From healthcentral.com
Learn the key differences and how to work with a dermatologist to manage your symptoms effectively
If you’re suddenly dealing with an outbreak of red, itchy, and inflamed skin, you may be wondering what’s going on. Is this psoriasis? Or rosacea? And, on that note, how can you differentiate between the two?
This can be tricky to navigate because some symptoms are pretty similar. But even though eczema and rosacea are both inflammatory skin conditions and often mistaken for one another, there are some notable distinctions as well, not only in appearance but also in their causes and treatments.
To properly manage and treat either condition, an accurate diagnosis is important. Here, we’ll take a closer look at the differences between psoriasis and rosacea, what causes each of these conditions, and how to work together with a board-certified dermatologist to treat them.
What Is Psoriasis?
Psoriasis is an inflammatory skin condition that affects approximately 7.5 million people. It occurs when the body’s immune system triggers the body to produce way many skin cells, causing them to rapidly build up on the surface of the skin. “This results in red, inflamed patches of skin covered with silvery scales,” says Hannah Kopelman M.D., a board-certified dermatologist at Kopelman Aesthetic Surgery in New York City. “While it’s not contagious, it can significantly impact a patient’s quality of life, both physically and emotionally, especially during flare-ups.”
Psoriasis can pop up anywhere on the body. Carmen Castilla, M.D., a board-certified dermatologist at New York Dermatology Group and a volunteer faculty member at Mount Sinai Hospital in New York City, adds that psoriasis patches are most commonly located on the elbows and knees, but can occur on any area of skin, including the face, scalp, chest, back, armpits, and groin.
Often, psoriasis occurs in cycles, where symptoms flare for a few weeks or months and then ease up or go into remission.
What Is Rosacea?
Rosacea is a chronic, inflammatory skin condition that mostly affects the face, particularly the nose, cheeks, chin, and forehead. Approximately 14 million Americans are living with rosacea, which involves symptoms like persistent redness, visible blood vessels, acne-like breakouts, and even eye irritation. Location is a key factor with this condition: If you’re worried you have rosacea on your hands, you’re most likely dealing with a different condition, like psoriasis. Rosacea mostly appears on the face and doesn’t affect the hands.
Rosacea can occur on all skin types, but it is most common among individuals with fair skin.
“Rosacea can also cause significant discomfort, including stinging, burning, and, in more severe cases, thickening of the skin, especially around the nose, a condition known as rhinophyma,” Dr. Kopelman says.
Types and Symptoms of Psoriasis
There are many different types of psoriasis. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, these include:
Plaque psoriasis. As the most common type of psoriasis, plaque psoriasis causes symptoms like raised, red patches of skin with thick, silvery scales. “These patches often appear on the elbows, knees, lower back, and scalp but can develop anywhere on the body,” Dr. Kopelman says. “Patients often report intense itching, burning, or soreness, and in severe cases, the plaques may crack and bleed.” It can also impact the nails, causing symptoms like pitting, ridges, or discoloration.
Guttate psoriasis. Most common in children and adolescents, guttate psoriasis is often triggered by upper respiratory tract infections like strep throat. It typically causes small, red or pink patches on the arms, legs, and torso that are either round or teardrop-shaped. These patches can be scaly or itchy.
Inverse psoriasis. Inverse psoriasis affects areas where there are folds in the skin, such as the armpits and groin. “[It] will appear as red, smooth, well-outlined patches without the classic silvery scales,” Dr. Castilla says.
Pustular psoriasis. In pustular psoriasis, small, white, pus-filled bumps surrounded by red skin appear. It typically shows up on the hands and feet, but it can happen anywhere on the body. Often, pustular psoriasis symptoms are triggered by infections, stress, medications, or chemicals.
Erythrodermic psoriasis. This is a very rare and serious type of psoriasis where nearly the entire body becomes covered in red, scaly patches that may burn, itch, or shed. It can be triggered by medications, infections, or even by a bad sunburn.
There are four different types of rosacea. According to the Cleveland Clinic these include:
Erythematotelangiectatic rosacea. With this type of rosacea, people experience persistent redness on the face. Small blood vessels under the surface of the skin may become enlarged and visible. The symptoms often flare and then subside.
Papulopustular rosacea. This form of rosacea causes pus-filled pustules and swollen red bumps. It often appears on the forehead, cheeks, and chin, and can look similar to acne.
Ocular rosacea: This form of rosacea impacts the eyes. They can become bloodshot, watery, irritated, and sensitive to light. Painful bumps called styes can also develop on the eyelids.
Phymatous rosacea: With this type of rosacea, the skin might thicken, swell, and scar. It can also become bumpy and discoloured. It most commonly affects the nose, but can also occur on the forehead, ears, and chin. It is more common among men than women.
Psoriasis is a chronic autoimmune condition that occurs when the body’s immune system goes into overdrive. “Psoriasis is caused by an overactive immune system that mistakenly targets healthy skin cells, leading to their rapid overproduction,” Dr. Kopelman says.
Scientists don’t fully understand exactly what causes this immune response, but they believe it happens due to a combination of genetic factors and environmental triggers like stress, infections, skin injuries, and medication reactions.
