Psoriasis or Eczema?

Eczema presents as thinner patches of dry red or brown, bumpy skin, and the borders between affected and unaffected skin are less well-defined than with plaque psoriasis, he says. Infants with eczema may present with tiny bumps on the cheeks, while older children and adults may present with a rash in the creases and folds of the body, such as the inner elbow, or behind the knees. [4] The rash may also present on the neck and trunk. [1] Small, fluid-filled sacs may ooze or crust. Eczema on darker skin tones may look darker brown, purple, or grey and may show signs of skin swelling and dryness. [3]

Both eczema and psoriasis can affect the palms of the hands and soles of the feet, though psoriasis is more often the diagnosis when presentation occurs on the soles. [1]

With both, the skin may burn or feel very itchy, Dr. Yosipovitch says. Itching may be a more common complaint in patients with eczema. While itch is a complaint, those with psoriasis more commonly complain of soreness or pain due to the cracking skin [3] and may also complain of joint pain. [1] One in 3 people with psoriasis will develop psoriatic arthritis (PsA), which can permanently damage joints. That is why those with psoriasis should screen regularly for PsA using the five-question screener.

While the majority of the cases may be easily distinguished by a health care provider, Dr. Yosipovitch advises providers to be aware of atypical presentations of psoriasis and eczema, highlighting forms of psoriasis that present similarly to eczema and noting that it is possible that a patient could have both conditions. 

Psoriasis that presents on the palms of the hands, in the folds of the skin, or on the scalp may not appear with the typical thick, silvery scales usually observed on lighter skin. These plaques may appear red, smooth, and shiny, [6] and the rash may be more diffuse with less distinct edges. [5] In cases like these, it may be possible to mistake psoriasis for eczema, Dr. Yosipovitch says.

“If a patient has a well-demarcated plaque with vesicles on his palms and soles, most probably this is more dyshidrotic eczema than psoriasis. Although, in some cases, both could occur,” Dr. Yosipovitch says. “If a patient has pustules on his palms and or soles with erythema, it could be pustular psoriasis and not eczema.” 

Dr. Yosipovitch advises monitoring treatment progress. If, after beginning treatment for suspected eczema with either a topical corticosteroid or a biologic, the rash worsens or becomes more demarcated or defined, the individual probably has psoriasis, he notes.

The National Psoriasis Foundation (NPF) has several resources to help you better understand your psoriasis and treatment options. NPF has also partnered with the American Academy of Dermatology to update the guidelines for psoriasis treatment, so that your health care provider can stay up to date with current treatment options and best practices for managing psoriasis.