Have you ever had rashes appearing at random places on your skin that feel itchy or sting? You might think, “Oh, maybe it’s an allergic reaction, or a sunburn. I’ll just go to the pharmacy and apply some lotion. It’s probably nothing serious”. Except not only does it not go away, but the rashes also keep getting worse and growing larger by the day, making you extremely uncomfortable to do anything at all.
Newsflash: you may be living with actual skin disorders, either psoriasis or eczema.
Psoriasis vs. Eczema
Psoriasis and eczema are non-contagious chronic skin conditions, meaning they are lifelong diseases and cannot be cured. Fortunately, treatments coupled with self-care can help to keep the symptoms under control.
Both are often mistaken to be the same disorder, mostly due to several similarities in symptoms, triggers, and treatments. Both even appear quite alike to the eyes of laymen: red patches, itchy, inflamed, and dry. We will soon learn how to spot the differences in this article.
Psoriasis is an autoimmune disease; your immune system goes awry and attacks your healthy cells—which can lead to other illnesses developing at the same time (comorbid). In 2010, it was estimated that 500,000 Malaysians were diagnosed with psoriasis.
Psoriasis is more prevalent in adults, but can still affect children as well. There are 5 types of psoriasis :
- Guttate psoriasis
- Pustular psoriasis
- Plaque psoriasis
- Inverse psoriasis
- Erythrodermic psoriasis
Eczema, on the other hand, is agreed by most experts as NOT an autoimmune disease; rather, it has more to do with your skin barrier condition that leads to an oversensitive immune system.
Eczema is more widely known as it is very common—1 in 10 persons are expected to develop eczema. This skin condition usually begins in childhood (as young as babies) and continues until adulthood, but it can also emerge for the first time in an adult.
Eczema is a form of dermatitis and can be categorised into 7 types :
- Atopic dermatitis (AD)
- Contact dermatitis
- Dyshidrotic eczema
- Nummular eczema
- Seborrheic dermatitis
- Stasis dermatitis
Difference in Causes
To better understand how psoriasis and eczema differ from each other, we need to look at what causes them to happen in the first place.
Psoriasis, an autoimmune disease
Your immune system naturally acts as a protector to fight against bacteria and viruses—causing inflammation. Inflammation is actually a good sign that your white blood cells are functioning properly. However, when the immune system becomes dysfunctional, it can lead to a more serious condition.
In autoimmune diseases like psoriasis, your immune system becomes overactive. On top of protecting your body from harmful antigens, your immune cells recognise the healthy cells as a threat too and in turn wrongly attack (misfire) them. As a result, white blood cells are overproduced causing the inflammation to worsen as flare-ups.
Your overactive immune system is now forcing the body to speed up the growth of cells, including skin cells. Normally, the cycle of skin cell production takes about one month. Skin cells grow from the lowest layer of your skin and gradually push upwards into the surface as dead cells, before shedding or falling off to make way for new skin cells.
In psoriasis, new cells are rapidly regenerating (growing and being replaced) in just 3 to 4 days. With such limited time, the dead skin cells fail to shed properly and in turn accumulate on the surface of your skin—forming psoriasis plaques.
Eczema and filaggrin
While psoriasis is caused by a dysfunction in the immune system, eczema occurs due to a genetic mutation in your skin that leads to an oversensitive immune system.
Researchers suggest that there might be a lack of filaggrin protein in your skin layers. Filaggrin plays an important role in maintaining a strong skin barrier by glueing all the blocks of moisture, fats, oils, and other skin cells together to ensure your skin is well hydrated and protected.
Filaggrin deficiency means there are gaps between those blocks. When this happens, your skin tends to lose moisture and gets penetrated by irritants or allergens more easily. This means your body may react more strongly compared to other people when exposed to harmless substances such as soaps, perfumes, dust, cold weather, and pet fur. This also explains why people with eczema might have allergies as well.
Symptoms of Psoriasis vs. Eczema
Symptoms of psoriasis and eczema go through a cycle: from being active (flare-ups) to a state of less active or inactive (remission) for a certain period of time, before the next flare-up gets triggered.
Similarities in symptoms
Both psoriasis and eczema share these common signs :
- Red patches or rashes (might appear purple in darker skin tone)
- Skin dryness
- Non-contagious, but are at higher risk of infections.
