Eczema vs. Psoriasis on Face: Identifying Key Differences and Treatments

April 18, 2024

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Eczema and psoriasis are common immune-mediated skin conditions affecting over 30 million Americans. They both can cause red, flaky, itchy rashes leading to a decreased quality of life. However, despite some overlapping features, eczema and psoriasis have distinct differences in their presentation, underlying causes, and management.

This article provides an in-depth overview comparing and contrasting eczema vs. psoriasis – from symptoms and diagnosis to the latest treatments. Understanding the nuances between these conditions is key for proper management and relief of symptoms.

Key Similarities Between Eczema and Psoriasis

Although eczema and psoriasis have more differences than commonalities, they do share some general features:

  • Both cause red, irritated areas of skin that may itch or burn
  • They can appear anywhere, including the face, hands, feet, elbows, scalp and genitals
  • Symptoms may flare sporadically and then resolve (relapsing-remitting course)
  • Itching and discomfort can negatively impact mood, sleep, relationships and overall wellbeing
  • Topical moisturizers and medicated creams can help control mild cases of either disorder

However, the causes, clinical appearance, and best treatments do differ between eczema and psoriasis – discussed next.

Key Differences in Symptoms and Signs

There are visual and symptomatic variances that help distinguish eczema vs psoriasis:

Eczema (Atopic Dermatitis)

Eczema (atopic dermatitis) classically appears as:

  • Dry, scaly patches that may ooze clear fluid when scratched
  • Poorly defined red rashes favoring skin creases like inside elbows or backs of knees
  • Intense itching is common, often worse at night
  • Rough, leathery texture from chronic rubbing of itchy skin

Eczema often first develops in infancy or early childhood. For many patients, it ultimately goes into remission by early adulthood.


Alternatively, psoriasis manifests as:

  • Sharply demarcated red plaques covered by silvery-white scales
  • Occurs more on extensor surfaces like shins, elbows, low back or scalp
  • Mild itching or burning; rarely intensely pruritic
  • Associated nail changes like oil spots, onycholysis, pitting
  • Can begin at any age and tends to be lifelong

Thus, while bothConditions can cause irritated red rashes, the morphology and distribution of lesions differs between eczema vs psoriasis.

What’s Causing This? Pathophysiology and Triggers

Eczema and psoriasis also stem from entirely different underlying processes:

Eczema Pathology

Atopic dermatitis results from:

  • Barrier dysfunction – reduced ceramides, filaggrin mutations
  • Allergic inflammation dominated by Th2 cells
  • Environmental allergens like dust mites, pollen and pet dander
  • Skin microbiome alterations
  • Many genes implicated with variable inheritance patterns

Thus, external allergic triggers interacting with barrier abnormalities perpetuate inflammation flares in eczema. The immune response skews heavily towards Th2 activation.

Psoriasis Pathology

In contrast, psoriasis mainly involves:

  • Hyperproliferation of skin cells – rapid turnover every 3-5 days
  • Abnormal differentiation and reduced maturation of keratinocytes
  • Prominent Th17 response with overproduction of IL-17/IL-23
  • Strong hereditary component modulated by environmental exposures

As a result, runaway activation of Th17 immune pathways accelerates skin cell growth in psoriasis. This manifests clinically as thick scaly plaques from excessive keratinocyte production.

Therefore, while both are immune-mediated conditions, eczema and psoriasis have distinct underlying processes driving inflammation.

How Are They Treated? Management Options

Given the varying pathology, treatments for eczema vs psoriasis also substantially differ:

Eczema Management

First line treatments for eczema focus on:

  • Barrier repair with frequent moisturizer use
  • Identifying and avoiding triggers like foods or environmental allergens
  • Topical anti-inflammatory creams – corticosteroids, calcineurin inhibitors
  • Phototherapy for recalcitrant cases
  • Oral immunosuppressants if severe – cyclosporine, azathioprine, methotrexate
  • Biologics (dupilumab) for moderate-severe atopic dermatitis unresponsive to other therapies

The emphasis is restoring skin barrier function and hydration. Allergen avoidance and anti-inflammatory creams manage flares.

Psoriasis Management

For psoriasis, primary therapies include:

  • Topical vitamin D analogs – calcipotriene, calcitriol
  • Topical retinoids like tazarotene to regulate skin cell turnover
  • Phototherapy – NB UVB, PUVA
  • Oral systemic medications – methotrexate, acitretin (a retinoid)
  • Biologics blocking IL-17 or IL-23 pathways – secukinumab, ustekinumab, guselkumab

Here, the focus is slowing down rapid skin cell proliferation. Phototherapy, vitamin A derivatives, and biologics targeting psoriatic immune pathways achieve this goal.

Thus, both conditions have multiple therapeutic options available – but the specific treatments utilized differ significantly between eczema vs psoriasis.

Frequently Asked Questions

Can you have both eczema and psoriasis at the same time?

Yes, it’s possible to have both eczema and psoriasis concurrently. Around 20% of psoriasis patients also have atopic diseases like eczema or asthma. Seeing a dermatologist can help distinguish irregular thick plaques (psoriasis) from itchy red rashes in skin creases (eczema) when both conditions occur together.

What does psoriasis look like on the face?

Facial psoriasis often appears as red patches with thick, dry silvery scales around the hairline, between the eyebrows, on the forehead, or around the nose and ears. The well-demarcated edges and plaque-like appearance helps differentiate it from the ill-defined rashes of facial eczema.

Can eczema turn into psoriasis?

No, eczema does not turn into psoriasis or vice versa. They have distinct underlying causes. However, sometimes incorrectly treated or undiagnosed rashes are actually early manifestations of psoriasis or atopic dermatitis rather than one condition transforming into the other. Seeing a skin specialist can help clarify the diagnosis.

What’s the difference between dermatitis and psoriasis?

Dermatitis is a broad term for skin inflammation. Eczema is a common type of dermatitis. Psoriasis is also a form of dermatitis but has unique features like thick, scaly plaques on extensor surfaces and associations with other immune disorders. A dermatologist can distinguish a likely eczema rash vs one suggestive of psoriasis.

Can psoriasis occur inside the nose?

Yes, up to 80-90% of people with psoriasis get inflammatory lesions inside their nose at some point. Intranasal steroids or saline rinses can help manage nasal psoriasis flares. Plaques may also occur on the outside of the nose. Nasal eczema is less common but can also rarely occur.

Key Takeaways on Eczema vs. Psoriasis

  • Eczema and psoriasis both cause red, scaly, itchy skin rashes but have more differences than similarities
  • Eczema appears as ill-defined, oozing patches often in creases; psoriasis forms thick demarcated plaques with silver scales
  • Allergic triggers and barrier dysfunction perpetuate eczema; rapid skin turnover and immune dysfunction drive psoriasis
  • Eczema management revolves around skin hydration and anti-inflammatory creams; psoriasis requires medications slowing cell turnover
  • About 20% of psoriasis patients also have eczema demonstrating they can co-occur and require concurrent management

Recognizing the distinctions between these conditions allows for proper diagnosis, treatment, and control. Continued research elucidating their complex underlying pathology will uncover future targeted therapies providing more definitive solutions for those suffering from disabling eczemapsoriasis or both.

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