Urgent Care / Skin / Psoriasis and Eczema
Psoriasis tends to cause thick, raised, clearly outlined patches with heavy scale, often on the elbows, knees and scalp. Eczema tends to cause drier, very itchy patches with blurry edges, often in skin folds and on the hands. They can look alike, and they can both come and go. Because the treatments differ, getting the right name for your rash is the first step to feeling better.
What are psoriasis and eczema?
Psoriasis is a long-term condition of the immune system. It speeds up how fast skin cells grow, so they pile up on the surface and form thick patches called plaques. It isn't contagious. Some people with psoriasis also develop joint pain and stiffness, called psoriatic arthritis.
Eczema, also called dermatitis, is a group of conditions where the skin barrier doesn't hold moisture well and the skin overreacts to irritants. The most common type, atopic dermatitis, often starts in childhood but can begin or return in adulthood. It isn't contagious either.
Both can start at any age, and both can flare and settle over time.
How can you tell them apart?
No checklist replaces an exam, but these differences are a useful guide:
| Psoriasis | Eczema | |
|---|---|---|
| Edges | Sharp, well-defined | Blurry, less defined |
| Thickness | Raised, thick plaques | Flatter, dry or rough skin |
| Scale | Heavy, silvery-white scale | Fine flaking; may ooze or crust when flaring |
| Itch | Can itch, sting or burn | Usually very itchy, often worse at night |
| Common spots | Elbows, knees, scalp, lower back, behind the ears | Inner elbows, backs of knees, hands, neck, eyelids |
| Nails | May show small pits, thickening or lifting | Usually unaffected |
| Joints | May have joint pain or stiffness | No joint involvement |
On darker skin tones, both conditions can look purple, gray or dark brown rather than red, which can make them harder to recognize.
In older adults, very dry skin can also cause a cracked, itchy type of eczema, especially on the shins in winter or in air-conditioned rooms. And some other rashes, like fungal infections, can look similar to both.
What makes them worse?
Psoriasis flares can be triggered by:
- Stress
- Skin injuries, including scratches, cuts and sunburn
- Infections, such as strep throat
- Smoking and heavy drinking
- Some medications
- Cold, dry weather
Eczema flares can be triggered by:
- Dry skin and long, hot showers
- Fragranced soaps, lotions and laundry products
- Sweat and heat, a real factor in Florida
- Wool or rough fabrics
- Stress
- Contact with things you're allergic to
What can you do at home?
These steps help both conditions and are safe for most people:
- Moisturize at least once a day, ideally right after a shower, with a thick, fragrance-free cream or ointment
- Keep showers short and lukewarm, and use a gentle, fragrance-free cleanser
- Pat your skin dry instead of rubbing
- Wear soft, breathable fabrics like cotton
- Try not to scratch. Keep nails short, and use a cool compress when itch is intense
- Notice your triggers and keep a simple log
A small amount of sun may help some people with psoriasis, but sunburn can make it worse. Use sunscreen, and ask your clinician before using sun exposure as treatment.
Don't use leftover prescription creams on a new rash without checking first. Some creams that help one condition can make another worse, or thin the skin with long use.
How are psoriasis and eczema treated?
Treatment depends on which condition you have, where it is and how much skin is involved. Your clinician decides what's appropriate. Options may include:
- Prescription topical anti-inflammatory creams or ointments, in different strengths for the body, face and skin folds
- Non-steroid prescription creams that calm inflammation, often used on thin skin like the face
- Vitamin D-type creams for psoriasis
- Medicated shampoos or scalp solutions for psoriasis on the scalp
- Treatment for infection if broken skin has become infected
- For more widespread or stubborn disease, a referral to a dermatologist for options like light therapy, or pills or injections that act on the immune system
Both conditions are long-term, so treatment usually focuses on controlling flares and keeping skin comfortable. A plan that fits your daily routine is one you'll actually use.
What does a video visit at MD Care look like for a rash?
Skin problems are well suited to a video visit, because your clinician can see what you see. During the visit, your clinician will:
- Ask when the rash started, how it feels and what you've tried
- Look closely at the patches on camera, including the edges and the scale
- Ask to see your scalp, nails and other common spots
- Ask about joint pain, new medicines and family history
- Recommend treatment and, when appropriate, send a prescription to your pharmacy
Use natural daylight or a bright lamp, and have clear photos ready if a patch is hard to show on camera. Read more about rashes and skin infections.
A video visit is $50 without insurance, with no membership. A $20 message visit with photos may be enough for some follow-ups, when your clinician agrees it's appropriate. If you have Medicare, we confirm your coverage before your visit, and you pay your plan's share. Most patients are seen within three hours, and you need to be in Florida at the time of your visit. See pricing and Medicare.
When should a rash be seen in person?
Seek in-person care the same day if:
- The rash is painful, warm and spreading, or oozes pus or forms honey-colored crusts
- You have a fever with a rash
- Eczema suddenly turns into painful, punched-out sores or blisters, especially with fever. This can be a viral skin infection that needs prompt treatment.
- Psoriasis suddenly breaks out into many small pus-filled bumps
Go to the emergency room or call 911 if your skin turns red over most of your body and you have chills, fever or feel very unwell, or if you have swelling of the lips, tongue or throat or trouble breathing.
Can you have both psoriasis and eczema?
It's uncommon, but possible. Sometimes a rash has features of both. A clinician may suggest a dermatologist visit if the picture isn't clear.
Is psoriasis contagious?
No. You can't catch psoriasis or eczema from another person.
Can stress really cause a flare?
Stress doesn't cause either condition, but it's a common trigger for flares of both.
Can a rash be diagnosed by video?
Many can. Your clinician can see the color, shape, edges and location of the rash on camera. If anything is unclear, they may ask for photos or suggest an in-person exam.
Does Medicare cover a visit for a skin rash?
Medicare can cover visits to diagnose and treat skin conditions. We confirm your coverage before your visit.
Not sure what your rash is?
Show it to a Florida-licensed clinician by video, from home.
Sources
- American Academy of Dermatology (AAD). Psoriasis: signs and symptoms; Eczema types: atopic dermatitis. aad.org.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Psoriasis; Atopic dermatitis. niams.nih.gov.
- MedlinePlus, U.S. National Library of Medicine. Psoriasis; Eczema. medlineplus.gov.
This article is for general information and isn't medical advice. It doesn't replace an evaluation by a clinician. MD Care is not for emergencies: if you have a medical emergency, call 911 or go to the nearest emergency room.
