information-and-advice/types-of-eczema/seborrhoeic-dermatitis-in-adults/
https://www.psoriasis-association.org.uk/plaque-psoriasis
https://www.nhs.uk/conditions/psoriasis/
https://www.nhs.uk/conditions/psoriasis/symptoms/
https://www.nhs.uk/conditions/atopic-eczema/treatment/
https://www.nhs.uk/conditions/psoriasis/treatment/