What Separates Eczema and Psoriasis?

Oct 01, 2023 By Madison Evans

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Eczema and psoriasis are the most common dermatological conditions. A layperson may misdiagnose skin issues because they seem the same. To manage and treat them, know their key differences. The "psoriasis vs eczema" or "eczema psoriasis" debate may appear confusing, but delving deeper helps clarify.

Redness, itching, and inflammation characterize eczema. They have similar symptoms but different causes, signs, and treatments.

Causes and Pathophysiology

Eczema

Eczema, a skin condition often synonymous with atopic dermatitis, is predominantly an allergic reaction. It’s closely associated with familial histories of allergies or asthma, suggesting a vital genetic component in its occurrence. Eczema propensity means those with a family history are more vulnerable to environmental triggers.

Eczema is caused by various genetic, immunological, and environmental factors. Eczema weakens the skin barrier, making it more sensitive to allergens. This weakened skin barrier increases transepidermal water loss, making eczema skin dry.

Environmental variables exacerbate eczema. Soaps, laundry detergents, temperature changes, and textiles are common triggers. These irritants can worsen inflammation and irritation, weakening the skin barrier and prolonging the cycle. Stress and certain foods, especially in food allergy patients, can worsen eczema, showing its complexity.

Psoriasis

Doctors call psoriasis an autoimmune condition, but its cause is uncertain. Immune cells wrongly target healthy skin cells in psoriasis. This immune misfiring accelerates skin cell production far beyond the norm.

The rapid skin cell turnover in psoriasis results in the accumulation of skin cells on the surface, forming the characteristic and often discernable plaques associated with the condition. Silvery scales cover these thick, red plaques. Immune dysregulation increases inflammation, making plaques red and itchy.

While psoriasis is fundamentally an immune-mediated condition, several triggers have been identified. These include infections, stress, certain medications, and even physical trauma to the skin, known as the Koebner phenomenon. These factors can induce or exacerbate psoriatic flares, adding complexity to managing this chronic condition.

Appearance and Symptoms

Eczema

  • Often appears as patches of chronically itchy, dry, thickened skin.
  • Common areas include the insides of the elbows, the back of the knees, and the face, but they can occur anywhere.
  • The skin might also blister or ooze in severe cases.

Psoriasis

  • It presents red, thick, and scaly patches, which can sometimes appear silvery.
  • The patches, commonly called plaques, can occur anywhere but are frequently seen on the knees, elbows, lower back, and scalp.
  • Psoriasis can manifest as nail changes, such as pitting or separation from the nail bed.

Triggers

Eczema

Common triggers of eczema include:

  • Dry skin
  • Environmental factors such as pollen or pet dander
  • Irritants like soaps and detergents
  • Stress
  • Certain foods, especially for those also suffering from food allergies

Psoriasis

Common triggers of psoriasis include:

  • Infections
  • Stress
  • Certain medications, including lithium and high-blood pressure medications
  • Injury to the skin, known as the Koebner phenomenon

Associated Health Concerns

Eczema

Eczema isn’t merely a superficial skin condition; it’s associated with various health concerns. Eczema is linked to asthma and hay fever. Several eczema patients have both disorders, suggesting a common immunological cause.

Additionally, chronic itchy and scaly skin can give rise to a condition known as neurodermatitis. This condition commences with a patch of itchy skin. The persistent scratching in response to this itchiness can make the skin thickened and leathery, further exacerbating the state and potentially leading to infection. The chronic nature of neurodermatitis can significantly impact the quality of life, underscoring the need for effective management strategies for eczema.

Psoriasis

Similarly, psoriasis extends beyond skin involvement, being linked to several health conditions. Psoriatic arthritis is a notable concern, characterized by joint inflammation that produces symptoms of arthritis in patients with psoriasis. Psoriatic arthritis can significantly impair mobility and overall quality of life.

Psoriasis raises cardiovascular, metabolic, and diabetic risk. Psoriasis' systemic nature and necessity for complete therapy may cause these issues.

Treatment

Eczema

  • Moisturizing: Essential to repair and maintain the skin barrier.
  • Topical corticosteroids: To reduce inflammation and relieve itching.
  • Light therapy: Exposing the skin to controlled amounts of natural sunlight or artificial UV light.

