Skin conditions can take on many forms, and result in a range of different symptoms.
They can also affect people to varying degrees. For some, they may only be a mild or occasional irritation, whereas for others they may present a much more irritating and persistent problem.
Psoriasis and eczema are two skin conditions that are fairly common; in the UK, it’s estimated that psoriasis affects around two or three in every 100 people, and that eczema affects roughly one in five children and one in 12 adults.
When skin symptoms develop, it might not be obvious what the cause is based on appearance alone. Psoriasis and eczema certainly share some similarities; but there are also some characteristics that set them apart.
With Psoriasis Awareness Week taking place later this month, we decided to take a look at the symptomatic differences between these conditions. We got in touch with Carla Renton from the Psoriasis Association to discuss the subject in more detail.
Psoriasis and eczema: how are symptoms different?
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Both conditions do share some common ground on symptoms. Psoriasis and eczema both break out in patches, and can often occur in similar areas. They also both cause itching and discomfort. But there are some key differences.
It’s important to note firstly that there are several different types of eczema, of which atopic eczema is the most common. In atopic eczema, inflamed patches will often be red or dark red, and develop into dry, crusty or cracked skin. These tend to cause severe itching, which might make someone scratch until their skin bleeds.
The symptoms of psoriasis are not entirely dissimilar.
‘Psoriasis usually appears as pink or red patches on white skin, or darker-coloured patches on darker skin tones.’ Carla notes.
However, in psoriasis, ‘these patches are often covered with white or silvery skin scales, and are referred to as ‘plaques’.’
The patterns in which eczema and psoriasis appear are also quite different.
‘One of the key distinguishing factors of psoriasis compared to eczema is that psoriasis plaques are well-demarcated,’ Carla explains, ‘it is easy to see (and sometimes feel) where psoriasis ends and normal skin begins. With eczema, this is often not the case.’
The patches associated with eczema may be less distinct at their edges, and fade more gradually into unaffected skin.
Eczema has the capacity to develop anywhere, but is more common in ‘flexural’ areas (parts of the body that bend) such as the elbows, wrists, ankles and backs of the knees.
‘Psoriasis can occur on any area of the body, including genital and flexural areas such as the armpits and groin; although it tends to be less dry in these areas, brighter in colour and shiny.’
Whereas intense itching is the main symptom of eczema, ‘psoriasis is often uncomfortable, itchy, and sometimes painful.’ Carla adds. In psoriasis, someone may also feel a stinging and burning sensation in the affected region.
Aside from the symptoms themselves, the age at which they develop can also sometimes provide a clue. While both conditions can develop for the first time at any age, in eczema it’s more common for symptoms to appear during early childhood; whereas in the majority of cases, psoriasis occurs for the first time either between the ages of 15 and 35, or between the ages of 50 and 60.
There are several possible causes of eczema, and these can vary depending on the type of eczema present. For instance, someone with contact dermatitis may be allergic or sensitive to a particular substance; and contact with this substance then triggers symptoms.
Atopic eczema occurs because the skin is not able to hold on to moisture, which causes it to become dry and cracked. Again, this is an autoimmune reaction which can be triggered by an irritant (such as a cosmetic or washing product), but sometimes allergens, changes in weather conditions, hormonal fluctuations or skin infections can initiate a flare too.
Eczema is thought to be genetic to an extent; someone who has one or more parents with the condition is likely to be more susceptible to it themselves.
As Carla explains, psoriasis is not unlike eczema in this regard.
‘The development of psoriasis is two-pronged. Firstly, every person with psoriasis is thought to be genetically predisposed to the condition, and there is ongoing research to identify which genes are involved. However, just having an associated gene does not definitely mean you will get psoriasis. For most people, there is an ‘environmental trigger’ that causes their first flare. This could be stress, an infection, certain medications, or an injury, amongst other things. Unfortunately, it is not always possible to pinpoint a person’s trigger, or to predict if they will develop psoriasis or not.’
