Eczema or psoriasis: how to tell the difference

Red, scaly, itchy patches of skin can be eczema, psoriasis or something else, and the two conditions are often confused. Both are common, both tend to flare and settle, and both are long-term conditions, though treatment can help manage them. Telling them apart matters because the treatment differs. This post sets out the differences described by the NHS, why a visual guess is not reliable and when to see a doctor.

The short answer

• Atopic eczema (atopic dermatitis) causes itchy, dry, cracked skin. It is most common in young children and often appears on the elbows, knees and hands.
• Psoriasis causes dry, itchy, sore, flaky patches that form what look like silvery-white scales. It often starts between ages 15 and 25, or 50 and 60.
• Both have flare-ups and quieter periods. Both can look different on brown and black skin.
• A doctor or dermatologist is the reliable way to tell them apart, and some people have both.

How eczema typically looks

The NHS says atopic eczema can appear anywhere but is common on the elbows, knees and hands, and in babies and toddlers it is also common on the face. It can make skin:

• itchy
• dry, cracked, crusty, scaly or thickened
• red, white, purple or grey, or lighter or darker than the skin around it, depending on skin tone
• blistered or bleeding

Symptoms usually start in babies and young children and tend to get better with age, though they can begin at any age. The NHS describes it as a long-term condition, and treatment can help manage symptoms.

How psoriasis typically looks

According to the NHS, the main symptom is dry, itchy, sore, flaky patches of skin with silvery-white scales. Patches are usually 1 to 2cm, oval or irregular in shape. They are pink or red on white skin, turning silvery-white. They may sometimes be waxy yellow or orange-brown. On brown or black skin they are grey and may leave dark marks after the psoriasis has gone.

Common places are the scalp and behind the ears, the chest, tummy and back, the bottom, forearms and elbows, lower legs and knees. It can also affect folds of the body, and nails, where the surface can have dents and pits. Most people have only a few patches, but some have large areas.

Comparing the two

These are general patterns. They overlap, and only an examination can confirm which you have. Other conditions such as contact dermatitis, fungal infections and scabies can look similar, and our posts on contact dermatitis and ringworm cover some of them.

When to see a doctor

The NHS advises seeing a GP if you or your child have symptoms of atopic eczema or psoriasis, if treatments are not helping, or, with psoriasis, if you have joint pain, stiffness and swelling that keeps coming back.

Eczema warning signs

Ask for an urgent appointment or call a health helpline if eczema is blistered, crusty, leaking fluid or has pus-filled spots, if it is painful, swollen or warm, if it suddenly gets worse or bigger, or if you have a high temperature or feel generally unwell. These can be signs of infection or a more serious condition called eczema herpeticum.

Psoriasis emergencies

The NHS says to call for emergency help if your skin quickly turns red and you develop white pus-filled bumps that join together, if patches on your feet turn yellow-brown and are filled with pus, or if your fingers and toes have red, scaly, pus-filled bumps at the tips.

What a consultation involves

A doctor will ask about when the rash started, where it is, what makes it better or worse, family history, and whether you have allergies, asthma or hay fever. They look at the skin, scalp and nails and may ask about joint symptoms. Sometimes a small skin sample or other tests are used when the picture is unclear. Treatment may include moisturisers, creams or other therapies, and your doctor may refer you to a dermatologist. Our guide to a dermatology consultation for acne and eczema explains the visit, and the skin consultation service page gives an overview. For wider background see the dermatology topic.

Things to take

• Photographs of the skin at its worst, since it may look different on the day.
• A list of creams, medicines and products you use, including any bought over the counter.
• Notes on triggers you have noticed.

Everyday skin care

Moisturising regularly is a common part of managing both conditions, and a pharmacist or doctor can say what suits your skin. Avoid products that sting or make your skin worse, and do not stop a prescribed treatment without advice. If you want help finding a clinic, you can send an inquiry.

Frequently asked questions

Can eczema turn into psoriasis?

They are separate conditions. It is possible to have both, so a new pattern of rash is worth checking with a doctor.

Are either of them contagious?

No. Neither atopic eczema nor psoriasis can be passed to others by contact.

Can children get psoriasis?

Yes, at any age, although it often begins in the late teens and twenties, or in the fifties and sixties, according to the NHS.

Does diet cause either condition?

The NHS pages we reviewed do not link either to diet as a cause. Ask your doctor if you suspect a food trigger.

General information only

This article is general information, not medical advice. If your skin is blistered, painful, leaking, quickly changing, or you feel unwell with a fever, seek urgent medical care.