- Can appear anywhere on the body
- May cause skin cracks and bleeding due to friction or constant scratching
Due to these similar symptoms, you might get confused and misdiagnose either of the conditions, especially in infants and children. Hence, it is crucial to consult your doctor, specifically a trained dermatologist who can distinguish between the two skin conditions.
How to differentiate?
Some differences may seem to overlap, but there are typical symptoms more evident in psoriasis than the other and vice versa.
Can I Have Both Eczema and Psoriasis?
In general, having both eczema and psoriasis at one time is extremely rare. Till today, limited research has been done on whether eczema and psoriasis can coexist simultaneously. A study reported that only 5 out of 354 children suffered from both eczema and psoriasis at the same time; however, the scope of the study excluded adults in the sample group.
Although, you could struggle with eczema during childhood which then gradually subside over time, and later begin to develop psoriasis as an adult.
Diagnosis of Psoriasis and Eczema
Skin disorders are best diagnosed by experts in the field: dermatologists. Usually, they are able to determine either psoriasis or eczema from a physical examination alone. If necessary, skin examinations such as patch test and skin biopsy may be conducted to gather clearer details.
During the procedure, you may be asked to describe existing symptoms including questions like:
- Where do the symptoms appear on your body?
- When did you start having them?
- How frequent are the flare-ups?
- Were you in contact with any harsh substances?
- Do you have existing allergies?
- How intense are the symptoms from mild, to moderate to severe?
- Did you experience any stress?
- Do any of your family members have a history of eczema or psoriasis?
Your dermatologist may also want to know the kind of hygiene and beauty products you used, in case those contain irritating ingredients.
As psoriasis can easily be mistaken for eczema, it is wise to disclose as much information as possible that may be useful to get your symptoms accurately diagnosed. Avoid self-diagnose and taking in over-the-counter prescriptions without getting yourself clinically checked first.
Skin patch test
This pain-free test is done by leaving several patches of different substances (allergens) on the skin, usually taped to your back for 2 days. During this period, you are not allowed to get them wet—meaning no exercising and being extra careful when showering.
After being removed, your dermatologist will keep track of any reactions to the allergens for up to 4 days before finalising the diagnosis.
This test is typically reserved for eczema diagnosis, as the condition is closely linked to allergies.
Skin biopsy is a suitable technique to diagnose skin conditions that go beyond the surface, like psoriasis, but can also be used to identify eczema. It is a minor procedure performed in a doctor’s office to obtain a sample of your skin tissue.
Also known as punch biopsy, a small tube-like instrument is used to puncture the skin as deep as 2 to 3 mm to extract all three layers of skin. The skin specimen is then brought to the lab to be examined further under a microscope.
Anaesthesia is injected first to numb the area, so you would feel less to no pain—though soreness is expected afterwards. The biopsy wound may take up to 3 weeks or a month to heal.
Psoriasis & Eczema Triggers
Apart from sharing a few similar symptoms, psoriasis and eczema also have some of their triggers in common.
Similarities in triggers
Both can be triggered by dry weather which aggravates itching—this includes long exposure to sunlight or extremely cold conditions. Also, having frequent or high emotional stress potentially reduces the level of cortisol (a hormone useful to minimise inflammation and infection), thus weakening your immune system which causes flares to act out.
The excess of immune cells in psoriasis and the highly sensitive immune system in eczema, skin infections and skin injuries can add to the severity of inflammatory response. Skin injuries may include skin burns, scratches, cuts, and injections.
Other psoriasis triggers
Other triggers of psoriasis involve substance use that alters the way your immune system normally works through:
- Smoking and alcohol consumption: The harmful chemicals in cigarettes and alcohol can overstimulate your immune system to become overactive.
- Certain medications: Common drugs such as lithium (for bipolar disorder), antimalarials (for malaria), and blood pressure medicines among others.
Other eczema triggers
Most eczema triggers consist of external substances that can cause irritation to the skin including:
- Hygiene and cosmetic products: shampoo, body wash or soap, make-up
- Household chemicals: fabric and floor detergents, disinfectants, dish soap
- Scented products: fragrances, perfumes, essential oils, scented items
- Exposure to allergens: dust, pollen, pet fur, cigarette or fire smoke, certain types of fabric and food
A person with eczema can also be affected by excessive sweating, especially in areas that get sweatiest like the back of the knees, inner elbow, and neck. Not only does it increase your body heat and moisture loss, but the sodium (salt) component in sweats is also known to trigger irritation as well.
