Differences Between Psoriasis and Eczema

Introduction

Have you ever had itchy, red patches on your skin and wondered, "Is it psoriasis or eczema?" These two skin conditions often look similar but are very different in how they are caused, their triggers, and their treatments. In this article, we will understand the difference between psoriasis and eczema in simple terms.

Understanding Psoriasis and Eczema

1. What Is Psoriasis?

Psoriasis is a long-term autoimmune condition (when the body turns against itself) that speeds up skin cell growth. Instead of shedding in weeks, the skin builds up within days, creating thick plaques. While psoriasis is not contagious, it does not spread and can still affect more than the skin. It can also involve joints.

2. What Is Eczema?

Eczema, also known as atopic dermatitis, is a condition that causes the skin to be red, dry, and itchy. It often begins in childhood and continues lifelong. Eczema is caused by a weak skin barrier and an overactive immune system to allergens and irritants.

What Do Eczema and Psoriasis Look Like?

Symptoms can differ based on individual factors and skin tone.

Psoriasis symptoms include:

1. Raised, thick patches on the skin.

2. Scales of skin in silver-white color.

3. Well-defined edges.

4. Bleeding, dry, and cracked skin.

5. Itching and joint pain.

6. Sometimes, nail changes, such as pitting or crumbling, appear.

7. Less commonly present is a severe form where the skin gets fiery red and extremely painful.

Eczema presents itself as

1. Severe itching, especially at night. The itching is often persistent and very intense.

2. Dry, red, and flaky skin. With time, rashes are seen as small bumps that may further ooze.

3. The skin tends to appear thickened and leathery. Patients also complain of a change in color to a darker tone.

4. Comes in waves, flare-ups, and calm periods.

Where Are They Commonly Found?

The location of the rash is one clue to differentiate between them.

1. Psoriasis can affect various body parts, including the elbows, scalp, lower back, and knees.

2. Eczema often appears on the face, scalp, arms, and legs. Older people commonly see it on the insides of the elbows, the backs of the knees, the wrists, the ankles, and the neck.

The common locations and ways to differentiate between them:

1. Psoriasis Versus Eczema on Hands: Both appear on hands, but psoriasis tends to cause thicker plaques, whereas eczema causes dry, cracked, and itchy skin.

2. Psoriasis Versus Eczema Scalp: Psoriasis appears as thick scales, whereas eczema on the scalp appears as dandruff with itching.

3. Eczema Versus Psoriasis on Face: Eczema is more common on the face, whereas psoriasis tends to be more common around the hairline or eyebrows.

Psoriasis Versus Eczema Triggers

Psoriasis happens when the immune system is triggered by:

1. Stress: This provokes the body to activate the immune system.

2. Infections: Streptococcus infections can also trigger psoriasis.

3. Injuries: Cuts, scrapes, and sunburn can further lead to psoriasis.

4. Medications: Lithium, beta-blockers, and antimalarial drugs are known to cause psoriasis.

5. Smoking and Heavy Alcohol: Can worsen inflammation in the body.

Eczema occurs when the skin’s barrier is weak and gets triggered by

1. Irritants: Soaps, detergents, fragrances, lotions, perfumes, and cleaning products.

2. Allergens: Dust, pollen, and wool.

3. Stress: Extreme stress and excess heat can trigger eczema flare-ups, especially in humid climates.

4. Food Triggers: Sometimes foods like eggs and milk curds can precipitate eczema in individuals. Common in children.

How Are Eczema and Psoriasis Diagnosed?

1. Medical History Review: A careful, thorough medical history review is done. When did it start, and what makes it better or worse? Is there any family history?

2. Clinical Examination: A skin specialist makes the diagnosis by looking at the skin texture and pattern of lesions.

3. Allergy Testing: They are used in eczema to evaluate triggers.

4. Blood Tests and X-Rays: This is done if there are associated autoimmune symptoms or joint pain.

Psoriasis Versus. Eczema: How Treatments Differ

While psoriasis and eczema primarily affect the skin, the treatment protocol differs slightly.

