Eczema vs. Psoriasis (All you need to know about)
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Eczema and Psoriasis are chronic skin conditions which can be really distressing to the patients who suffer from them. Sometimes the same individual can suffer from Psoriasis and Eczema together. Both Eczema and Psoriasis can have flare ups (periodic exacerbations of the disease) and total remissions where the patient is totally disease free. Chronic means they are long term skin conditions which can continue throughout life with exacerbations and remissions. Both skin conditions have dry skin and itching as main symptoms and sometimes it may be difficult to differentiate these two.
What is Eczema?
Eczema is also called Atopic dermatitis. It is a chronic skin condition commonly seen in children. It usually starts in childhood and continues into adulthood with flares and remissions or goes into total remission during teenage years. Even elderly can suffer from eczema. Sometimes eczema can start during adulthood for the first time (Adult onset eczema). It is a long term skin condition which usually has several flares and remissions.
Eczema can run in families. It can also associate with Hay fever (Allergic rhinitis), allergic conjunctivitis or bronchial asthma. Usually there is a family history of one or more of these conditions suffered by a family member or a close relative.
Eczema can be either wet or dry. In wet type there is oozing from lesions, followed by crusting. The lesions can be raw and angry looking. There is a risk of infection especially when there is wet eczema. When it is dry, there are red patches, sometimes scaly and cracked associated with dry skin. The lesions gradually thicken with time due to constant scratching.
Eczema lesions are almost always itchy. Itching can be so intense that it can disturb ones sleep. Continuous scratching can occur as a habit. People who suffer from eczema claim that scratching is soothing and sometimes they can continue to scratch until it bleeds knowingly or unknowingly. This increases the risk of infection as germs get in through damaged skin. Continuous scratching can cause lesions to become thick, discolored and leathery.
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What is Psoriasis?
Psoriasis is a chronic skin condition that appears as dry skin lesions on and off in a person’s lifetime. The skin cells in a patient with psoriasis are formed at a faster rate than the rate they are shed. These skin cells build up and accumulate as thick scales/ plaques on the surface of skin. Psoriatic lesions are dry and itchy. They can be red or purplish patches with silvery scales on them.
Itching is usually mild, but can be moderate to severe. Skin is very dry. There can be a burning or stinging sensation.
Genetic predisposition can be common for psoriasis. It can run in families. Usually there is a disturbance in the immune system which may be thought as a cause. There are certain trigger factors which are identified, that can lead to or exacerbate psoriasis. They are; stress, smoking, various infections and sun burn.
Psoriasis can associate with arthritis where certain joints are inflamed, swollen and painful. Psoriatic arthritis is common in fingers and knees, which can be disabling to the patient. The nails, eyes and scalp can also get affected in psoriasis. When it affects the nails, there can be pitting of the nail surface, onycholysis (separation of nail from nail bed), thickening and discoloration of nails.
Psoriasis on feet and hand can be painful and more challenging to treat than psoriasis on other parts of the body because these are the parts which are constantly on use.
Psoriasis on feet
When Psoriasis affects the eye, it can lead to dry eyes, conjunctivitis (inflammation of conjunctiva of eye), Uveitis (inflammation of uvea of eye), Episcleritis (inflammation of episclera) which can lead to red eye and often threaten the eye sight if not treated properly.
Sometimes psoriasis can occur as severe forms which can be life threatening.
- Pustular psoriasis – Tiny blisters appear on skin which are filled with pus
- Erythrodermic psoriasis – Whole body becomes red and starts peeling off (Exfoliative dermatitis). Itching is prevalent with severe burning sensation.
These conditions should be treated early. If not, they can lead to dehydration and hypo-proteinaemia (low protein levels in blood) due to excessive shedding of skin cells. There can be fever and chills due to possible infection and skin surface damage leading to hypothermia (Low body temperature).
- Inflamed red skin
- Skin which is dry and sensitive
- Itching – which can be severe
- Oozing, crusting
- Leathery, scaly and thickened areas
- Dark patches on skin
- Red or purplish raised plaques or patches on skin
- Silvery scales over plaques
- Dry skin – cracks, sometimes can bleed
- Inflamed patches which are sore
- Burning and stinging sensation rather than itching
- Nail changes
- Eye involvement
- Joint involvement
Both Eczema and Psoriasis are chronic skin conditions. They cannot be cured but controlled only. The patient has the responsibility to stick to the treatment plan outlined by their doctor.
Treatment of Eczema
Although there is no cure for eczema, disease can go into total remission especially after childhood in many, and luckily may never reappear. Below are few tips on how to get rid of eczema.
Home remedies that can be used to treat and prevent eczema
- Use a mild soap to bathe. Pat dry your skin using a soft towel
- Always avoid strong soaps and detergents which are known to worsen eczema
- Take shorter showers and keep the water at a warm, not hot, temperature.
- Moisturize your skin well and regularly with a good emollient. Use an emollient which is paraben and alcohol free and with minimal fragrance. Some ingredients in a good moisturizer includes glycerol, Dimethicone, Lanolin oil, Shea butter, Coconut oil, Argon oil, aqueous cream, cocoa butter etc. Choose the best emollient which is suitable for your skin or get help from your doctor to select the best for you.
- Pure Aloe Vera gel helps in providing a nice cooling effect to itchy skin. consider growing your own aloe plant so that you can take the gel straight from its natural source avoiding the chemicals.
- Incorporate turmeric in your diet This spice helps in reducing inflammation in many skin conditions
- It is best to apply moisturizer after a bath when your skin is damp. It helps to absorb and lock in the moisture.
- Avoid scratching as it worsens your eczema. Eczema is known as “The itch that rashes”, which means rash appears following itching and worsen once the person scratches.
- You can use over the counter creams like Hydrocortisone over the lesions. Your doctor can also prescribe you with more potent steroid creams and ointments like Betamethasone, Clobetasol and Mometasone. These help to control lesions better.
- You can use over the counter antihistamines like Cetrizine, Fexofenidine, Chlorpheniramine or Loritidine to reduce itching. Make sure the dose and frequency of administration is correct.
- Certain triggers like excessive sweating, pollen, dust, smoking, certain foods, using strong soaps and detergents can worsen your eczema. Identify them early and avoid them as much as possible.
Treatment of Psoriasis
Psoriasis can be controlled and kept in remission, if you are committed to your treatment plan and avoid trigger factors. Compliance to psoriasis treatments is very important to keep disease in remission. Make sure you do regular follow up with your doctor because the doctor can start treatment early when you show signs of a flare up.
What are the home remedies which you can use to prevent and treat psoriasis?
- Moisturize your skin well with a good emollient, apply a thick layer so as to lock the skin moisture
- Avoid – fragrances Most soaps and perfumes have dyes and other chemicals in them that may irritate your skin.
- Avoid injury to skin because damage to skin causes new lesions to appear around the injured site
- Avoid stress – practice relaxation, yoga and meditation techniques
- Quit smoking, avoid passive smoking
What works for one person may not work for another. Remember that while these home remedies for psoriasis may help with mild cases, prescription therapy is required for more severe cases.
There are many treatment options for psoriasis;
- Topical preparations – Steroid creams and ointments, Vitamin D analogues, Retinoids, Salicylic acid etc.
There are several combination products which are available in the market proven to be effective in controlling psoriasis. Your doctor will prescribe you what he thinks is best for you. Apply the topical preparations as instructed. Topical products are used when the lesions are mild and localized.
- Systemic medicines – These are taken orally. They are prescribed when psoriasis is wide spread. Frequent monitoring should be done to identify and prevent side effects early.
Ex: Methotrexate, Cyclosporin
- Light therapy – use of UVA or UVB light to treat psoriasis
Often a combination of these treatments is used to treat and control psoriasis.
What are the differences between Psoriasis and Eczema?
- Psoriasis is commonly seen in outer (extensor) surfaces of elbows and knees, palms, soles, around umbilicus, ears, eye brows and back. Eczema is commonly seen in inner (flexor) surfaces of elbows and knees, wrists, ankles and neck.
- Psoriasis has thick, well defined, scaly, red, purplish or silvery plaques. Eczema does not have well defined lesions. There are red patches due to inflammation.
- Psoriasis when appear in head is called “Scalp psoriasis”. Eczema usually doesn’t occur in scalp in adults.
- Psoriasis has a Koebner phenomenon (lesions can appear over sites of skin injury). If scratching damages your skin surface, psoriatic lesions can appear along your scratch marks. Eczema does not have Koebner phenomenon.
- Itching is more intense in eczema. Psoriasis makes you itch, but burning or stinging sensation is felt more than an itch.
- Pitting, onycholysis, discoloration and thickening are changes which are seen in nails of patients with psoriasis. Nails of eczema patients are shiny. Because they scratch so much making the nails well-polished and shiny. But there are no specific nail changes.
- Arthritis can associate with Psoriasis especially in small joints. They can get painful swellings on and off which can be disabling. There is no association of eczema with arthritis.
- Eczema is common in children, whereas psoriasis is more common in adults.
- Eczema can associate with Asthma, allergic conjunctivitis and Hay fever. These diseases are not associated with Psoriasis.
What are the similarities between Psoriasis and Eczema?
- Both Psoriasis and Eczema are chronic skin conditions which are long term. They can have exacerbations due to several reasons depending on the environmental factors and stress.
- Both diseases can have disease free periods or go in to total remission any time. However cannot be cured. Remission does not mean that the illness is cured. They can flare up anytime during lifetime.
- These skin conditions are not passed from one person to another. They are not contagious.
- Both Eczema and Psoriasis are itchy skin diseases which can vary from mild to severe.
- They are associated with dry skin. It is very important to moisturize your skin well with a good emollient to control the disease and to prevent exacerbations.
- Both Eczema and Psoriasis can have a genetic predisposition and may run in families. It is common to find a family member or a close relative suffering from the same illness.
- Stress can trigger both these skin conditions to exacerbate. So it is very important to lead a relaxed and happy life to prevent flares.
Both Eczema and Psoriasis can be quite distressing to anyone who suffers from them as they are chronic skin conditions. However with proper treatment and avoidance of trigger factors, you can keep the disease well under control.
Psoriasis and Eczema are not contagious. Do not be afraid to touch them. Never stigmatize, as they are already distressed with their chronic skin condition. Do not make it more difficult for them by showing that you are scared of their skin condition.
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