Rosacea, psoriasis, and eczema share some symptoms, such as rashes, bumps, redness, and itching. However, they are different conditions, though it is possible to have more than one of them at the same time. The symptoms may not warrant much attention when they cause minor discomfort.
Still, rosacea, psoriasis, and eczema tend to be chronic conditions, even if they're rarely life-threatening. They can lead to complications if left untreated, so it's worth seeing a healthcare provider to get a formal diagnosis, particularly if symptoms persist. Read on to learn how to distinguish psoriasis from eczema or rosacea.
Psoriasis vs. Eczema vs. Rosacea
Psoriasis, eczema, and rosacea can look alike. But, there are some ways to tell them apart.
Psoriasis | Eczema | Rosacea | |
---|---|---|---|
Age it affects | Childhood and up | Childhood and up | Most common age 30 to 50 |
Location | Elbows, knees, scalp | Skin folds, cheeks, hands, arms, legs | Nose, cheeks, chin |
Flushing | No | No | Yes |
Pimple-like rash | No | No | Yes |
Skin-thickening | Yes | Yes | Yes |
Pus-filled bumps | Sometimes | No | Yes |
Smooth rash | Sometimes | No | No |
Swelling | Sometimes | Sometimes | Sometimes |
Itching | Yes | Yes, severe | Yes |
Red rash | Yes | Yes | Yes |
Crusty, scaly rash | Yes | Yes | No |
Rash weeps fluid | No | Yes | No |
Rosacea
Rosacea is more common among fair-skinned people ages 30 to 50 years. It's slightly more common in females rather than males. Even so, rosacea can develop at any age, even during childhood.
Symptoms of Rosacea
Rosacea primarily occurs on the face and causes symptoms that include:
- Easy or severe blushing or flushing
- Hotness or redness
- Skin bumps
- Swelling
These symptoms often come and go, with periods when they're more severe and times when they're milder.
In addition, the symptoms of rosacea typically follow a pattern. Initially, the central areas of the face are affected, with flushing spreading over time to the cheeks, forehead, chin, and nose. Rosacea can even extend to include the eyes, ears, chest, and back.
Tiny blood vessels, pimples, and pustules sometimes, but not always, crop up in the red areas of the face. As such, rosacea is commonly mistaken for acne. However, with rosacea, no blackheads appear. The absence of blackheads can help distinguish rosacea from acne.
Over time, the facial blood vessels can become enlarged and make the redness more visible.
It's worth noting that more than half of people with rosacea develop a problem called ocular rosacea, in which the eyes sting, burn, and feel gritty. Left untreated, this may lead to problems with vision.
Lastly, rosacea may eventually lead to thickening of the skin, most commonly of the nose (called rhinophyma). Rhinophyma tends to strike men who have had rosacea for years and may become disfiguring enough to require surgery.
Rosacea Triggers
Scientists are still trying to understand the underlying causes of rosacea, but there is believed to be an underlying genetic predisposition. There's some evidence that a specific protein active in the immune system may contribute to the skin color changes in some people.
Bacterial infection or the presence of mites commonly affecting humans may play a role. Common environmental triggers include:
- Temperature extremes or changes
- Sunburn
- Stress
- Menstruation
- Personal care products and cosmetics that contain alcohol
- Scrubbing of the face
- Hot beverages
- Spicy foods
- Caffeine
- Alcohol
- Certain medications
Rosacea Treatments
A variety of topical treatments may help treat rosacea, including:
- Antibiotics
- Anti-yeast creams
- Finacea (azelaic acid)
- Soolantra (ivermectin)
- Epsolay (benzoyl peroxide)
Laser treatment or electrodesiccation—using a tiny needle that delivers electricity to the blood vessel to destroy it—may also improve symptoms. Light therapy also can be used.
Lastly, blood pressure medications like beta-blockers and Catapres (clonidine) are sometimes helpful in reducing flushing associated with rosacea.
Rosacea vs. Eczema
One distinguishing difference between rosacea and eczema is that it is not uncommon to see blood vessels beneath the skin with rosacea. In addition, the location of the rash can help identify the culprit: A rosacea rash is more common on the cheeks, whereas facial eczema is more common around the eyes and lips.
Psoriasis
Autoimmune disease is the root cause of psoriasis. That means your immune system treats your skin like a foreign invader, attacking and damaging it.
Psoriasis can develop at any age, even during childhood. However, it tends to run in families and waxes and wanes in severity over a lifetime.
Symptoms of Psoriasis
The most common form of psoriasis is called plaque psoriasis, in which areas of the skin become covered by thick, red patches (the so-called plaques), topped by a silvery-white scale. It can occur anywhere on the skin but usually affects the elbows, knees, and scalp. The areas where plaques form can be itchy and tender.
Plaque psoriasis can also affect the scalp, causing it to become very scaly, resembling dandruff. Nails, too, may be targeted, and if so, they may become pitted, ridged, and loose.
