Introduction

When it comes to skin conditions, the two most common chronic inflammatory skin diseases people face are eczema and psoriasis. While both can significantly impact an individual’s quality of life due to discomfort, appearance, and itchiness, they are quite different in terms of causes, triggers, and treatment.

In this blog article, we’ll dive deep into understanding these two conditions and explore what the differences are between eczema and psoriasis, and provide insights on how best to manage each.

What is Eczema? [1]

Eczema, or atopic dermatitis, is a chronic inflammatory skin condition that results from a combination of genetic, environmental, and immune system factors. At its core, eczema involves a defective skin barrier that struggles to retain moisture and protect against environmental irritants, allergens, and microbes. This impaired barrier function leads to increased trans-epidermal water loss, making the skin more prone to dryness, cracking, and inflammation.

The condition is often associated with a heightened immune response, particularly involving the activation of T-helper cells (Th2), which release cytokines such as interleukin-4 (IL-4) and interleukin-13 (IL-13). These cytokines contribute to the inflammatory response seen in eczema, causing the redness, swelling, and itching commonly observed in flare-ups.

In individuals with eczema, the expression of filaggrin, a protein essential for maintaining the skin's structural integrity, is often reduced. This deficiency weakens the skin barrier, leaving it more vulnerable to environmental triggers such as irritants, allergens, and microbes. External factors like harsh soaps, extreme temperatures, stress, and allergens further aggravate the condition, leading to flare-ups.

The interaction between genetic predispositions, immune dysregulation, and external triggers creates a cycle of inflammation and barrier dysfunction, which defines the pathophysiology of eczema. Treatment approaches focus on restoring the skin barrier, reducing inflammation, and minimizing exposure to known triggers.

Who is Affected by Eczema?

Eczema predominantly affects infants and children, with approximately 10-20% of children worldwide experiencing the condition, though a smaller percentage, about 1-3%, may continue to have symptoms into adulthood. Genetic predisposition plays a significant role, as individuals with a family history of atopic diseases—such as asthma, hay fever, or other allergic conditions—are at higher risk of developing eczema. This genetic link is associated with mutations in the filaggrin gene, which impairs the skin barrier function.

Additionally, eczema is more common in urban and developed regions, possibly due to environmental factors like pollution, increased exposure to allergens, and lifestyle factors that reduce microbial diversity, which may affect immune system development. Despite being more prevalent in children, eczema can affect people of all ages and is often associated with other allergic or immune-mediated conditions.

What Causes Eczema?

Although the precise cause is not currently known, it is thought to be related to a combination of genetic, immunological, and environmental factors that lead to skin barrier dysfunction and chronic inflammation. In other words, it appears to all boil down to the biological interplay between inflammation and its impact on the skin barrier.  That said, the question then becomes what is the root cause of the eczema-triggering inflammation?

According to the “Inside-Out” theory, allergic inflammation begins inside the body, in a person’s gut, which leads to a breakdown in the gut’s intestinal lining, enabling toxins and bacteria to enter the bloodstream, triggering: inflammation; the breakdown of the skin barrier; and subsequent penetration of harmful allergens like S. aureus.

Conversely, the “Outside-In” theory proposes that a breakdown in filaggrin (a critical skin protein) leads to decreased natural moisturization factor in the skin (i.e., decreased moisturization) causing the skin barrier to become compromised. A poorly functioning skin barrier, in turn, increases inflammation within the skin and systemic inflammation in the body allowing for the development of allergic diseases like asthma and various food allergies.

This weakened skin barrier results in increased water loss and heightened susceptibility to irritants, allergens, and microbial infections. Immunologically speaking, eczema is driven by an overactive (hypersensitive) immune response to an eczema trigger that promotes inflammation. Environmental triggers such as allergens, harsh detergents, climate changes, and stress further exacerbate the condition, creating a cycle of skin barrier disruption and immune activation that leads to the characteristic symptoms of eczema such as skin dryness, redness, and itching.Common Eczema Triggers

Eczema can be triggered by a variety of different factors, and it’s important to note that these triggers can vary from person to person. Some common eczema triggers include:

•  Harsh soaps and detergents: These products can strip the skin barrier of its natural oils (sebum), leading to dryness and irritation.
• Extreme temperatures: Very hot or cold weather can trigger eczema flare-ups, especially when humidity levels are low.
• Stress: Psychological stress is known to worsen eczema-related symptoms in many individuals.
• Allergens: Exposure to pollens, dust mites, and animal dander can provoke flare-ups.
• Contact with certain fabrics: Believe it or not, wool and certain types of synthetic fabrics have been found to irritate the skin and trigger a reaction.
• Foods: Consumption of dairy and/or gluten can provoke flare-ups as well.

