You have patches of dry, itchy, inflamed skin — is it eczema or psoriasis? Eczema (also known as atopic dermatitis) is one of the most prevalent skin diseases in the United States. But psoriasis affects many people, too.

To the untrained eye, these skin concerns can look very much the same. The most widespread symptoms — dry, itchy, scaly patches of skin — may show up in either condition.

But while eczema and psoriasis may look similar, they are actually different conditions with different causes, says Shilpi Khetarpal, MD, a dermatologist at the Cleveland Clinic in Ohio.

The most common form of eczema, atopic dermatitis, is a skin condition causing itchy rashes and dry, discolored skin. It can start in infancy and is most common in children and adolescents, though it can affect adults as well. An impaired skin barrier and underlying immune-system problems within the skin are linked to the condition.

Although a patch of psoriasis or eczema may look similar, there are some differences in how these conditions present themselves, says Dr. Khetarpal. These include:

Degree of Itchiness People with eczema tend to experience a lot of itchiness, says Khetarpal. “In our younger patients, the itching can wake them up in the middle of the night — it’s incredibly uncomfortable. People with psoriasis can have some itching but usually not to the same degree as eczema,” she explains and adds that, “in eczema, people are scratching more, so it's common to see the skin superficially infected.”

Location on the Body Both eczema and psoriasis can show up anywhere, but they have their favorite areas, says Khetarpal.

Psoriasis commonly causes troubles on the following body parts:

• Scalp
• Elbows
• Front of the knees
• Buttocks
• Lower back
• Palms
• Soles of feet

Eczema can occur on those places as well but more typically will affect the following:

• Insides of the elbows
• Behind the knees
• Hands

Dry vs. Wet Psoriasis tends to appear drier and flakier, whereas eczema can sometimes be oozy with fluid-filled blisters.

Nail Changes It’s very common to see nail changes in someone who has psoriasis, says Khetarpal. These can include tiny dents; white, yellow, or brown discoloration; crumbling nails; or separation of the nail from the finger or toe. None of this is typically true for eczema. “In eczema, usually the nails are completely normal unless there’s eczema around the cuticle,” Khetarpal adds.

Reaction to Skin Injuries When a person with psoriasis has a skin injury, a flare or new lesion can occur in that area, a response known as the Koebner phenomenon. “A sunburn or a vaccine or any kind of trauma can cause psoriasis to appear in that area — that doesn’t happen in eczema,” says Khetarpal.

Age of Onset “We typically see psoriasis beginning in the teens — the average age is 15 to 30 years old, and so it tends to be later in life compared to eczema,” Khetarpal says. Although people who are older can also develop it, eczema most commonly appears in young children, who often outgrow it in a few years.

Psoriasis and Eczema in Skin of Color

Psoriasis and eczema can look different in people depending on their racial and ethnic backgrounds.

On light skin, both psoriasis and eczema can cause red patches, but “skin of color may not show redness as much. It can look like hyperpigmentation or darker brown patches instead of red scaly patches,” Khetarpal says. Doctors trained to look for redness may misdiagnose both psoriasis and eczema in people of color, leading to a delay in treatment.

Treatments are the same for anyone with any skin color, says Khetarpal.

“Psoriasis is an autoimmune disease [that results in] an overproduction of skin cells,” Khetarpal says.

She explains that in normal skin, it takes around 28 days for a cell to mature, travel to the surface of the epidermis, and be shed along with other dead cells.

In people with psoriasis, however, that process speeds up to just a few days. As a result, live cells can accumulate along with dead ones, which can lead to the formation of scaly lesions.

In eczema, the skin isn’t able to retain water as it needs to, which can make the skin dry and itchy, as well as more sensitive to irritants, says Khetarpal.

Eczema also tends to run in families, suggesting it has a genetic component, too. It’s seen more commonly in people with a personal or family history of asthma, hay fever, or other allergies. “We call it the allergic triad,” says Khetarpal. “Sometimes someone else in the family has one of these conditions, or the patient may have one, two, or even all three of these conditions.”