Treatments for Psoriasis and Eczema
Although there are no cures for chronic long-term conditions like psoriasis and eczema, experts suggest managing symptoms is the way to go. Common treatments include medications, phototherapy, natural remedies, and self-care precautions.
Dermatologists recommend treatment plans based on the type of psoriasis/eczema, how severe the symptoms are, and the side effects consideration.
Topical medications serve as the most important need in psoriasis/eczema essentials, as you can apply them directly on the skin to reduce inflammation and itchiness.
Here is a list of topical medications:
- Corticosteroids: Found in many forms such as creams, gels, lotions, ointments, and sprays. Can also be taken orally for severe cases.
- Ceramides: This holy grail for dry skin helps to lock the moisture and repair your skin by strengthening the damaged skin barriers. Some skin care moisturisers are infused with ceramides.
- Salicylic acid (SA): Works to make the plaques in psoriasis thinner and softer. The ideal concentration is between 2% to 10%; a higher concentration however can worsen your inflammation.
- Emollients: Applied as a moisturiser to soothe inflammation and hydrate the skin.
Known as light therapy, phototherapy is used for people with severe psoriasis or eczema who show no improvements with topical treatments. It can also act as a convenient treatment for symptoms that cover large areas of the body.
This method should be administered by a healthcare provider or dermatologist as it involves a specialised machine that releases UV light—which helps to slow down the growth of cells and reduce inflammation.
Phototherapy is not a one-time treatment; it requires several visits to the doctor, usually up to 2 months, but is gradually reduced as the symptoms get better. It is also important to consider the side effects of phototherapy with your doctor firsthand.
Oral or injected medications
Topical treatments and light therapy alone may not be helpful for people with moderate to severe symptoms—instead, another alternative is to opt for oral medications (in tablets or liquids), and injection shots.
As there are possible adverse effects, healthcare providers would typically advise short-term usage or to use minimally together with topical treatments.
These medications should require prescriptions from your doctor to avoid drugs overuse :
- Antihistamines: Helps to relieve itchiness.
- Antibiotics: Works best for infections that may be caused by constant scratching.
- Systemic drugs or immunosuppressants: Methotrexate and cyclosporine target your whole immune system to calm down overactive responses and reduce flares. However, these drugs are used only when necessary as side effects are plenty.
- Vitamin D synthetics or analogues: Known to boost a stronger skin barrier for eczema patients and reduce inflammation in general. Examples include calcipotriol, tacalcitol, and calcitriol.
- Biologics: Functions similarly to immunosuppressants by reducing the severity of symptoms. Usually given through injections or infusion into the bloodstream (intravenous or IV infusion).
Natural or home remedies come in handy particularly when other treatments are not instantly accessible. These agents are simple yet work wonders to relieve inflammation, improve skin barrier, retain moisture in the skin, and have antibacterial properties.
The most effective ones include:
- Aloe vera
- Colloidal oatmeal
- Honey, especially manuka honey
- Natural oils like coconut oil and sunflower seed oil
Apart from medications and therapy, you can make small changes to your daily habits by being extra careful :
- Ensure the water is set to lukewarm during showers and the sessions short.
- Avoid rubbing or wiping your body harshly after showers. Instead, pat your skin gently and let the air dry it naturally.
- Apply moisturisers daily and immediately after showers (while your skin is still damp). Opt for oil-based moisturisers such as body butter,
- Wear loose clothes and non-abrasive fabrics including towels.
- Use a humidifier, especially at night when the temperature is cold and dry. Humidifiers increase the moisture level in the air which can relieve your dry skin. Be careful not to adjust the humidity too high, as damp air may result in the growth of bacteria.
- Choose hygiene, skincare, and cosmetics products that contain gentle ingredients or those specially formulated for psoriasis and eczema. Steer clear of those that are unsuitable for skin dryness such as foam cleansers and water-based moisturisers.
- Avoid being under the sun and in an air-conditioned room for too long.
- Minimise participating in rigorous activities like intense workouts that can lead to excessive sweating and increased body heat.
- Include anti-inflammatory foods in your diet for example fishes rich in omega-3 fatty acids, ginger, nuts, leafy vegetables, and antioxidant-rich fruits.
- Keep your fingernails and toenails short to avoid bleeding in care
- Be extra alert of the triggers.
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