Eczema and psoriasis are two distinct skin conditions, but they have much in common. They share similar symptoms, including dry, inflamed, and itchy skin. Both are chronic (long-term) and can show up on many areas of the body, in people of any age. They even respond to some of the same treatments. You may be wondering, though: What is the difference between psoriasis and eczema?

There are several types of eczema and psoriasis, and each one can affect the skin in different ways. Most people have one condition or the other, but it’s possible to have both at the same time. Here are seven important ways these two conditions differ.

1. Eczema Symptoms Usually Appear Earlier in Life

One major difference between eczema and psoriasis is when they tend to begin. Eczema often starts in infancy or early childhood, and in some cases, symptoms may improve or disappear with age.

Psoriasis usually begins later, often in early adulthood, and is typically a lifelong condition. For most people, managing psoriasis involves ongoing care to help reduce symptoms and flare-ups over time. Both eczema and psoriasis can have periods of remission (when symptoms improve or go away) and flare-ups (when symptoms get worse).

Eczema is more common than psoriasis. In the United States, about 30 million people are affected by eczema, compared to about 8 million people living with psoriasis.

2. Eczema Often Feels More Itchy Than Psoriasis

Both psoriasis and eczema can cause itchy, irritated, dry skin. But with eczema, the itch is often more intense. Sometimes, the itch is so strong that it can disrupt sleep or daily life.

Psoriasis, on the other hand, may cause a burning, stinging, or tight sensation. For some people, it’s mildly itchy as skin cells build up too quickly and form thick, scaly patches. These spots can be dry, flaky, and painful. However, not everyone with psoriasis experiences itching — some people feel more discomfort from the pain or tightness of the plaques.

3. Eczema and Psoriasis Often Appear in Different Places on the Body

Another way dermatologists tell the difference between eczema and psoriasis is by where symptoms show up. While both conditions can affect nearly any part of the body, eczema is more likely to appear in skin folds or creases. Common spots include the insides of the elbows and wrists, behind the knees, around the ankles, and on the neck.

Psoriasis is more likely to affect areas such as the:

• Ears
• Lower back and buttocks
• Nails
• Outer elbows and knees
• Scalp
• Palms of the hands and soles of the feet

What About the Scalp?

Both eczema and psoriasis can affect the scalp, but they often look and feel different. One form of eczema that affects the scalp is called seborrheic dermatitis. It typically causes yellowish flakes, greasy or crusty patches, and flakes resembling dandruff. These signs usually stay on the scalp.

Scalp psoriasis, in contrast, tends to cause thicker, silvery-white scales and may extend past the hairline to the forehead, neck, or ears. It’s also more likely to appear in other areas of the body at the same time.

In babies, seborrheic dermatitis on the scalp is called cradle cap. It’s harmless and usually goes away on its own within a few months.

4. The Immune System Reaction Is Different

Eczema and psoriasis both involve the immune system, but in different ways.

Eczema is caused by a combination of genetic and environmental factors. People with eczema often have a weakened skin barrier and a more sensitive immune system that tends to overreact to external irritants. These triggers can include certain fabrics, soaps, fragrances, dust, pollen, and pet dander.

Psoriasis is an autoimmune condition. That means the immune system mistakenly attacks the body’s own tissues — in this case, the skin. This causes skin cells to grow too quickly, leading to thick, scaly plaques. Psoriasis is also associated with systemic (whole-body) inflammation.

Having one autoimmune disease, like psoriasis, can raise your risk of developing another. People with psoriasis may be more likely to also have conditions such as:

• Vitiligo
• Type 2 diabetes
• Thyroid disease
• Rheumatoid arthritis
• Inflammatory bowel disease (IBD)

Researchers are still learning more about these links, but screening for other autoimmune conditions can help people with psoriasis get the care they need if more than one condition is present.

To sum it up:

• Eczema happens when your immune system overreacts to something outside the body.
• Psoriasis happens when your immune system mistakenly attacks your own skin from within.

