Psoriasis vs Eczema: How to Tell the Difference
How psoriasis and eczema differ on the skin, scalp, face, hands and nails, and other rashes that can look similar.
Part of our psoriasis guide.
Get urgent help first. Call 999 or go to A&E if your skin suddenly becomes red and inflamed over most of your body, or you have widespread pus-filled spots, especially with a fever, chills or feeling very unwell. These can be signs of erythrodermic or generalised pustular psoriasis, which are emergencies. See a GP soon if you have painful, swollen joints. Online treatment isn't suitable in these situations.
Key fact: psoriasis usually forms thick, sharply edged, scaly plaques on the elbows, knees and scalp, while eczema is usually drier, less clearly edged, very itchy and found in skin creases. You can have both, but one doesn't turn into the other.
Adults only online, and not in pregnancy or breastfeeding. Access Doctor's online psoriasis service is for adults aged 18 and over, and can't supply treatment if you're pregnant or breastfeeding: your GP or midwife can help. Children with psoriasis should see their GP.
Psoriasis or eczema? The quick guide
| Psoriasis | Eczema | |
|---|---|---|
| Edges | Sharp, well-defined edges | Blurred edges that fade into normal skin |
| Surface | Thick, raised plaques with silvery or grey scale | Dry, rough or weepy; can be crusted |
| Usual places in adults | Outer elbows, knees, lower back, scalp, behind the ears | Inner elbows, behind the knees, neck, wrists, hands |
| Itch | Often itchy, sometimes sore or burning | Usually very itchy, worse at night |
| Nails | Pitting, lifting and discolouration are common | Nails usually normal, or ridged from scratching |
| Age it starts | Usually early adulthood or age 50 to 60; uncommon in children | Usually childhood, but can start at any age |
| Linked with | Psoriatic arthritis; family history of psoriasis | Hay fever, asthma, food allergy (atopy) |
On darker skin, the redness of both conditions can be hard to see. Psoriasis may look purple, grey or dark brown with thick scale, and both can leave darker or lighter patches as they heal. See psoriasis on black and brown skin.
How to tell if it's eczema or psoriasis
Look at the edges, the scale and where the patches are. A thick, clearly edged patch with silvery scale on the outside of the elbow or knee is typical of psoriasis. A dry, itchy, poorly defined patch in the crease of the elbow or behind the knee is typical of eczema. Check your nails and scalp too: pitted nails or thick scale along the hairline point towards psoriasis.
Sometimes it really is hard to tell, even for doctors, especially on the hands, feet, face and scalp. If you're not sure, a GP can examine your skin. A correct diagnosis matters because some treatments, such as Enstilar and Dovobet, are for psoriasis only.
Can you have both, and can eczema turn into psoriasis?
You can have both conditions, and some people have features of each, particularly on the hands and scalp. But eczema doesn't turn into psoriasis, or the other way round. They are different conditions with different causes: psoriasis is driven by the immune system speeding up skin growth, while eczema is mainly caused by a weak skin barrier and allergic tendency.
Scalp, face and hands
- Scalp: psoriasis forms thick, well-defined scale that often spreads past the hairline. Eczema and seborrhoeic dermatitis cause finer, greasier or flaky scale. See our scalp psoriasis and dandruff and seborrhoeic dermatitis treatment pages.
- Face: psoriasis on the face is often around the eyebrows, hairline, ears and sides of the nose. Eczema on the face is more often around the eyes and mouth. See psoriasis on the face.
- Hands: both cause cracked, sore hands. Psoriasis tends to form well-defined thick patches on the palms; eczema often causes tiny itchy blisters or redness between the fingers. See psoriasis on the hands and feet.
Other rashes that look like psoriasis
| Rash | How it differs from psoriasis |
|---|---|
| Fungal infection (ringworm) | A ring with a raised, scaly edge and clearer centre that slowly spreads. Often on one side only. Steroid creams make it worse. |
| Pityriasis rosea | Starts with one larger "herald patch", then many oval patches on the chest and back in a Christmas-tree pattern. Clears by itself in about 6 to 12 weeks. |
| Seborrhoeic dermatitis | Greasy, yellowish flakes on the scalp, eyebrows and sides of the nose. Can overlap with psoriasis ("sebopsoriasis"). |
| Lichen planus | Shiny, flat-topped purple bumps, often on the wrists, with lace-like white lines. |
| Discoid eczema | Coin-shaped patches that can look like psoriasis but are usually very itchy and may weep. |
Fungal rash or psoriasis? If a patch is spreading outwards with a clearer middle, don't put a steroid on it until it has been checked. Steroids can make ringworm spread.
How treatment differs
Both conditions are treated with emollients and steroid creams, and the same steroids, such as Betnovate and Elocon, are used for both. The differences are in what comes next: psoriasis is treated with vitamin D (calcipotriol) and combined products such as Enstilar and Dovobet, while eczema is managed mainly with emollients, steroids and, for infected patches, steroid and antibiotic creams. See our psoriasis treatment options and our eczema and dermatitis guide.
Diagnosed with psoriasis and need treatment?
Our GPhC-registered pharmacist independent prescribers can assess your skin online and recommend the right treatment, or tell you if you need to see your GP. Adults 18 and over. Dispensed from our UK pharmacy. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose.
Start Psoriasis Consultation →UK safety and reporting side effects
Prescription psoriasis treatments are only supplied after a GPhC-registered pharmacist independent prescriber reviews your consultation, including where your psoriasis is, how much skin it covers and what you have used before. Always read the patient information leaflet. Since 2024, UK steroid packs show their strength on the front (mild, moderate, strong or very strong). The MHRA advises using topical steroids for the shortest time needed, and to tell a healthcare professional if your skin flares badly after you stop a steroid you have used for a long time, which can be a topical steroid withdrawal reaction.
If you think you've had a side effect, tell your pharmacist or doctor. You can also report it to the MHRA through the Yellow Card scheme.
Psoriasis and eczema treatments from Access Doctor
We treat both conditions online after a consultation. See our psoriasis treatment page or our eczema and dermatitis treatment page for the treatments we supply.
Potent steroid · Rx
Betnovate Cream
Betamethasone 0.1%. A 4-week course for body plaques, then a 4-week break.
View product →Potent steroid · Rx
Elocon Cream
Mometasone 0.1%, applied once a day.
View product →Vitamin D + potent steroid · Rx
Enstilar Foam
Calcipotriol with betamethasone in a spray foam, once a day for up to 4 weeks. For diagnosed plaque psoriasis.
View product →Vitamin D + potent steroid · Rx
Dovobet Gel
Calcipotriol with betamethasone, for the scalp and for mild to moderate plaque psoriasis on the body.
View product →Frequently Asked Questions
How do I tell if it's eczema or psoriasis?
Look at the edges, the scale and where the patches are. Psoriasis usually has sharp edges, thick silvery or grey scale and appears on the outer elbows, knees and scalp. Eczema has blurred edges, is very itchy and usually appears in skin creases. Pitted nails also point to psoriasis.
Can eczema turn into psoriasis?
No. They are different conditions with different causes, so one doesn't turn into the other. Some people have both, and some rashes have features of each, especially on the hands and scalp.
Is psoriasis or eczema more itchy?
Eczema is usually more itchy, but many people with psoriasis also find it itchy, sore or burning, especially during a flare.
Can the same cream treat psoriasis and eczema?
Some can. Steroid creams such as Betnovate and Elocon are used for both. But vitamin D treatments and combined products such as Enstilar and Dovobet are for psoriasis only, and steroid and antibiotic creams are mainly for infected eczema.
How can I tell psoriasis from a fungal infection?
A fungal infection (ringworm) usually forms a ring with a raised, scaly edge and a clearer centre that slowly spreads, often on one side of the body. Psoriasis plaques are scaly all over and usually symmetrical. If you're not sure, get it checked before using a steroid, which can make a fungal rash worse.
References
- NICE Clinical Knowledge Summaries. Psoriasis. cks.nice.org.uk
- NHS. Psoriasis. nhs.uk
- British Association of Dermatologists. Psoriasis: an overview (patient information leaflet), August 2023. skinhealthinfo.org.uk
- NICE. Psoriasis: assessment and management (CG153). nice.org.uk
Medical disclaimer: This article is for information only and isn’t medical advice. Prescription psoriasis treatments need a clinical consultation before they can be supplied. If your skin is red all over, you have widespread pus spots, a fever or you feel unwell, seek medical advice the same day. In a medical emergency, call 999.