Psoriasis

  • Topical treatments: Includes corticosteroids, vitamin D analogs, and topical retinoids.
  • Light therapy: UVB phototherapy is a common method.
  • Systemic treatments: Oral or injected medications such as methotrexate, cyclosporine, or biologics that target the immune response.

Prevalence and Age of Onset

Eczema

Eczema is a common condition, frequently beginning in childhood, especially during infancy. Early development of eczema shows genetic predisposition and environmental triggers. Eczema can start at any age, highlighting its unpredictability.

Eczema has a higher prevalence in urban areas and developed countries. The reasons behind this are multifactorial, possibly involving increased exposure to environmental pollutants, lifestyle factors, and reduced microbial exposure in childhood, which can influence immune system development.

Psoriasis

In contrast, psoriasis typically manifests between the ages of 15 and 25. The onset can be difficult, given the social and psychological effects of living with a visible skin disorder in adolescence and early adulthood. Psoriasis, like eczema, can start at any age, adding unpredictability.

While children younger than ten can develop psoriasis, it’s less common in this age group. The genetic propensity and severity of early-onset psoriasis are higher.

Diagnosis

Diagnosing these conditions requires a nuanced approach, amalgamating clinical acumen with appropriate investigative measures, where the journey often begins with a thorough physical examination.

Physical Examination

A meticulous physical examination is the cornerstone of diagnosing eczema and psoriasis. Dermatologists delve into the intricacies of the patient’s medical history, teasing out details of familial predispositions, environmental exposures, and the evolution of the skin lesions. The visual characteristics and distribution of the skin lesions provide valuable insights, with eczema often presenting as itchy, inflamed patches in characteristic areas such as the folds of the elbows and knees. At the same time, psoriasis manifests as thick, red plaques with silvery scales commonly found on the elbows, knees, scalp, and lower back.

Biopsy and Skin Scraping

Further, investigative measures such as skin biopsy or scraping may be warranted when the diagnosis is nebulous or clinical presentation is atypical. A small piece of damaged skin is removed and examined under a microscope for a skin biopsy. On microscopic examination, epithelial thickness, inflammatory cell infiltrates, and dermal vascular changes can distinguish eczema from psoriasis.

Although less invasive, skin scraping delicately removes and analyzes the superficial layers of the skin. Fungal infections can mimic eczema and psoriasis, so this procedure helps rule them out.

Allergy Testing

Specifically, allergy tests may be recommended in cases of suspected eczema to identify potential triggers. Eczema is often interlinked with allergic conditions, and uncovering allergenic triggers can be instrumental in managing the situation effectively. Skin prick, blood IgE, and patch tests can diagnose allergies.

A tiny needle injects small amounts of possible allergens into the skin and observes for allergic reactions, usually localized swelling and redness. Blood tests measuring specific IgE levels aim to detect the presence of antibodies produced in response to allergens, providing insights into the patient’s sensitization to particular substances. Patch testing is beneficial for detecting contact allergens, where potential allergens are applied to the skin using adhesive patches, and the skin’s reaction is observed after a set period.

Complementary Investigations

In addition to the aforementioned diagnostic methods, complementary investigations may be employed to assess systemic involvement and rule out other differential diagnoses. Blood tests may measure inflammatory indicators, immunological factors, and organ function. Psoriasis patients must be screened for cardiovascular disease, metabolic syndrome, and psoriatic arthritis for comprehensive care.

Patient History and Lifestyle Assessment

Beyond clinical and laboratory investigations, a holistic approach to diagnosis involves assessing the patient’s lifestyle, stress levels, dietary habits, and exposure to potential irritants. Gaining insights into these factors not only aids in the diagnosis but also shapes the management plan, addressing the multifactorial nature of eczema and psoriasis.

Bottom Line

The term "eczema psoriasis." can be confusing due to the symptoms of both conditions. However, recognizing their traits, triggers, and treatments can help separate them. You must see a dermatologist if you suspect either condition. These chronic skin disorders can be managed and relieved with proper diagnosis.

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