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Psoriasis versus Eczema

This is a tricky one and admittedly, it can be a challenge even for experienced clinicians to tell these apart. They are both itchy, but #eczema can be itchy enough that you cause your skin to bleed by scratching. Psoriasis does cause you to scratch, but the sensation is not as intense, but may also sting and burn.


Eczema makes your skin red and inflamed, and it can be scaly, oozing, or even crusty. It can also make your skin feel rough and leathery. Psoriasis also makes your skin a bit red, but they are often more silvery than the eczema, and raised. The skin is thicker and more inflamed than you'll find with eczema patches. Because of the intensity of the itching with eczema, it is a bit more inclined to invite the risk of an impetigo infection as well.



There are multiple types of eczema, but often, when you hear someone talk about eczema, they're talking about the more classic, and quite common, atopic dermatitis. These people often also have asthma and allergies - often coined the trifecta. Like this picture above, about 10 to 20 percent of all infants have eczema, but most all will outgrow it.


Eczema often appears on parts of your body that bend, like the inner elbow or behind your knees. You can also have it on your neck, wrists, and ankles. Babies sometimes get it on their chin, cheeks, scalp, chest, back, arms, and legs. Psoriasis often shows up on places like your elbows, knees, scalp and face, lower back, palms of your hands, and soles of your feet. You may also have patches on your fingernails and toenails, mouth and lips, eyelids, ears, and in your skin folds.


Eczema is more of an irritation, like soaps, detergents, disinfectants, and juices from produce or meats. Allergies can also set off eczema, like dust, pets, pollen, mold, dandruff, and some foods. Infections can also cause eczema to flare, as can stress, sweating, heat, humidity, and changes in your hormones. Psoriasis shares some of these triggers, like stress and infection, but you can also get #psoriasis flares when your skin is injured, such as with vaccinations, sunburns and scratches. Lithium and some drugs for malaria can also flare psoriasis.


Psoriasis is more of a chronic, immune-mediated disease. It's more than just a local irritation or acute exposure or #allergy, and more a chronically activated condition that results in skin changes. There are also many types of psoriasis, but the most common is plaque psoriasis, which accounts for nearly 80 to 90 percent of psoriasis cases. There is thought to be no cure.


Atopic Dermatitis & Plaque Psoriasis are Different but Similar Conditions


Eczema usually starts in babies or young children. Often symptoms improve with age. It's less common, but possible, to get it as an adult. When that happens, it's usually because you have another condition such as thyroid disease, hormone changes, or stress. Psoriasis on the other hand, usually shows up between the ages of 15 and 35 years, but you can get it at any age, although rare to see on babies.


These look similar, but eczema usually comes along with dry, sensitive skin. You may have someone in your family who has it or has asthma or hay fever. Psoriasis, again, is more immune system based, or autoimmune even, and is linked to diabetes, heart disease, metabolic syndrome and even depression. My oldest daughter has a type of psoriasis called, guttate psoriasis which she got as a result of a strep infection. When your immune system creates inflammation within the skin, more cells are created in effort to heal which causes the buildup or plaque appearances on the skin with psoriasis.


An obvious clue pointing towards eczema is fluid leaking through your skin, known as serous exudate. This is called weeping eczema, and its the result of inflammation and puts you at risk of infection, so important to have evaluated by your clinician.


Neither are infectious or contagious. Both are genetic, which means they run in your family. Diagnosing them as a clinician is about more than just how they appear on the skin. It means taking a thorough history and evaluating all that with the individual's other medical conditions. Although a visual inspection is often very telling, and a history can really help us discern the difference, sometimes a #biopsy is necessary.


Treatment


Keep your skin hydrated. Dry skin is itchy skin, so caring for your skin is important. Use a moisturizing cream or ointment. Colloidal oatmeal baths (not food oatmeal) can be helpful for both eczema and psoriasis. A warm Epsom salt bath can also help relieve inflammation and remove those flaky scales from your skin. Magnesium has also been used in the salt bath for additional relief.


Conventional medicine recommends over-the-counter moisturizers such as Vanicream, CeraVe, and Cetaphil which target dryness and itchiness. They also lack fragrances and other ingredients which can irritate the skin. Over-the-counter hydrocortisone creams are also used to decrease the inflammation.


Light therapy or even sunlight can help psoriasis conditions, and is the most convenient. My daughter would even use a tanning bed five to ten minutes at a time when her's flared up the worst, as we tried to avoid use of steroidal creams which pose risk to the skin.


A healthy diet goes a long way. Avoid high glycemic foods, and eat healthy sources of protein. Good, clean food and lots of movement are great for the immune system in general so will certainly add to your overall health and minimize inflammation contributing to either eczema or psoriasis. Eggs, dairy, soy, #gluten, fish and nuts are common triggers. Fatty fish, yogurt, apples, broccoli, spinach and sourdough bread may help though.


Eczema is treated based on how severe it is, with mild to moderate cases often offered topical corticosteroids to control inflammation as well as an emollient. This is a moisturizer with an oil or cream base, not a water base, like a lotion, which is more drying. More moderate to severe eczema is often given medicine that impacts your immune system, such as methotrexate, azathioprine, or cyclosporine. Worst case, a biologic drug, dupilumab is often given. Light therapy can also be helpful, but super important is to identify and avoid the trigger. Often this is cigarette smoke and air pollutants, pet dander, or skin products. Wool can also do this, or even stress and weather.


In my own practice, steroids are rarely prescribed for these conditions, or any condition, but vitamin B12 topically has proven to be quite helpful. Evening primrose oil can also ease irritated skin as it contains omega-6 fatty acids and gamma-linolenic acid, which may improve overall inflammation. Coconut is like breastmilk, it cures most everything, and its a great moisturizer. Even the National Eczema Association has appreciated its use for this reason, and acknowledges the antibacterial abilities of coconut oil for reducing staph bacteria on the skin, minimizing infections. Choose a virgin or cold-pressed coconut that's processed without chemicals. Sunflower oil is another option; apply while skin is still damp. Although there isn't a tone of research, witch hazel has long been used for skin inflammation. Calendula cream is my go to skin ointment and fun to make at home for skin inflammation, burns, and cuts. Vitamin D, manuka honey, and tea tree oil are other approaches.


Psoriasis treatment is either systemic, which impacts your entire body, or its topical so just on your skin. If your disease is limited or mild, topical is preferred, but often this too is a topical corticosteroid and an emollient. Light therapy paired with acitretin, apremilast, cyclosporine, deucravacitinib, methotrexate, or a biologic are also the more common, conventional approaches. There are a number of biologic drugs which may be prescribed. Again, identify and avoid the trigger, which may be harder to discern than with eczema. Infections are a common cause though, as well as skin injuries, stress, and especially cold, dry air.


Stress can be a trigger for both so relaxation techniques really shouldn't be overlooked or under appreciated. Meditation, cognitive behavioral therapy, deep breathing, visualization, music therapy, hypnosis, biofeedback, tai chi, and y-o-g-a!

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