Suffering from red, patchy skin? Does your doctor keep sending you home with medication that does not seem to work? Psoriasis has often been misdiagnosed. An itch that just won’t leave alongside with blotches of redness on the skin can be caused by either psoriasis or eczema. Both skin conditions have similar symptoms therefore it is important to know how to differentiate. In this article, Dr Ch’ng Chin Chwen shares some key things to look out for to help you better identify psoriasis.
Psoriasis is most commonly mistaken for its less severe counterpart, eczema. It is important to distinguish between the two skin conditions so that they can be treated correctly.
Psoriasis commonly affects areas such as the elbows, knees, face, buttocks, and scalp, causing well-defined thick, red, and scaly patches2. These patches can range from a few spots of dandruff-like scaling to major eruptions over large areas3. People with small scaling spots3 of psoriasis can make diagnosis difficult.
When in doubt, follow-up visits are important. In clinical practice, I commonly see psoriasis following a cyclical pattern, with flares that can occur for weeks or months before subsiding or going into complete remission3.
Moreover, psoriasis can result in changes to your nails such as pitting, abnormal growth, and loosening from the nail bed3. On the other hand, most eczema patients will come with one major complaint – itching4! Sometimes the itch can be so severe that patients scratch until they bleed! Eczema skin often flares up with active inflammation, which is often wet and weepy . During remission, the skin can be soft but often dry. In areas with repetitive flares, the skin is usually thickened5. Areas affected by eczema varies based on the patient’s age group5, lifestyle and daily activities.
Key symptom Dandruff-like scaling spots on the skin Itching
Skin presentation Well defined, thick, scaly patches Dry, red and inflamed areas
Areas affected Elbows, knees, face, buttocks, and scalp Crooks of knees and elbows
Pattern of symptoms Cyclical pattern with periods of remission in between flare-ups No specific pattern
Beyond the Skin
While it is not uncommon for psoriasis to be mistaken for other skin conditions, it is important to remember that it is not just a skin disease. Psoriasis is an immune disease that affects multiple systems6.
So keep an eye out for these other signs and symptoms too!
Sore throat and infection7
For years now, scientists have known that strep throat or streptococcal infections can trigger psoriasis7. According to recent studies, the majority of people with psoriasis found that flare-ups occur around the same time they experience throat infections7. In addition, almost one third of patients with plaque psoriasis found their condition worsening when they were having a sore throat7.
Dry eyes and swollen lids8
Most of the time, eye conditions are subtle and go unnoticed. They also occur later on in the disease, after the appearance of skin lesions8. However, complications such as glaucoma and cataract can occur8, so if you have been diagnosed with psoriasis, schedule an appointment with your eye doctor to get checked.
Psoriatic arthritis is a complication of psoriasis that can occur before or after the appearance of skin lesions9. It can affect any joint including your knees, fingers and elbows. Joints become painful, swollen and warm to the touch9. While common, I have seen varying degrees of psoriatic arthritis amongst patients. Some patients have come in complaining about mild lower back stiffness, while others have presented with painful sausage-like swelling of the fingers and toes! So it’s important for patients to take note of any small changes and consult with their doctor before the problem worsens.
Have you experienced any of these symptoms? Speak to a dermatologist today and get an expert’s opinion to put your concerns to rest!