What is Psoriasis? [2]

Psoriasis is a chronic inflammatory skin condition that occurs when the immune system goes into overdrive and speeds up the process of skin cell production. Normally, skin cells grow and shed over the course of about a month, but with psoriasis, this process happens in just a few days. As a result, skin cells build up on the surface, leading to the formation of thick, scaly patches called plaques that are usually red or pink in color with a silvery-white coating of dead skin cells which can appear anywhere on the body. Psoriasis can be itchy and sometimes painful, but it’s not contagious, meaning you can’t catch it from someone else.

Psoriasis is considered an autoimmune disorder, which means that the body’s immune system mistakenly attacks healthy skin cells, thinking they're a threat. Scientists believe that certain genes play a big role in making someone more likely to develop psoriasis, especially when triggered by things like infections, stress, or skin injuries.

While the exact cause isn't fully understood, we do know that psoriasis can run in families. For some, it’s mild and manageable, but for others, it can be severe and affect not only the skin but also joints and overall health. In fact, people with psoriasis are at a higher risk of developing conditions like psoriatic arthritis and heart disease.

Who is Affected by Psoriasis?

Although psoriasis can appear at any time in a person’s life, it most commonly starts between the ages of 15 and 35. It also tends to run in families, so if you have a close relative with psoriasis, you might be more likely to develop it yourself. Moreover, this chronic inflammatory disease does not discriminate based on gender as both men and women are affected at about the same rate.

What Causes Psoriasis?

Psoriasis is an autoimmune disorder. For those suffering from psoriasis, their immune system mistakenly attacks healthy skin cells, causing them to reproduce at an accelerated rate. Skin cells typically take about 30 days to cycle through the process of being created and then shed. Unfortunately, when it comes to those who suffer from psoriasis, this process occurs in just 3-4 days, resulting in a buildup of skin cells that form the characteristic scaly patches.

What Triggers Psoriasis Flare-Ups?

Understanding the causes of psoriasis flare-ups is critically important to managing the condition. Although the exact triggers can vary from person to person, common factors include:

• Infections: Streptococcal infections such as strep throat, for example, are known to trigger a specific type of psoriasis reaction called “guttate psoriasis”.
• Skin injuries: Cuts, burns, or even insect bites can trigger a phenomenon called the Koebner response which results in psoriatic symptoms developing at the site of skin injury.
• Medications: Certain classes and types of drugs such as beta-blockers and lithium, are known to trigger psoriasis in some people.
• Stress: As is the case with eczema, stress can also exacerbate psoriasis and trigger flare-ups.
• Weather conditions: Cold, dry weather can dry out the skin making it more susceptible to psoriasis flare-ups.

Symptoms of Eczema vs. Psoriasis

While both conditions involve skin inflammation and itching, their respective symptoms are distinct in many ways.

Common Eczema Symptoms:

•  Itchy skin: Intense itching is a hallmark of eczema, and scratching can lead to open sores or infections.
• Dry, flaky skin: Affected areas are often very dry, leading to flaking or peeling.
• Red patches: These red or pink patches represent skin inflammation and, as a result, are oftentimes accompanied by swelling.
• Location: Eczema often appears on the face, neck, inner elbows, and behind the knees.

Common Psoriasis Symptoms:

• Thickened, scaly patches: The most obvious symptom of psoriasis is thick, silvery scales or plaques.
• Raised red areas: These patches of scaly skin are typically raised due to the uncontrolled accumulation of skin cells and appear inflamed.
• Dryness and cracking: Psoriasis plaques can become so dry and parched that they also tend to crack and bleed.
• Location: While psoriasis most commonly appears on the scalp, elbows, knees, and lower back, it can appear anywhere on the body.

Treatments for Eczema and Psoriasis [3]

While there is, unfortunately, no cure for either eczema or psoriasis, both can be effectively managed with the right type of treatment plan. The following represent some of the more effective treatment options available for each condition:

Eczema Treatments:

•   Moisturizers: Keeping the skin hydrated is crucial for eczema sufferers as it helps to maintain the skin barrier.
• Topical corticosteroids: These anti-inflammatory creams can help reduce redness and itching.
• Topical calcineurin inhibitors: These medications are often used when steroids aren’t effective or as a long-term solution to reduce inflammation.
• Antihistamines: These can help reduce itching, particularly at night.
• Phototherapy: Exposure to ultraviolet (UV) light can help control symptoms.
• Systemic medications: For moderate to severe cases, systemic treatments like biologics or oral medications may be necessary

Psoriasis Treatments:

• Topical corticosteroids: Like eczema, psoriasis can also be treated with corticosteroid creams to reduce inflammation.
•  Vitamin D analogs: These treatments slow down skin cell production and can be effective for plaque psoriasis.
• Phototherapy: Exposure to ultraviolet (UV) light can help control symptoms.
• Systemic medications: For moderate to severe cases, systemic treatments like biologics or oral medications may be necessary to suppress the immune system's overactivity.

