What is the Difference Between Psoriasis and Atopic Eczema?

Psoriasis and atopic eczema (also known as atopic dermatitis) are both conditions that affect the skin, and they both tend to run in families. However, there are differences between the two conditions, and proper diagnosis is important to receive the right treatment and manage symptoms. If you or your child has symptoms that might be atopic eczema or psoriasis, you should consult with a dermatologist, a specialist with expertise and training who can properly diagnose and treat skin conditions.

Differences in symptoms

Psoriasis causes thick, scaly patches that have well-defined borders, while atopic eczema causes a rash that is dry and scaly (but not raised). Plaques are the most common symptom of psoriasis, and they can cause itchiness and burning. They can occasionally crack and bleed, particularly if they are very dry or located on an area of the body that bends or moves frequently (like a knee or elbow).

Atopic eczema may also have blisters that ooze (weepy sores), papules (small bumps that look like pimples without pus), and with chronic atopic eczema, patches of lichenification (leathery patches).¹ One of the key characteristics of atopic eczema is an intense itch. Psoriasis may cause itching, but the severity of itch is associated with atopic eczema.¹

Differences in location

Psoriasis plaques can develop anywhere on a person’s body, but may often form on the scalp, elbows, knees, lower back, hands, feet, nails, genitals, and skin folds. A person with psoriasis may have plaques just in one area of the body, or they may develop in multiple locations. The parts of the body that are affected by atopic eczema changes based on the age of the person:

• In infants and young children, the atopic eczema rash commonly shows up on the scalp or face, especially the cheeks or chin, or the arms and legs
• In older children, atopic eczema frequently appears as a rash on the inside creases of the elbows or knees, the neck, wrists, ankles, and/or the crease between the buttocks and the thighs
• In adults, the atopic eczema rash can appear anywhere, such as on the inner creases of the elbows or knees, and/or the nape of the neck, or it may be localized to just the hands, feet, or nipples²

Atopic eczema can also affect the skin behind the ears or in the junction between the ear and the face, causing painful cracks in the skin, or it may affect the skin around the eyes, and cause complications like eye watering, inflammation of the eyelid (blepharitis), and infection (conjunctivitis).^3-5 People with psoriasis are somewhat more likely than the average person to develop eye problems. Of the eye problems that people with psoriasis develop, the most common is Uveitis, which is an inflammatory disease process internal to the eyes.⁶ Psoriasis can also cause ear symptoms, either on the ear or in the ear.

Inside the ear can sometimes become blocked due to the combination of wax and the build up of scales inside the ear canal. This may cause additional itching, possibly pain and could affect hearing. Clearing the ear canal of scales is important, not just for comfort, but for the protection of the delicate ear drum. A person who develops psoriasis in their ear should consult with their medical provider to discuss an appropriate method for removing scales in the ear, or have a doctor assist with removing the blockage in office as to not damage the eardrum or injure the skin.

Both psoriasis and atopic eczema

It is possible for an individual to have both psoriasis and atopic eczema, and in some cases, a person may be diagnosed with psoriasiform dermatitis, a type of inflamed skin condition that resembles psoriasis.¹

Psoriasis is a chronic, life-long autoimmune condition. It cannot be cured, but most people will cycle through periods of flare-ups and remissions. Flare-ups are periods of time when symptoms get worse. Remissions are periods of time when the symptoms get better or even go away completely for a time. People who have psoriasis can learn to identify and avoid their own psoriasis triggers, which are things in the environment that can cause psoriasis symptoms to flare up.

Like psoriasis, there is currently no cure for atopic eczema, but proper treatment can help manage the symptoms and give someone periods of remission when symptoms are few or not present at all. The majority of people who have atopic eczema as a child have resolution of the disease – it goes into remission – by adulthood, however, 10-30% continue to have relapses of atopic eczema in adulthood.