Eczema and Psoriasis: How to Tell Them Apart

Learn the similarities and differences between these common skin conditions

Eczema and Psoriasis

Eczema and psoriasis are both common skin conditions and it can sometimes be difficult to distinguish between them. It is important to have the right diagnosis since some treatments work for one and not the other. Both, however, can cause itchy, red rashes and both can occur at any age. Both are caused by the immune system attacking the skin when it shouldn’t, but in very different ways. If you are not sure what kind of skin disease that you have, it is important to see a board-certified dermatologist to help you get the correct diagnosis and treatment.

Below are some ways you can begin to tell the difference between these two common conditions.


Eczema (sometimes call “atopic dermatitis”) is almost always itchy. It usually begins in childhood and gets better as you approach the teenage years. It can also appear as the skin begins to naturally dry out with age, especially in the elderly. Eczema prefers the folds of the arms and legs, the inside crook of the elbow, and the back of the knee. Babies often get it on their cheeks as well. Eczema frequently becomes infected, especially by staphylococcus (“staph”), which causes it to be sticky or weepy with a honey-colored ooze. An infection will often cause the eczema to flare up over the whole body.

Psoriasis can either be extremely itchy or not itchy at all. It can begin at any age but most typically begins to appear at around 20 or 50 years old and tends to appear on the back of the elbows, the front of the knees, the scalp, and the lower back.

It is also regularly found on the hands and feet. It is very rare for psoriasis to become infected, although it can bleed when scratched or rubbed.


  • Topical steroids: steroid creams and ointments are commonly used to treat both psoriasis and eczema. These are applied directly to the affected skin to calm the immune reaction that is causing the disease. Stronger steroids are often used on thicker skin like the hands or feet. More gentle ones may be used on the delicate skin of the face, underarms, or groin. It is important not to overuse topical steroids as they can permanently thin the skin (called “atrophy”).
  • Antibiotics: antibiotics (either pills or antibiotic creams) are used when the eczema becomes infected. It is helpful to have a dermatologist take a swab culture of the skin to see what type of infection you have and which antibiotics can treat it best. When eczema becomes infected, it can be very difficult to treat it without curing the infection first. Psoriasis, however, generally does not get infected so antibiotics are not routinely used to treat psoriasis.
  • Oral steroids: steroid pills (like prednisone, or sometimes steroid shots) are often used to treat a severe flare of eczema to help make it better quickly. They are usually very effective in the short-term but not a good choice for long-term treatment for eczema due to their many side effects. Taking oral steroids can lead to bone loss/fractures, diabetes, weight gain, and ulcers. Although oral steroids can improve psoriasis, the psoriasis can rebound much worse than before when they are finished. Because of this, oral steroids are generally not used to treat psoriasis.
  • Light treatments: light treatments like narrow-band ultraviolet B are regularly used to treat psoriasis by dampening the immune system response in the skin. This type of treatment can be very safe and effective, although it requires visiting the doctor’s office several times a week when starting treatment. Light is also effective for eczema, but is typically used to continue improvements once it is under control with other medications.
  • Immune-suppressing medications: medications that suppress the immune system, like cyclosporine, methotrexate, and mycophenolate mofetil (CellCept), can help both eczema and psoriasis and are used when simpler and safer choices do not work. Since they knock down the overall immune system, they can lead to a higher risk of severe or unusual infections. They can also affect other organs, like the liver or the kidneys, and so it is important to see your dermatologist regularly for blood tests and monitoring.
  • Biologics: newer biologic medications (like etanercept (Enbrel), adalimumab (Humira), ustekinumab (Stelara), and secukinumab (Cosetnyx)) have become mainstays of treatment of severe psoriasis. These are more targeted treatments that seek to only work on the specific parts of the immune system that cause psoriasis. They have fewer side effects than the more general immune-suppressing medications, but can still have side effects including infections like tuberculosis and perhaps an increased risk of certain cancers. These medications are typically not effective for eczema since they are designed to target the part of the immune system that causes psoriasis. There is, however, a new biologic in trials to treat eczema, called dupilumab. It seems to be effective for many patients in early studies and would be the first biologic medication for eczema if it is eventually approved.


Most of the time, a seasoned doctor can tell eczema and psoriasis apart by learning about your symptoms and examining the skin. Seeing your dermatologist is the best way to not only learn which of these conditions you may have, but also to find a long-term treatment plan to control these chronic, and sometimes miserable, skin conditions.

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