As we’ll come to later in this article, while genetic factors are beyond our control, there are measures people with eczema or psoriasis can take to avoid triggers, and to limit the severity of flare-ups.
When to see a doctor
The temptation when skin symptoms arise may be to wait and see if they go away on their own, and in many cases they might; however, where they do persist, it’s better to see your GP. They will be able to help you determine the cause and, if necessary, point you in the direction of a specialist who can suggest a suitable treatment.
‘If you think you might have psoriasis, it is a good idea to see your GP to get a confirmed diagnosis.’ Carla explains.
‘Lots of skin conditions can look quite similar, and it is important to get an informed diagnosis. If you already have psoriasis but haven’t been to see your doctor in a while, it is a good idea to go back. Treatments have changed in recent years, and there are lots of options available. For most people, topical treatments (creams, ointments, shampoos and so on) are appropriate to manage psoriasis, but if your condition is more moderate or flaring severely, you might need more aggressive treatment. This is why it is important to visit a GP regularly, try the treatments on offer, and get a referral to a dermatologist if required.’
When someone has been given a diagnosis, getting help might not seem as pressing or urgent once they know what the problem is. Even when an eczema or psoriasis flare occurs, the inclination may be to just ‘ride it out’. But Carla maintains that keeping on top of the condition is important.
‘Many people aren’t aware that chronic skin conditions like psoriasis often do need active treatment to improve, and therefore just try to get on with things themselves. Psoriasis cannot be cured, but there are many treatments available that can improve the symptoms and manage flares, and healthcare professionals are able to offer a lot of help and support.’
As with any chronic condition, employing self-help strategies can sometimes serve to limit the severity of symptoms, and reduce the impact skin conditions like psoriasis and eczema have on other aspects of life.
For instance, for people with eczema, limiting exposure to triggers wherever possible can help to minimise the risk of flares. This might include staying clear of chemicals in certain shampoos or cosmetics known to be irritants (and opting instead for mild, tar-based soap or shampoos which have been dermatologically tested), and avoiding allergens and triggers such as damp, pollen, or cold weather.
For those with psoriasis, it might not always be possible to completely avoid triggers such as stress; but staying generally fit and healthy, as well as eating a balanced diet, can help to alleviate stress, which can in turn reduce the likelihood or severity of flare-ups.
Speaking to your pharmacist may be able to help, Carla notes, as can hearing from people in a similar position.
‘There are some treatments available to buy over-the-counter from a pharmacist - moisturisers, coal tar-based shampoos and mild steroids mainly - which may be helpful to people with mild psoriasis. However, people with psoriasis that is actively flaring should see a healthcare professional in order to obtain treatment to bring the flare under control.’
‘Much of the self-help focus in psoriasis is around dealing with the condition and treatments on a day-to-day basis, and coping with the impact that it can have on quality of life and mental wellbeing. Lots of people find that the forums on our website as well as our social media channels (our Facebook group for instance) are a good place for tips and support from others with the same condition.’
Is psoriasis awareness increasing?
Last month, National Eczema Week took place. World Psoriasis Day takes place on the 29th October this year, and in the UK, Psoriasis Awareness Week starts on the same day and continues on until the 4th November.
The events aim to raise understanding among the general public of eczema and psoriasis respectively, as well as to help those affected by these conditions find sources of useful information and support.
As Carla explains, even though the message is breaking through, and people are becoming more familiar with conditions such as psoriasis and their effects, there is still work to be done:
‘At the Psoriasis Association we do feel that awareness of psoriasis is improving,’ Carla notes, ‘it certainly helps that some celebrities in recent years have talked openly about having the condition and how it affects them. That said, there is still a lot of misunderstanding of just how much psoriasis can impact on a person’s life, as well as its causes and the most effective ways to treat the condition. We always urge people to get their health information from a reliable evidence-based source, such as organisations who are part of the Information Standard scheme.’
You can find out more about Psoriasis Awareness Week over on the Psoriasis Association website.