Causes of Rosacea
“The exact cause of rosacea is not fully understood, but it is thought to be a combination of genetic, environmental, and immune system factors,” Dr. Castilla says. This may have you wondering if rosacea is an autoimmune condition. Technically, rosacea isn’t an autoimmune disease, but it involves an overactive immune response that triggers inflammation.
“Factors like heat, alcohol, sun exposure, emotional stress, and spicy foods can all exacerbate symptoms, Dr. Kopelman says. “People with lighter skin tones are more predisposed to rosacea, though it does occur in all skin types.”
Psoriasis Treatment
Psoriasis treatment varies depending on the type and severity of the condition, and whether joints are involved. Ranging from topical steroids to pills and injectable biologics, psoriasis treatments have rapidly evolved over the last 10 years, leading to highly effective therapies, Dr. Castilla says.
“For mild cases, I often start with topical treatments like corticosteroids, vitamin D analogs, or salicylic acid to reduce inflammation and scaling,” Dr. Kopelman says. “For moderate-to-severe psoriasis, systemic treatments, such as biologics (e.g., IL-17 or TNF inhibitors) or oral medications like methotrexate, are highly effective.”
Sometimes, light therapy—such as phototherapy with ultraviolet blue light—is used to slow the turnover of skin cells. “This wavelength of light is dosed based on skin type and can help decrease the inflammation in the skin,” Castilla says.
You can work together with a board-certified dermatologist to figure out which treatment options are right for you.
Rosacea Treatment
“Rosacea treatment focuses on reducing inflammation, redness, and triggers,” Kopelman says. The exact treatments that are prescribed vary depending on the severity of the condition. Common treatments include:
Topical treatments: “I often recommend topical treatments like metronidazole, azelaic acid, or ivermectin for managing bumps and pustules,” Kopelman says.
Oral antibiotics: “Oral antibiotics, like doxycycline, can help control inflammation in moderate cases,” Kopelman explains.
Laser therapy: This can be helpful for treating persistent redness and visible blood vessels.
Lifestyle factors: Lifestyle modifications like avoiding known triggers, wearing sunscreen, and using gentle skincare products can help manage rosacea and prevent symptom flares.
As with other skin and medical conditions, it’s important to work with a board-certified dermatologist to determine what rosacea treatments are right for you.
Preventing Psoriasis
“Psoriasis can’t be completely prevented because it’s largely genetic, but flare-ups can be managed,” Dr. Kopelman says. “I encourage patients to identify and avoid triggers like stress, infections, and injuries to the skin. Maintaining a healthy lifestyle—managing weight, avoiding smoking, and treating comorbidities—can also help reduce the frequency of flares.”
Preventing Rosacea
Rosacea isn’t fully preventable either. But symptoms and flare-ups can be managed and minimized by avoiding triggers like alcohol, sun exposure, spicy food, extreme heat and cold, and harsh skincare products. Meanwhile, reducing stress and regularly using sunscreen and gentle skincare products can also help.
Differentiating Between Psoriasis and Rosacea
There are some distinct differences that can help you differentiate between psoriasis and rosacea. First things first, where on your body are you experiencing symptoms? Rosacea usually only occurs on the face, but psoriasis can arise anywhere. Some of the most common symptoms are a bit different, too.
“Psoriasis typically presents as thick, scaly plaques that may occur anywhere on the body, including the scalp, knees, and elbows, whereas rosacea is limited to the face and characterized by persistent redness, flushing, and visible blood vessels,” Dr. Kopelman says. “Another key distinction is that psoriasis often itches, while rosacea tends to cause burning or stinging sensations.”
Meanwhile, psoriasis can cause dents, pitting, and discoloration of the nails, but rosacea doesn’t involve the nails, Castilla says.
Conditions With Similar Symptoms
If you’re trying to figure out if you’re dealing with psoriasis versus rosacea, it’s important to understand that some other skin conditions can appear similar to both. Here are a few:
Eczema can cause dry and red patches of skin, which are also seen in rosacea and psoriasis. But eczema doesn’t cause scaly patches of skin like plaque psoriasis, which is the most common form of psoriasis. And eczema also doesn’t cause the visible blood vessels or skin flushing that you might see with rosacea.
Acne can sometimes be confused for rosacea, but these two conditions are not the same. As we mentioned earlier, when someone has a form of rosacea called papulopustular rosacea, there’s a good chance they’ll experience symptoms that look a lot like acne. But acne generally comes and goes, whereas rosacea is a chronic condition that can flare throughout someone’s lifetime.
Contact dermatitis is another inflammatory skin condition that can cause redness, burning, and itching, like psoriasis and rosacea. But contact dermatitis occurs in response to an allergen or something that irritates your skin and is usually localized to that one spot.
Despite their differences, it’s not easy for the average person to self-diagnose their skin condition—nor should you try. Misdiagnosis or delayed diagnosis only leads to a delay in getting effective treatment, which in turn allows your skin symptoms to get worse.
If you are dealing with a skin rash or outbreak, don’t try to figure out for yourself if it’s psoriasis, rosacea, or another condition. Make an appointment with your primary care doctor or a dermatologist and together you’ll discuss what’s going on, and how to make things better.
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