What Is The Difference Between Eczema And Psoriasis?

Skin related issues, besides creating unpleasant appearance, can also cause immense discomfort. It is important to diagnose a skin condition correctly. Despite looking similar to other skin problems, each and every skin problem requires a specific treatment, and if left unattended, can lead to other health problems. Eczema and psoriasis are two different skin problems which are usually confused for one another, but are quite different. So, what is the difference between eczema and psoriasis? This article discusses this in detail. Read on to know how eczema Vs psoriasis.

What Is The Difference Between Eczema And Psoriasis?

What Is The Difference Between Eczema And Psoriasis

Eczema, also referred to as dermatitis, is a class of skin conditions which make it dry, hot, scaly and itchy. In extreme outbreaks of eczema, the skin becomes red and raw, and starts bleeding. Statistics say that about 20% of the children and 3% of the adults of the world are affected by Eczema. It is believed that eczema is caused due to allergies or environmental irritants. The symptoms of eczema can worsen with hormonal fluctuations and stress.

Psoriasis is an inflammatory skin condition characterized by swollen reddish skin, coated with a silvery white layer. Plaque psoriasis, which is the most common form of psoriasis, usually occurs on the elbows, knees, lower back and the scalp. It is said that about 1 to 3% of the world’s population has been affected by this chronic disease.

Comparison Chart Of Eczema And Psoriasis

Eczema

Psoriasis

Causative agent Eczema arises because of environmental factors such as exposure to substances having harsh chemicals. There is genetics involved too. Psoriasis generally arises due to genetic reasons, and is therefore a response to internal body conditions.
Age factor Usually affects during childhood. Usually affects during the adulthood.
Appearance of the condition Eczema appears as dry skin in the form of raised spots or tiny blisters. No itchiness will be experienced. Psoriasis appears as red, rough and raised area of skin. This can even by itchy.
Silvery while scales on the lesion Absent in case of Eczema. Present in case of Psoriasis.
Extra skin fold below the eye (also known as Dennie Morgan fold) Present in case of Eczema. Absent in case of Psoriasis.
Food allergy Allergic reaction to some kind of foods may be associated with Eczema. Usually, no food allergy is associated with Psoriasis.
Emotional anxiety Generally, no emotional distress is associated with Eczema. Sometimes, emotional distress may be associated with Psoriasis.
Arthritis Arthritis is not associated with Eczema. Psoriasis is associated with arthritis, called psoriatic arthitis.
Treatment Emollients, pimecrolimus, topical steroids, antihistamines (fexofenadine, loratadine, cetirazine), sirolimus, tacrolimus Topical treatment, biological agents (Efalizumab, Adalimumab), UV photo therapy, photo chemotherapy, cognitive behavior therapy, coal tars, methotrexate, topical vitamin A/D derivatives, systemic treatment
Symptoms pruritus, xeroderma, ichthyosis, erythema Skin plaques, nail pitting, arthritis, “silvery white” scales
Location flexor surfaces, face Hairline, trunk, extensor surfaces, lower back
Causes genetic component, dry skin genetic factors, immune mediated injury to skin
Diagnosis Clinical diagnosis Skin appearance, a biopsy of skin

Causes

Some years back, Eczema was considered to be caused only due to environmental or external factors such as exposure to heat or harsh chemicals. However, a combination of both genetic and external factors causes Eczema. Only in recent years, science proved this. Scientists who work in this area of medicine have established a relation between a genetic defect in the epidermal layer of the skin and the development of Eczema. It has been found that this genetic defect in the epidermis allows the penetration of microbes, allergens and irritants into it, which causes unfavorable reactions, referred to as Eczema.

Since Eczema can be triggered by specific kinds of foods also, avoiding those foods is an effective solution to control this skin condition in some people.

Psoriasis is caused by a genetic factor which causes a problem in the immune system. Skin cells that are located in the deep layers of the skin rise to the upper layer. This process is referred to as cell turnover. This natural process takes place over a month in normal conditions. But in case of psoriasis, this takes place within a few days because of the fast rising of the cells.