In both psoriasis and eczema, certain triggers can bring on a flare. While emotional stress is believed to trigger or worsen both psoriasis and eczema, other triggers are more specific to each condition.

• Dry skin
• Metals (especially nickel)
• Fragrance
• Fabrics (like wool and polyester)
• Soaps
• Household cleaners
• Antibacterial ointment (like neomycin and bacitracin)

• Cigarette smoke
• Drinking alcohol frequently or excessively
• Smoking
• Skin injury
• Dry, cold weather
• Sunburn
• Infection
• Tattoos and piercings

If you think you might have eczema or psoriasis, make an appointment with a dermatologist, or your primary care doctor who can refer you to a dermatologist.

To diagnose psoriasis, a dermatologist will examine your skin, scalp, and nails, and ask about your family history (do you have relatives with the disease) and your medical history (any recent illnesses or stress, certain medications you may be taking, any joint tenderness you may be experiencing).

There’s no single test that can lead to an eczema diagnosis. Your doctor will ask about your health and family history and perform a skin exam. If this is not enough to make a definitive diagnosis, your doctor may request allergy testing like a patch test to identify certain allergens that may be triggering your condition. They may also perform a skin biopsy.

There is no cure for either psoriasis or eczema, but the right therapies can often keep skin clear.

Many of the same treatments are used for both eczema and psoriasis. A doctor may recommend:

• Topical Corticosteroids Either an over-the-counter or prescription steroid cream is often a first-line treatment for either psoriasis or eczema to help ease itching and inflammation.
• Topical Nonsteroidals These include calcineurin inhibitors, crisaborole (Eucrisa), roflumilast (Zoryve), and tapinarof (Vtama).
• Immunosuppressive Drugs Medications such as cyclosporine or methotrexate can help control the immune system response, reduce inflammation, and stop the itch-scratch cycle.
• Bioligics Biologics target the protein behind the inflammation response. They’re usually given by injection or intravenous infusion.
• Immunomodulators These drugs, such as JAK inhibitors, disrupt signals in the body that are thought to cause inflammation.

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• Prescription Phototherapy Also called light therapy, phototherapy uses a machine to safely expose the skin to a controlled amount of ultraviolet light. It can reduce itching and inflammation and boost the skin's ability to fight bacteria. The treatment has been shown to improve both psoriasis and eczema, says Khetarpal, but is more effective in psoriasis.

Eczema may also be treated with:

• Other Over-the-Counter Treatments These might include oral antihistamines, acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs, and coal tar or dandruff shampoos for scalp eczema.
• Oral Steroids These can help fight inflammation.

Psoriasis treatment may also include:

• Other Over-the-Counter Topicals Lotions and shampoos with salicylic acid or coal tar are approved by the FDA to soothe or help get rid of psoriasis.
• Other Prescription Topicals Prescription nonsteroidal medications such as vitamin D analog products, vitamin A, and anthralin may help reduce inflammation and slow down the formation of plaques.

Liberal use of a thick, nonirritating moisturizer (either a cream, lotion, or ointment) can ease dryness and help restore the skin barrier in both conditions, says Khetarpal.

Avoiding products with dyes and fragrances is important in eczema.

Since sunburn can worsen both psoriasis and eczema, it’s important to wear a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher when spending time outdoors.

While there isn’t evidence that a specific diet that eliminates items like dairy or sugar can help either condition, you can benefit from drinking alcohol only in moderation, eating a healthy diet, drinking plenty of water, and exercising (which can reduce stress).

• Telling the difference between psoriasis and eczema can be tricky as both can cause dry, itchy, and scaly patches on your skin.
• While these conditions appear similar, they have unique traits and triggers. Some therapies help manage both, but each condition also has specific treatments.
• A key tip: Eczema tends to cause more intense itching, while psoriasis often develops in specific areas like the scalp, backs of elbows, and the front of knees.