With Dr. Google and all the awesome free information online sometimes it’s easy to diagnose ourselves at home. Often times patients tell me what they think they have, often times I agree. Sometimes I disagree. Dr. Sandy has been gracious enough to explain the differences between eczema and psoriasis. These are two very commonly confused diagnoses among patients and sometimes even health care providers.
It’s a bird. It’s a plane. It’s superman. Sometimes that is what it feels like in clinic. It’s psoriasis. It’s eczema. It’s a rash. It’s a job for Super-dermatologist. Really though, most people don’t know or care to know the differences between eczema or psoriasis or any other rash. Most people just know they have a rash and they don’t want to have a rash. Well as dermatologists, we care about what kind of rash you have and what the best way to treat that rash is. Most people are fortunate and only develop self-limited rashes that resolve over a few days, weeks or months. Other people however develop rashes that last a long time. We call those long lasting rashes “chronic” and the two most common are eczema and psoriasis. A simple way to differentiate between the two is this chart
|Age when rash starts||Usually first 5 years of life||Usually after first 5 years|
|Where on body||Usually “flex” areas—bends of elbows and back of knees||Usually “extensor” areas—backs of elbows and front of knees. Involves nails|
|Appearance||Moist and eroded, “wet”||Thicker skin, white scales, “dry”|
|Associations||Asthma, allergies, itchy eyes||Arthritis, obesity, metabolic syndrome|
Above are 2 pictures taken from the internet to compare and contrast the 2 rashes. The top photo of psoriasis shows the well demarcated thick red silver scaled plaques on the elbow of an adult. The bottom photo of eczema shows the wet lichenified (accentuated skin lines) patches on the back of the leg of a young person.
Some of the treatments for the different rashes are the same but some are different and specific for the specific rash. I have been blessed in my careering many ways. One way is that I got to be involved with the research for the first “biologics” for psoriasis more than 20 years ago. Now, the Johnson Dermatology research team and myself, got to and continue to get to take part in the clinical trials for the first “biologic” for eczema, dupixint. We are also researching other treatments for both eczema and psoriasis. Since these treatments are not yet available to the general public to learn about them you get to (sounds better than have to) email Crystal who leads our research team at firstname.lastname@example.org.
Crystal will probably want me to also mention that we are also researching treatments for warts, acne, rosacea, and itch in addition to psoriasis and eczema. We are also researching treatments for kids who have acne, warts and psoriasis. I love clinical research which makes my inner nerd happy. I would be remiss if I didn’t also admit that I love cosmetic dermatology which makes my inner artist happy. It is truly a blessing to be able to work with an amazing group of people and be able to use both the left side (nerd) and right side (artist) parts of my brain.
Since Nina let me write a blog, I would like to take this time to brag on both Nina and Honey. The three of us have worked very closely together for more than 5 years. We practice very similarly. However, Honey is definitely more left brain. She excels in treating patients with complicated rashes. She is even recognized nationally for her approach to treating patients with psoriasis. Nina is definitely more right brain. She is so artistically gifted especially when it comes to helping people who feel “botched” (no I have not watched that show but I hear about it often) by someone who is offering a sale or does not fully love the skin as much as we love the skin. Nina appreciates symmetry, proportion and the natural look. The 3 of us make a great team. Adding in Dr Amy as our board certified dermatopathologist, my husband Dr Brad as a dermatologic surgeon, and Dr Nelson as both a dermatologist and a dermatologic surgeon—we have a complete skin care provider team. Together with the rest of the JD team—the entire team is needed–we are here to keep you skintastic.