It has been found that altering one’s diet can to some extent reduce psoriasis’ severity, but it cannot completely eliminate or avert its occurrence.

Age factor

  • Eczema generally affects during one’s childhood, and in some people, it can continue into adulthood as well.
  • Psoriasis has the tendency to affect people usually in their adulthood.

Biology Behind Eczema

In case of Eczema, certain genetic defects cause the skin cells to differentiate in an abnormal manner. During differentiation, the keratinocytes in the basal layer of epidermis move to the stratum corneum. This natural process is called as keratinization or epidermal differentiation. Several kinds of proteins are involved in this. One of the proteins involved is known as filaggrin. It is responsible for epidermal homeostasis, and performs two different functions, one of which is piling the keratin filaments into thick bundles. These bundles in combination with other byproducts get converted into skin’s NMF (Natural Moisturizing Factor). Therefore, if filaggrin does not function properly, unfavorable effects can result in skin’s level of natural moisture. This is dry skin’s biological basis. Recent research has established a link between filaggrin mutations and the development of skin conditions such as atopic eczema, ichthyosis vulgaris, and peanut allergies. Thus, day by day, the scientific community is gaining a better understanding of the genetic connection of various skin conditions.

Biology Behind Psoriasis

The ultimate cause of this skin condition is yet to be discovered. But, it is believed that the development of Psoriasis has connection with genetics, environmental factors, and immune system. An abnormal activity of the immune system makes inflammatory signals to go out of control in the epidermis of the skin. This in turn leads to the cell buildup on the skin’s surface, thus shortening the skin cell maturing period dramatically. Normal skin cells mature over 28 to 30 days, but psoriatic skin cells take just 3 to 4 days for this. Further, instead of shedding off, these cells build up on the skin’s surface, leading to the formation of plaques and lesions. The reason behind may be the T-cells’ hyperactivity, which kindle inflammation and overproduction of keractinocytes on the skin. Though the reason why this happens still remains hidden, the final result is skin cell cycle that goes too fast, accumulation of dead cells, and ultimate skin inflammation.

Symptoms

Symptoms of eczema are inflamed, itchy, and red skin; scaling; swelling and cracking of the skin; red crusty rash on cheek; blisters on the arms or legs; and blisters near the joints, particularly inside the elbows and behind the knees. The affected area of the skin itches, causing severe discomfort and difficulty sleeping. Other symptoms are allergic shiners (dark circles around the eyes), hives (urticaria), small rough-crusted bumps (keratosis pilaris), hyperpigmented eyelids, small raised bumps (papules), scaly skin areas (ichthyosis), leathery skin (lichenification) from excessive rubbing, Dennie-Morgan fold (extra skin fold under the eye), extra skin creases in the palms (hyperlinear palms), and Cheilitis (lip inflammation).

Symptoms of Psoriasis are initial small red patchy areas on the skin that progressively expand to become silvery, red and scaly plaques; skin itchiness and inflammation; cracked skin with lesions; and restricted joint motion. Approximately 10% of those affected with psoriasis also experience arthritis complaints. It has also been observed that those affected with psoriasis also experience lots of emotional distress and discomfort.

Appearance Of The Blisters On The Skin

Both Eczema and Psoriasis create blisters that are similar. However, upon close examination you will find evident differences between the two. In case of Eczema, the affected skin is dry and appears to have raised spots or tiny blisters on it. It is associated with excessive itching. Psoriasis results in red, rough and raised skin, which at times is itchy. The major difference between psoriasis and eczema is that the former is marked by scaly flaking which may also cause bleeding of the affected skin area.

