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Your skin is dry, tight, and irritated—perhaps with some red patches. It’s probably just regular old dry skin. Or is it?
Your skin could be affected by something else. After all, it’s not uncommon for people to confuse dry skin with skin conditions such as eczema and psoriasis.
“Both of these mimic dry skin in certain ways, but there are ways to identify if you actually have one of these conditions,” says Todd Minars, MD, assistant clinical professor of dermatology at the University of Miami School of Medicine.
How do you know the difference?
What could it be? Psoriasis vs. eczema? Psoriasis vs. dry skin? Eczema vs. dry skin? Learn how to recognize the differences between each condition so you can treat them appropriately.
Dry skin
Dry skin feels tight or rough, or sometimes itchy and flaky. It might be red and cracked. Sometimes, the cracks will even bleed, which can put you at risk for infection.
Triggers: When the temperature drops, your skin notices. Cold winter air (and the heat inside your house) tends to dry out most people’s skin. Hot baths and showers along with harsh, drying soaps and skin products can have a very similar effect, according to the Mayo Clinic.
Treatment: You can typically treat most cases of dry skin at home. Apply a generous layer of a thick moisturizing lotion or cream frequently, especially after washing your hands or taking a shower.
Eczema
Nearly 32 million people in the United States have eczema. About 18 million have the most common type of this skin condition, atopic dermatitis, according to the National Eczema Association. It’s more common in people with a family history of eczema. It typically develops in early childhood, and while some people “outgrow” their eczema, it can persist into adulthood. It causes a red, scaly rash, often on your legs and arms in places like the crooks of your knees and elbows. (It can also appear on your face.) Eczema is especially known for one defining characteristic: the itch.
“If I see a rash that is not itchy, it is not eczema,” says Cheryl Bayart, MD, a dermatologist with the Cleveland Clinic.
Triggers: The list of common triggers for eczema flare-ups typically includes:
- Heat
- Sweating
- Friction from clothes
- Stress
- Harsh soaps and detergents
- Fragrances
- Smoke
Some children with moderate-to-severe cases of eczema experience flare-ups when they eat certain foods, such as wheat or eggs.
Treatment: It might not be a case of eczema vs. dry skin—you might actually have eczema and dry skin. Dry skin can make your eczema worse. So, a good rule of thumb is to start with a daily routine of using a gentle cleanser, then applying a thick moisturizer like Aquaphor or Eucerin.
Next, you might benefit from a common first-line treatment for eczema: a topical steroid to help control the itching and moisturize your dry skin. An ointment containing hydrocortisone, such as Cortizone-10, can relieve the itch and bring some relief. A word of caution: overuse can lead to side effects, like thinning of the skin, so don’t overdo it.
Other possible treatments for eczema, depending on the severity of your case:
- Calcineurin inhibitor creams, such as Elidel (pimecrolimus) or Protopic (tacrolimus)
- Oral anti-itch or allergy medication, such as the antihistamines like Allegra or Zyrtec
- Phototherapy, which exposes your skin to controlled amounts of light
- Oral corticosteroids such as prednisone
- Dupixent (dupilumab), a monoclonal antibody medication
- Topical calcineurin inhibitors, pimecrolimus creams, and Tacrolimus ointments
Psoriasis
You’ll recognize psoriasis by the thick patches of skin that tend to develop on your knees, elbows, and feet, and maybe even your scalp and face. Psoriasis is an autoimmune disease that causes your body to produce skin cells at a very rapid rate. The skin cells pile up, causing scales and red plaques to form on the surface of your skin. You may experience discomfort, pain, or even itching as a result.
Triggers: Experts haven’t pinpointed a cause for psoriasis yet, but we do know about some common triggers for exacerbations, or flare-ups, of psoriasis:
- Injuries to the skin, like cuts or scrapes
- Infections
- Smoking
- Stress
- Heavy alcohol use
- Certain medications
New research suggests there could be a connection to gluten as a trigger, but only for people who are already sensitive to gluten.
Treatment: In addition to a moisturizer, your doctor may suggest applying a topical treatment such as:
- Corticosteroids
- Vitamin D analogs
- Vitamin A derivatives
- Calcineurin inhibitors
- Coal tar shampoos or creams
- Anthralin
Phototherapy is also an option. Severe cases might warrant certain systemic medications like methotrexate, cyclosporine, apremilast,or biologics that target the immune system.
RELATED: A guide to psoriasis treatment and medication
Is it eczema or psoriasis?
You can get eczema or psoriasis, or you can get both. It can be tricky to tell them apart. They can even appear in the same places, like the elbows and the knees. One key way to tell the difference: the itch. According to the American Academy of Dermatology, children who get eczema tend to experience intense itching, while psoriasis is more likely to only cause mild itching.
Which is worse: eczema or psoriasis?
So which is worse? It can depend on the severity of your case and your point of view, says Dr. Bayart.
“You can have a very mild case of either that barely affects your life or have a severe case of either that can be completely debilitating,” she says.
It may require some trial and error, but the right diagnosis and the right treatment can go a long way toward helping you manage. “While it can certainly be frustrating and in some extreme cases, debilitating, most patients can achieve relief with the proper treatment plan and regain and enjoyable quality of life,” says Dr. Minars.
However, it’s important to recognize that psoriasis is also linked to other serious health conditions, like heart disease, high blood pressure, and diabetes. “Your skin is telling you from the outside that you are at higher risk for those issues,” says Dr. Bayart. “You need to be especially careful about your health.”
The first step is the right diagnosis. Knowing what the rash means can put you in control of your health.
