Psoriasis vs. Eczema: Images and Key Differences

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.

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.

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:

Knees
Elbows
Belly button
Scalp
Buttocks
Nails
Palms and soles

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 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:

Stress
Infection and illnesses, like strep throat
Certain medications, such as prednisone and lithium
Scratches, burns, and injuries to the skin (the Koebner phenomenon)
Lifestyle factors, like having a heavier weight and drinking alcohol
Certain foods, like sugar, alcohol, and gluten

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 VladimirKhodataev/iStock via Getty Images	Sharply outlined areas of red, violet, or brown skin with silver or white scales Sometimes bleeds if picked 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:

Topical steroid creams
Nonsteroidal creams
Over-the-counter (OTC) emollients to moisturize the skin

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	Moisturizers and emollients Oatmeal baths	Moisturizers and emollients Creams with urea, salicylic acid, or coal tar
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	Steroids, like prednisone Immunosuppressants, like methotrexate and cyclosporine (Neoral, Gengraf) Immune system modulators, like Dupixent (dupilumab) and Adbry (tralokinumab) JAK inhibitors, like Cibinqo (abrocitinib) and Rinvoq (upadacitinib)	Immunosuppressants, like methotrexate or cyclosporine PDE4 inhibitors, like Otezla (apremilast) Injectable biologics, like Skyrizi and Humira
Procedures	UVB light therapy	UVB light therapy Excimer laser treatments

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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Written by:

Alina Goldenberg, MD, MAS, FAAD

Alina Goldenberg, MD, MAS, FAAD, is a board-certified dermatologist in private practice. She is also an assistant clinical professor in the Department of Internal Medicine at the University of California, Riverside School of Medicine.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

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.

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

Key takeaways: