Is it Eczema, Psoriasis (or Neither)?



So, you or your child have recurring (or constant) red, itchy patches of skin that are making you or him/her very uncomfortable, and it is difficult to sleep (because you are always itchy).  What is it?  Is it eczema or psoriasis?

Here are a few questions to help answer this question:

1. YOUNG AGE?
If the patient is less than 7, it is probably Eczema. Here is why;
  • Approximately 17% of all infants ages 0-2 get eczema, whereas less than 1 in 700 will get pediatric psoriasis.

  • About 13% of children ages 3-6 get eczema, compared to 1 in 500 that will get pediatric psoriasis.

2. SCHOOL AGE? (7-18)
It is still probably Eczema. Although eczema incidences decrease as children grow (and psoriasis incidences rise), the number of eczema cases still outnumbers psoriasis by ~ 200-1.

3. WHERE & HOW DOES it APPEAR on the BODY?
  • Psoriasis tends to cause blotches of well-defined raised, red and silvery-white scaly patches of skin.  Eczema may appear red, inflamed, peeling, cracked, blistered or pus-filled with intense itchiness – but is not generally covered with scales.

  • Psoriasis appears more often on the scalp, soles of feet, palms of hands, lower back, genitals, legs, buttocks, elbows, knees and nail beds.

  • Eczema appears more often in “creases” such as the back of the knee or inside the elbow, although psoriasis also can appear in these places.  Eczema is also common along the arms, legs and on the face.

  • Both psoriasis and eczema can occur anywhere on the body and cause itching.

4. Was there an ENVIRONMENTAL TRIGGER?
  • Secondhand smoke? - smoke exposure may trigger psoriasis

  • Stress? - stress can cause psoriasis to flare

  • Infection? - eczema is more common than psoriasis following an infection

  • Lacerations? - cuts are a frequent trigger for psoriasis

  • Prescribed drugs? - certain medications have been shown to trigger psoriasis

  • Dry air? - dry skin can occur in both psoriasis and eczema, but is more prevalent in eczema

5. Is there any POSITIVE FAMILY HISTORY?
Both eczema and psoriasis are immune disorders, and both have strong family history causation. For example, if two parents have psoriasis, there is a 75% chance that their child will develop it. If one identical twin has eczema, there is an 80% chance that the other twin will also get eczema.

FYI - in the image above, one is neither psoriasis, nor eczema.  The other is plaque psoriasis.

Kevin Fitzpatrick, Tori Fitzpatrick
Fitzpatrick Translational Science
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