5. Doctors Diagnose Psoriasis and Eczema Differently

Doctors diagnose eczema by examining your skin and asking questions about your symptoms, medical history, and any family history of allergic conditions like asthma or hay fever. If an allergist suspects that a specific allergy is triggering eczema symptoms, they may recommend patch testing or skin prick testing:

• Patch-testing involves placing small amounts of different substances on the skin (usually on your back) and checking for delayed reactions over a few days.
• Skin prick testing uses tiny needle pricks to place allergens just under the surface of the skin, with results showing up more quickly.

These tests can help identify environmental or food allergens that may trigger flare-ups. However, allergy testing is often negative in people with eczema, and even when a trigger is found, avoiding it may not fully prevent symptoms. That’s because eczema is a complex condition that also involves a weakened skin barrier and an overactive immune response.

In other words, managing eczema usually requires more than just avoiding allergens — it often involves moisturizing regularly and using medications to reduce inflammation.

To diagnose psoriasis, dermatologists typically perform a visual exam and review your personal and family medical history. In some cases, they may recommend a skin biopsy, where a small sample of skin is removed and examined under a microscope. This can help confirm whether a rash is psoriasis or another skin condition. Biopsies are sometimes used for diagnosing eczema as well, especially when symptoms aren’t typical or other conditions need to be ruled out.

6. Eczema and Psoriasis Can Lead to Different Health Issues Beyond the Skin

Even though eczema and psoriasis can look similar on the surface, they are very different conditions beneath the skin.

Eczema is usually related to other allergic conditions, such as asthma, hay fever, and food allergies. Many people with eczema have one or more of these issues. These conditions are connected by an overreactive immune system that responds to harmless substances like pollen, pet dander, or certain foods.

Psoriasis is a systemic disease, meaning that it affects the whole body. Psoriasis causes inflammation, fatigue, and other symptoms. About 30 percent of people with psoriasis develop psoriatic arthritis (PsA). PsA can cause progressive joint damage and lead to disability. It causes joint pain and stiffness and swollen fingers and toes.

Having psoriasis or psoriatic arthritis raises the risk of heart disease and other inflammatory conditions. Psoriasis and PsA are linked to uveitis (eye inflammation). People with uveitis may have eye pain, redness, and vision problems.

7. Biologics Target Psoriasis and Eczema Differently

Eczema and psoriasis share many of the same treatment options. For example, phototherapy (light therapy), topical corticosteroids (steroids), and methotrexate can help treat both skin conditions. In addition, people with eczema or psoriasis both need to find a good skin care routine and moisturizer that works for them.

However, a newer class of drugs, known as biologics, works in highly specific ways to target psoriasis or eczema. There are several different biologics approved by the U.S. Food and Drug Administration (FDA) for psoriasis and PsA, but only a few are approved for eczema. Each biologic is designed to interfere with specific immune pathways that differ between psoriasis and eczema.

Biologics are typically reserved for moderate to severe cases, especially for people who haven’t had success with standard therapies like steroids or immunosuppressants. While biologics are not a cure, they can significantly improve symptoms and quality of life for people whose conditions are difficult to control.

Keep an Eye Out for New or Changing Symptoms

While eczema and psoriasis may look alike and sometimes even respond to similar treatments, they are fundamentally different conditions with distinct underlying causes and health risks. Understanding these differences is important, especially because it’s possible to have both at the same time or to develop other related conditions over time.

If you notice new or changing symptoms, be sure to let your doctor know. Regular communication with your healthcare provider can help ensure you get the right diagnosis and treatment, and that you’re staying ahead of any related health concerns.

Talk With Others Who Understand

On MyEczemaTeam, the social network for people living with eczema and their loved ones, more than 55,000 people come together to ask questions, give advice, and share their stories about living with eczema.

Have you struggled to distinguish between eczema and psoriasis? How have skin diseases affected your life? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.