Other forms of psoriasis have notable features:
- Guttate psoriasis: This type of psoriasis causes small, tear-drop-shaped, salmon-pink spots to appear on the skin. The spots most often form on the trunk, arms, and legs but can also cover the entire body. In children, this type of psoriasis may resolve rather than be a chronic condition.
- Pustular psoriasis: With this type of psoriasis, a person develops inflamed, red skin covered with pus-filled bumps often found on the palms of the hands and soles of the feet.
- Inverse psoriasis: Like the name, this type of psoriasis causes lesions that are not scaly but instead are smooth, red, and shiny. Unlike plaque psoriasis, the areas affected by inverse psoriasis are usually areas of skin folds, such as armpits, under the breasts, and the groin area.
- Erythrodermic psoriasis: This is a rare, potentially severe form of psoriasis that causes widespread redness, swelling, and itching all over the body. In extreme cases, complications like dehydration, overwhelming infection, and congestive heart failure may cause this condition to become life-threatening.
Some people develop a form of arthritis called psoriatic arthritis. A few classic symptoms include prolonged morning stiffness, fatigue, and sausage-shaped fingers and toes (called dactylitis).
Psoriasis Triggers
Infections are frequent triggers of psoriasis flares, especially strep infections, which are highly correlated with guttate psoriasis.
Other possible triggers for psoriasis include:
- Skin injury
- Severely dry skin
- Stress
- Taking certain medications, like lithium or an interferon
Psoriasis Treatments
A variety of topical treatments may help improve symptoms of psoriasis, including:
- Steroid preparations
- Anthralin
- Dovonex (calcipotriene)
- Vitamin A creams
- Coal tar products
- Vtama (a novel topical product)
Exposure to ultraviolet light may improve symptoms, whether natural, outdoor sunlight or a special lamp/light at a healthcare provider's office.
Severe cases may require treatment with powerful psoriasis medications, including:
- Trexall (methotrexate)
- Sandimmune (cyclosporine)
- Biologic drugs, including Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Tremfiya (guselkumab), and Cosentyx (secukinumab)
- Otezla (apremilast)
- JAK inhibitors, including Xeljanz (tofacitinib)
Eczema
Eczema (also known as atopic dermatitis) can develop at any age, even during infancy. However, it usually begins before age 5 and affects about 13% of children in the United States.
Eczema tends to run in families, especially in those prone to allergies and asthma. About half of children diagnosed with eczema also will develop allergic asthma or hay fever.
Symptoms of Eczema
Experts believe eczema is primarily due to skin barrier dysfunction and is often genetically mediated. Affected areas may become cracked, discolored, blistered, crusty, or scaly and may weep clear fluid. People with eczema are at increased risk of developing skin infections, especially with Staphylococcus aureus.
Eczema can crop up anywhere, although common areas are in skin folds and on the cheeks, backs of the hands, tops of the arms, and fronts of the legs.
Eczema Triggers
Triggers for eczema include:
- Temperature changes
- Dry skin
- Irritants (for example, wool, dyes, cosmetics, perfumes, and soaps)
- Foods, especially the major allergens (i.e., eggs, peanuts, fish, soy, wheat, and dairy)
- Stress
- Dust mites
- Pollen
- Animal dander
Eczema Treatments
When you have eczema, it's essential to keep your skin clean and well-moisturized. Take short, warm (not hot) showers, and use a non-soap cleanser. Applying a moisturizer to the entire body within three minutes of getting out of the shower can go a long way in protecting your skin's barrier.
When skincare is not enough, topical steroids can improve redness and itching, but you should only use them for short periods. Topical medications that can help include:
- Elidel (pimecrolimus)
- Protopic (tacrolimus)
- Eucrisa (crisaborole) can improve itching and redness
Eczema vs. Psoriasis
One of the most significant differences between eczema and psoriasis is the level of itching. While both skin conditions can cause itching, the itch associated with eczema is intense, causing some people to scratch their skin until it bleeds, often in their sleep. In addition, the borders of psoriasis are more well-defined than those of eczema.
For moderate to severe cases of eczema that are not well managed with topical prescription treatments or for which topical treatments aren't advised, biologic drugs Dupixent (dupilumab) and Adbry (tralokinumab-ldrm), as well as oral JAK inhibitors like Rinvoq (upadacitinib), are other treatment options.
In severe cases of eczema, you might need immunosuppressants such as Trexall (methotrexate), Sandimmune (cyclosporine), or Imuran (azathioprine).
Summary
Rosacea, psoriasis, and eczema are common skin problems with some shared—and some unique—symptoms, triggers, and treatments. Eczema, for example, tends to be extremely itchy, while rosacea often leads to bright, flushed facial skin.
Aside from evaluating these conditions, your healthcare provider will also consider other skin conditions that need to be ruled out, including some conditions that may be more serious.