A. Topical Treatments:

For psoriasis and eczema, the first line of treatment is topical creams and ointments.

1. Corticosteroids: They help reduce inflammation and significantly reduce itching by suppressing the immune response. Stronger steroids are given for psoriasis. Hydrocortisone, Betamethasone, and Clobetasol are the steroids used.

2. Vitamin D Analogs: Commonly given in psoriasis to slow cell turnover. Commonly used are Calcipotriene and Calcitriol.

3. Calcineurin Inhibitors: Tacrolimus and Pimecrolimus are non-steroid options that act as anti-inflammatory agents. They are commonly used in eczema on delicate areas like the face.

4. Coal Tar and Salicylic Acid: Used mainly in psoriasis to soften thick plaques and scales. Care must be taken, as this can cause sun sensitivity and staining.

5. Tazarotene and Other Retinoids: They help regulate the proliferation of keratinocytes (skin cells) and reduce the elevation, scaling, and redness in psoriasis.

6. Tainarof: This is a novel treatment that targets the gene expression in immune and skin cells for psoriasis. This helps reduce inflammation and improves the skin barrier.

7. Moisturizers: They are a must-have in eczema treatment and should be applied regularly to protect the skin barrier. They are also useful for hydration in psoriasis.

B. Phototherapy:

Light therapy is used for resistant plaques of psoriasis and in chronic eczema.

1. Ultraviolet B (UVB) Therapy: This session uses light to slow cell production and is effective for plaques that do not respond to treatment.

2. Psoralen Plus Ultraviolet A (PUVA): A tablet containing psoralen is given, followed by exposure to UVA. Psoralen makes them more sensitive to light, making deeper action than UVB light. Long-term use is not advised, as it can increase the risk of developing cancer.

3. Excimer Laser Therapy: This involves targeted therapy to treat localized psoriasis in the palms, soles, elbows, etc.

C. Systemic Medication:

For Psoriasis:

1. Methotrexate and Cyclosporine: These are used in moderate to severe cases. They suppress inflammation. Methotrexate long-term use can damage the liver and is also harmful to developing babies, so it is contraindicated in pregnancy. Cyclosporin has a chance of causing kidney damage and must be monitored closely.

2. Oral Retinoids: Acitretin is advised in cases with severe psoriasis where other treatments are ineffective. Acts that reduce cell production have numerous side effects, so they must be taken cautiously.

3. Biologics like Adalimumab: These target the immune system cells directly.

4. Oral Phosphodiesterase 4 Inhibitors: Apremilast is given to control inflammation in severe plaque psoriasis.

For Eczema:

1. Antihistamines: To control intense itching, especially at night.

2. Biologics: Dupilumab is prescribed when the lesion is not responding to other treatments.

D. Lifestyle Changes:

1. Moisturize: The patients are advised to apply thick coats of fragrance-free moisturizer.

2. Bathing: Take gentle, lukewarm baths to keep skin clean. If the water is too hot, it can irritate the skin.

3. Avoid Triggers: Avoid harsh soaps, strong-scented perfumes, and scratchy fabrics, which can irritate the skin.

4. Control Scratching: It is best to keep nails short and trimmed to suppress the urge to scratch. Using cold compresses also soothes the area.

5. Comfortable Clothes: Wearing soft, breathable fabrics like loose-fitting cotton can help the skin breathe.

Conclusion:

While psoriasis and eczema can look alike on the surface, they are very different beneath the skin. Understanding their appearances, distinct locations, and causes is important to help treat them in the best possible manner. Psoriasis is caused by an overactive immune system, whereas eczema results more from a weakened skin barrier and a reaction to triggers. Understanding them and learning how the body reacts can help improve the quality of life.

Keynote From iCliniq:

A persistent itchy psoriasis or eczema rash is very frustrating and can affect daily life. If you or your loved one is facing skin issues like a rash or itchy skin, our experts at iCliniq can help you get the answers and treatment needed.