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HomeHealth TopicDermatology

How Do Psoriasis and Eczema Look Different? Here’s How to Tell the Difference (With Images)

Alina Goldenberg, MD, MAS, FAADMaria Robinson, MD, MBA
Updated on February 23, 2024

Key takeaways:

  • Eczema and psoriasis are chronic skin conditions that can cause patches of red, violet, or brown flaky skin. People commonly confuse the conditions, but they have some noticeable differences.

  • Eczema is very itchy, and it usually affects the skin on the inside surface of the arm, behind the knees, and on the neck.

  • Psoriasis often looks like outlined red, brown, or violet areas covered with white or silver scales. It often shows up on the elbows and the knees, and it can also affect the joints.

Psoriasis on elbows.
PositiveFocus/iStock via Getty Images Plus

The skin conditions eczema and psoriasis are often confused with each other. But there are differences to look out for. While eczema can be very itchy, psoriasis usually isn’t. Eczema also happens in the folds of the skin, whereas psoriasis happens over joints, like the knees or elbows. 

That said, both conditions can be severe and affect your daily activities, mood, and quality of life. That’s why knowing how to tell them apart and getting proper treatment is so important. 

Eczema and psoriasis affect different parts of the body

Eczema and psoriasis can affect any part of your skin. But they’re more likely to happen in certain spots. Knowing these common locations can help you tell them apart

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Eczema

In older children and adults, eczema usually happens in the folds and creases of the skin. This means you often see eczema in these spots: 

  • Behind the knees

  • In elbow folds

  • On the back of the neck

  • On the face

  • On the hands and feet

Psoriasis

Psoriasis tends to develop in opposite places than eczema. So, instead of the folds of the skin, psoriasis will often show up on the outer surfaces. You may see it on the:

Psoriasis and eczema start at different ages

You can develop eczema as a baby, a child, or an adult. But most of the more than 30 million people in the U.S. who have eczema are children. 

You can also develop psoriasis at any age. But there are two time periods when you’re most likely to get psoriasis: between the ages of 20 and 30 years old, then between 50 and 60 years old. Unlike eczema, psoriasis isn’t common in babies and children. 

Symptoms of psoriasis vs. eczema

Both eczema and psoriasis can itch, but eczema is usually worse. The itching in eczema may be so intense that you can’t sleep, or you scratch so much that your skin bleeds. Psoriasis can be mildly itchy, but it also causes a stinging or burning sensation.

How do eczema and psoriasis look different?

You can usually tell the difference between psoriasis and eczema based on how they look. Here are some key differences and what to look for. 

Eczema pictures

Beyond where it shows up on the body, eczema has some specific characteristics to watch for. Here are some images to help.

Left: Thick, violet-brown skin patches behind the knees in eczema. Right: The side of the neck with multiple small, reddish-brown bumps in eczema.
Left: Thick, violet-brown patches in dark skin from eczema. Right: Many small, reddish-brown bumps and patches on the neck from eczema.
Left: Close-up of an arm with pink and red bumps and patches from eczema. Right: Close-up of an arm with thickened pink skin that’s been scratched in eczema.
Left: Pink and red bumps and patches in the elbow crease from eczema. Right: Thickened and scratched red patches in fair skin from eczema.

Psoriasis

Beyond where it shows up on the body, psoriasis has some specific characteristics to watch for. Here are some images to help.

Left: Close-up of skin with thick patches with white scale in psoriasis. Right: Violet-brown round patches with fine scale on the chest in psoriasis.
Left: Violet-brown patches with thick, white scale from psoriasis in dark skin. Right: Violet-brown round patches with some gray scale on dark skin from psoriasis.
Left: Close-up of a knee with a thick, round, white patch in psoriasis. Right: Round and scaly red patches on the back in psoriasis.
Left: In fair skin, psoriasis causes thick, red patches with white scale. Right: Red, slightly scaly psoriasis patches in fair skin.

Triggers and causes

Eczema and psoriasis have different causes and triggers. Keep in mind that triggers are different for each person. 

Eczema triggers

Several different factors cause eczema, including your genes and an overactive immune system. Some people with eczema have a mutation (change) in a gene for filaggrin. This is a protein that helps moisturize and keep the skin barrier intact. Without enough filaggrin, skin is more prone to inflammation. 

These common triggers can also worsen eczema:

  • Extreme temperature changes or weather patterns

  • Stress (physical or mental)

  • Sweat and rubbing of the skin

  • Wool or other irritating clothing

  • Topical allergens, such as certain preservative and fragrances

  • Prolonged and frequent bathing with harsh soaps 

Psoriasis triggers

Experts don’t know exactly what causes psoriasis. But your genes and an overactive immune system play a role. Psoriasis causes skin cells to grow faster than normal, which leads to thick plaques forming on the skin. 

Like eczema, different triggers can make psoriasis worse. These triggers include:

Key differences between psoriasis versus eczema

The table below outlines the differences between the two commonly confused skin conditions.

Eczema Psoriasis
How does it look?
  • Red and flaky skin
  • Potential for cracks and broken skin

A person with an eczema flare-up on their arm.VladimirKhodataev/iStock via Getty Images
  • Sharply outlined areas of red, violet, or brown skin with silver or white scales
  • Sometimes bleeds if picked

A person with psoriasis on their elbow.DaveBolton/E+ via Getty Images Images
How does it feel? Very itchy, painful, and dry Sometimes itchy, can burn or sting
Where does it happen on the skin?
  • Folds of skin on the neck
  • Inside surfaces of the arms
  • Behind the knees
  • Hands
  • Wrists
  • Elbows
  • Knees
  • Belly button
  • Groin
  • Scalp
  • Palms and soles
What are additional symptoms and risks?
  • Commonly occurs with allergies and asthma
  • Possible infections with scratching
  • Thickening, pitting, and ridging of nails
  • Can affect the joints (psoriatic arthritis)
  • Increased risk of heart disease and diabetes

How to treat eczema and psoriasis

Eczema and psoriasis are treated in a similar way because they both use medications that lower inflammation in the skin. For mild eczema and psoriasis, this usually includes: 

More serious eczema or psoriasis need stronger treatment. This includes pills to lower inflammation throughout the body, or new biologics that target specific parts of the immune system. For people with psoriasis and psoriatic arthritis, it’s also important to choose a medication that treats the joints in addition to the skin.

Here’s a breakdown of treatment options for eczema versus psoriasis. 

Eczema Psoriasis
OTC treatments
Prescription creams and topicals
  • Steroids
  • Calcineurin inhibitors, like pimecrolimus (Elidel) and tacrolimus (Protopic)
  • Janus kinase (JAK) inhibitors, like Opzelura (ruxolitinib)
  • Phosphodiesterase 4 (PDE4) inhibitors like Eucrisa (crisaborole 2%).
  • Steroids
  • Calcineurin inhibitors, like pimecrolimus (Elidel) and tacrolimus (Protopic) used “off-label
  • Vitamin D analogues, like calcipotriene (Dovonex, Sorilux)
  • Retinoids, like tazorac (Tazarotene)
  • PDE4 inhibitors, like Zoryve (roflumilast)
  • Aryl hydrocarbon receptor (AhR) agonists like Vtama (tapinarof)
Prescription systemic treatments
  • Immunosuppressants, like methotrexate or cyclosporine
  • PDE4 inhibitors, like Otezla (apremilast)
  • Injectable biologics, like Skyrizi and Humira
Procedures
  • UVB light therapy

In general, practicing good skin care will help both psoriasis and eczema. Here are some skin care tips to keep in mind:

  • Keep your skin moist. Use a moisturizer regularly, and apply it right after you get out of the shower. If the air is very dry where you live, using a humidifier can also help.

  • Avoid irritating your skin. This means not showering or bathing with very hot water. And it also means not using harsh soaps, scrubs, or washcloths. 

  • Avoid triggers that affect your skin. Learning what triggers your skin can help you avoid them and prevent psoriasis or eczema symptoms from becoming worse. 

The bottom line

Eczema and psoriasis are chronic skin conditions that cause red, violet, or brown flaky skin. They’re commonly confused, but they have important differences. They look different, affect different parts of the body, and have different symptoms and triggers. 

If you’re having skin rashes and think you may have eczema or psoriasis, talk with your primary care provider or dermatologist. They can help you understand the cause of your symptoms and develop a treatment plan with you.

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Why trust our experts?

Alina Goldenberg, MD, MAS, FAAD
Alina Goldenberg, MD, MAS, FAAD, is a board-certified dermatologist in private practice in San Diego. She is also an assistant clinical professor in the Department of Internal Medicine at the University of California, Riverside School of Medicine.
Sophie Vergnaud, MD
Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.
Maria Robinson, MD, MBA
Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Images used with permission from VisualDx (www.visualdx.com). 

References

American Academy of Dermatology Association. (n.d.). Stress: Is it a common eczema trigger?

Armstrong, A. W. (2017). Psoriasis. JAMA Dermatology. 

View All References (7)

Ballard, R. (2022). Is it eczema or psoriasis? National Eczema Association.

Dębińska, A. (2021). New treatments for atopic dermatitis targeting skin barrier repair via the regulation of FLG expression. Journal of Clinical Medicine.

Elmets, C. A., et al. (2020). Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. Journal of the American Academy of Dermatology.

Ji, Y., et al. (2019). Koebner phenomenon leading to the formation of new psoriatic lesions: Evidences and mechanisms. Bioscience Reports.

Murota, H., et al. (2019). Why does sweat lead to the development of itch in atopic dermatitis? Experimental Dermatology.

National Eczema Association. (n.d.). Eczema stats.

National Psoriasis Foundation. (2022). Causes and triggers.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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