It should be noted, however, that while corticosteroids are effective at reducing inflammation and managing symptoms of skin conditions like eczema and psoriasis, they come with some serious downsides, especially with long-term use. Over time, corticosteroids can thin the skin, making it more fragile and prone to bruising or tearing.

They can also cause issues like stretch marks, changes in skin color (especially in melanated skin) and, in some cases, make the skin more susceptible to infections. If used inappropriately or over large areas, corticosteroids can even affect hormone levels and other parts of the body. Some patients may even develop a serious condition called Topical Steroid Withdrawal Syndrom (TSW).  That’s why if you’re going to use them, it’s important to do so under a doctor’s guidance and only for as long as is necessary to control flare-ups.

Prevention Tips

Preventing Eczema Flare-Ups:

• Moisturize daily: A consistent moisturizing routine can help to maintain the skin barrier, thereby reducing the frequency of flare-ups.
• Avoid harsh soaps: Choose gentle, fragrance-free cleansers which will not strip your skin of essential oils and moisture.
• Manage stress: Stress-relieving activities such as yoga or meditation can help prevent flare-ups.

Preventing Psoriasis Flare-Ups:

• Avoid skin injuries: Be cautious to avoid cuts, scrapes, or burns that may trigger psoriasis.
• Manage stress: As with eczema, reducing stress can also help manage psoriasis flare-ups.
• Stay hydrated: Keeping the skin moisturized helps reduce dryness and irritation.

Because both eczema and psoriasis involve systemic inflammation, managing this inflammation and attending to the skin barrier to ensure its healthy and functioning properly are critically important. Hence, the use of topical products (preferably natural rather than steroidal) containing ingredients that help to manage the body’s inflammatory cascade while replenishing/fortifying the skin barrier is a preferred way to go.

FAQs

How do I know if it’s eczema or psoriasis?

Eczema is typically characterized by intense itching and dry, flaky skin, while psoriasis is marked by thick, scaly patches of skin. Additionally, eczema often affects the face, neck, and inner elbows, whereas psoriasis commonly appears on the scalp, knees, and elbows.  If you have either condition, it is best to seek professional help from a dermatologist.

What is the best cream for psoriasis or eczema?

For eczema, moisturizing creams along with prescription steroid creams if necessary. For psoriasis, topical corticosteroids and vitamin D analogs such as calcipotriene are commonly used, but a good moisturizer and a body wash with salicylic acid are also helpful.

What are three symptoms of psoriasis?

Three common symptoms of psoriasis are thick, scaly plaques, raised red patches, and cracked, dry skin that may bleed.

What does eczema look like?

Eczema typically appears as red, inflamed patches of skin that are dry, flaky, and very itchy.

What triggers psoriasis?

Psoriasis flare-ups can be triggered by stress, skin injuries, infections, and certain medications.

Conclusion

Eczema and psoriasis may share some similarities, but they are distinct conditions that require different approaches for effective management. Understanding what causes psoriasis flare-ups and common eczema triggers can help you take the right steps to minimize discomfort and keep your skin healthy. If you suspect you have either condition, it's always a good idea to consult a dermatologist for personalized advice and treatment.

Call to Action

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1. ANTU® SKIN BARRIER SUPPORT SUPPLEMENT: Specifically formulated with potent anti-inflammatory and antioxidant plant extracts that help soothe and calm irritated skin, together with L-histidine, an aminoacid clinically shown to enhance both moisture retention and skin barrier repair, this daily supplement helps to manage your symptoms from the inside-out.
2. BIA® HYRDATING SKIN SUPERFOOD 2.0: This ultra hydrating moisturizer is precisely what dry, sensitive, psoriasis-prone skin needs to help cope with this troublesome skin condition. The fact that it’s been endorsed by the National Psoriasis Foundation is further proof that it’s safe to use on psoriasis-prone skin.
3. BIA® SENSITIVE SKIN SOAK: With itch-fighting oatmeal, skin conditioning serrated wrack, soothing tapioca, and relaxing Epsom + sea salts is precisely the bath tonic most needed by those suffering from eczema.
4. BIA® UNSCENTED SOAP: Representing the first-ever handmade, cold-processed soap to receive the Microbiome-friendly certification, this gentle fragrance-free soap is specifically formulated with moisturizing Shea Butter to protect and soften your skin without irritation.

In addition to the above-mentioned products, for those suffering from psoriasis, you should also consider using the SHAANT® BODY SCRUB. The combination of salicylic acid together with our patented ShaantComplex® technology allows for gentle exfoliation to help soften and remove psoriasis scales while introducing much needed hydration to help replenish and maintain the skin barrier.

References

1.     https://nationaleczema.org/eczema/
2.     https://www.psoriasis.org/treatment-and-care/
3.     https://www.niams.nih.gov/health-topics/psoriasis
4.     https://nationaleczema.org/blog/eczema-or-psoriasis/