Can You Have Eczema and Psoriasis at the Same Time?

From self.com

The symptoms overlap quite a bit—but an accurate diagnosis is crucial 

If you have painful skin symptoms that just won’t quit—you know, dryness that leads to obvious cracks, inflammation that just feels awful, or intense itchiness—and you’ve travelled down a rabbit hole via Dr. Google, then you’ve probably come across information on either eczema or psoriasis.

These skin conditions are different and complex in unique ways, but their respective lists of symptoms can overlap quite a bit, making them difficult for the average person (read: anyone who’s not a trained dermatologist) to tell apart.

If you think that suspicious rash could be a sign of eczema, psoriasis, or maybe even both, here’s some information to help you navigate what you’re experiencing, straight from dermatologists.

First, a little bit about how psoriasis is defined…

At its core, psoriasis is an autoimmune condition, meaning it’s caused by a glitch in the immune system that causes the body to mistakenly attack healthy skin cells. Because of this immune malfunction, the body overproduces skin cells, which then accumulate and pile up on the skin’s surface, according to the American Academy of Dermatology (AAD).

Plaque psoriasis, the most common form of the condition, causes raised lesions—often with a scaly appearance with a silver-to-grey plaque, depending on your skin tone—that can manifest anywhere on the body and feel itchy, tender, or even painful.

There are various forms of psoriasis, so the symptoms can vary widely. But plaque psoriasis often appears on areas like the elbows, knees, trunk, and scalp, Esther Kim, MD, an assistant professor of dermatology at Columbia University Medical Center, tells SELF. You may even start to feel pain in your joints: When inflammatory arthritis occurs alongside psoriasis, it’s called psoriatic arthritis, Dr. Kim says.

Many people with psoriasis experience flare-ups, or periods of time when symptoms become more active. These flares can last anywhere from weeks to months, and there is a range of triggers that can set them off, from infections and illnesses to skin stressors (like cuts and scratches) to changes in weather and stress levels, per the AAD.

Like other autoimmune conditions, the root causes of psoriasis aren’t well understood, but researchers believe that both environmental and genetic factors are at play, Dr. Kim says.

…and here’s a little eczema 101.

Eczema is an umbrella term for a group of skin conditions in which the skin barrier (the outermost protective layer) is damaged, leading to itchy, dry, and inflamed skin, per the AAD. Eczema is broadly referred to as atopic dermatitis, the most common form of the condition, but there are various types of eczema that have different triggers. An eczema rash can look and feel different from person to person, but it may include small, raised bumps, dry or cracked skin, itchiness, and oozing or crusting, among other symptoms that generally signal irritation. 

“Intense itch is a hallmark of eczema,” Dr. Kim notes. “Because of the itch, patients often suffer from a persistent itch-scratch cycle that can lead to thickening of skin and scratches that render the skin prone to superficial skin infections.”

Like psoriasis, eczema is known to flare from time to time. Unlike psoriasis, though, it is associated with an increased risk of asthma and allergies, Dr. Kim says. Experts believe eczema is triggered by a combination of genetics, environmental factors, heightened stress, and immune system activation, as SELF previously reported—but, technically speaking, it’s not classified as an autoimmune condition like psoriasis.

Yes, you can technically have psoriasis and eczema at the same time.

Experts know that psoriasis affects around 3% of adults in the United States; eczema is a bit more common, affecting around 7% of adults. It’s possible to have eczema and psoriasis at the same time, but it’s pretty rare, according to Alexa B. Kimball, MD, MPH, a professor of dermatology and the president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center. “They’re a little bit of a yin and yang, in terms of which parts of the immune system are being activated,” she tells SELF. “So they don’t usually occur in the same people, but they can.”

A 2021 paper published in the journal Skin Health and Disease reviewed the findings of 31 studies on these two conditions and found that the prevalence of them occurring together is approximately 2%. The researchers concluded that “clinicians should be aware of coexistence at diagnosis” and “when reviewing poor response to treatment.”

Even though psoriasis and eczema might look similar, they may require different medications and therapies, so it’s important to see a dermatologist who can diagnose you and figure out a treatment plan that’s most appropriate for your situation.

Getting an accurate diagnosis will help you start a treatment plan that actually helps your symptoms.

Usually, psoriasis and eczema aren’t that difficult for dermatologists to tell apart. One big giveaway is that the two conditions usually develop on different parts of the body. Eczema is more common in places like the insides of the elbows and the backs of the knees, whereas psoriasis plaques are more common on the outer parts of the elbows and the knees. When a doctor is examining your skin, the locations of your symptoms offer a huge clue in determining whether you have psoriasis, eczema, or both.

The rashes will likely look a bit different too, Dr. Kimball says. Psoriasis lesions tend to be thicker and more scaly, while eczema rashes are often flatter and itchier. The one place where it can be really hard to tell the two apart? The hands, she says.

Sometimes it can also be challenging to tell the two conditions apart if the lesion or rash has been scratched so much that it’s hard to identify. In these cases, Dr. Kim says if there’s a question about what skin condition you’re dealing with, your doctor will take a tissue sample (a.k.a. a biopsy) and send it to a lab for testing.

Treatments for mild cases of eczema and psoriasis overlap.

When we say “mild,” we mean just a small portion of the skin is affected, Dr. Kimball says. In these cases, treatment typically involves keeping the skin really moisturized and applying topical steroid creams and ointments as needed. “They’re very effective at calming down skin inflammation in general, no matter what causes it,” Dr. Kimball says. “So that’s why it works for both of them.”

And, as you may learn after your flare-ups, it’s helpful to avoid things that might trigger your symptoms. Both conditions can be exacerbated by heavy stress, long and hot showers, infections, allergens, and poor sleeping habits, among other factors, Dr. Kim says.

Treatments for severe cases are quite different, though.

For moderate to severe forms of psoriasis and eczema, the treatments tend to be specific to the condition. A few treatments are broad enough to be useful for both—such as UV light therapy and an oral medication called methotrexate, which works by suppressing inflammation throughout the body, Dr. Kimball explains.

But it’s not that common to use just one treatment for both conditions these days, because highly effective, targeted medications are available. “When we had fewer tools, we treated them more similarly,” Dr. Kimball says. “Now we have much better tools.” For example, biologics are an effective class of injectable medications that act on specific parts of the immune system that play a role in either psoriasis or eczema, Dr. Kim says. Because these medications are so specialized, they can be ineffective if used for the wrong diagnosis, she adds.

If someone happens to have both psoriasis and eczema, they may be prescribed a combination of treatments, which could include prescription-strength creams, light therapy, and oral or injected systemic medications. If someone has moderate-to-severe cases of both conditions, a dermatologist may prescribe two separate biologics as well, Dr. Kim notes.

According to the experts SELF spoke with, you don’t need to worry about a psoriasis medication causing an eczema flare, or vice versa—but it is really important to have an accurate diagnosis. The sooner you know what you’re actually dealing with, the sooner you can start treatment to get your skin feeling good again.

https://www.self.com/story/can-you-have-psoriasis-eczema-same-time