Types

The different types of Eczema are-

  • Atopic eczema or Topic dermatitis (the most common form of Eczema)
  • Dyshydrotic eczema or vesicular eczema
  • Adult seborrhoeic eczema
  • Eczema herpeticum
  • Varicose eczema
  • Discoid eczema
  • Irritant contact dermatitis
  • Allergic contact dermatitis

The different types of Psoriasis are:

  • Plaque Psoriasis
  • Psoriatic Arthritis
  • Pustular Psoriasis
  • Guttate Psoriasis
  • Inverse Psoriasis
  • Nail Psoriasis
  • Erythrodermic Psoriasis
  • Psoriasis of the Scalp

Diagnosis of Eczema

In order to diagnose Eczema, the physician examines the affected part of the skin, and makes enquiries of the symptoms. So, if skin inflammation is detected, it is important to visit your doctor, show him the affected areas, and inform him of your allergies (if any). You also have to tell him of any strange products you are recently exposing yourself to. A physician can identify Eczema just by looking at it. In some cases, a skin biopsy may be needed.

Diagnosis of psoriasis

The physician examines your skin, scalp and nails for symptoms of psoriasis. He also enquires of your family history of psoriasis. Further, he also asks questions to know about your recent lifestyle. These he may ask to know if you are stressed, have suffered a recent illness, or have begun a medicine intake. Sometimes, a skin biopsy may be required to confirm psoriasis diagnosis.

Treatment Options

Treatment for Eczema

  • Moisturizing
    • Applying a moisturizing body wash or an aqueous cream helps by maintaining the natural oils of the skin.
    • Using colloidal oatmeal bath for bathing.
    • Avoiding the use of soap
    • Avoiding products such as perfume and powder as these may dry the skin.
  • UV Rays
    • Sunbathing
  • Skin cleansers
    • Avoid using drying soaps and harsh detergents.
    • Use a fat or oil based soap. It is good to use a goat milk soap which is super-fatted.
    • Avoid using scented soaps.
    • Perform a patch test of the soap of your choice by applying it on a patch of your skin till you are satisfied with its results.
    • Use a cleanser which is non-soap based.
  • Corticosteroids
  • Itch relief
    • Apply anti-itch medications like antihistamine.
    • Apply capsaicin to your skin. It acts well to counteract irritation.
    • Apply menthol
  • Immunomodulators
    • Apply topical immunomodulators such as tacrolimus (Protopic)and pimecrolimus (Douglan and Elidel).
  • Antibiotics
    • Your skin acts as a normal protective barrier against microbes and other foreign entities. When it gets distrupted via drying and cracking, foreign entities gain easy access into the body. Further, scratching introduces and spreads infection from one area of your skin to another. This further irritates the skin and accelerates the rapid deterioration in the skin’s condition. So, an appropriate antibiotic should be given for Eczema.
  • Light therapy
    • UVA (mostly used)
    • UVB
    • Narrow Band UVB.
  • Immunosuppresants
    • Cyclosporin
    • Azathioprine
    • Methotrexate
  • Food and nutrition
    • Recent research says that food allergies can cause atopic dermatitis in some people. For them, identifying and avoiding the allergenic foods can help minimizing the symptoms.
    • Food items that trigger eczema are dairy products, soybean products, coffee (caffeinated and decaffeinated), eggs, wheat, nuts, maize. However, you need to remember that food allergies vary from person to person.

Treatment for Psoriasis

  • Phototherapy
    • Narrowband UVB of the wavelength 311 to 312 nm helps in treating psoriasis. For getting a complete cure from psoriasis, several times exposure to UVB per week, over a number of weeks is necessary.
    • A combination of UV treatment and topical treatment (calcipotriol, retinoids, coal tar, etc) is used as synergism is witnessed in such combinations. The combination of UVB and anthralin paste application is termed the Ingram regime. And the combination of coal tar ointment and UVB is termed as the Goeckerman regime.
  • Topical treatment
    • Medicated ointments and creams that contain corticosteroids,coal tar, Vitamin D 3 analogues like calcipotriol, anthralin (dithranol), and retinoids are applied.
    • Moisturizers and bath solutions.
  • Systemic treatment
    • Methotrexate
    • Cyclosporine
    • Retinoids
  • Photochemotherapy
    • PUVA (Ultraviolet A phototherapy) is a combination of the topical or oral administration of psoralen and UVA (ultraviolet A) light exposure.

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