Chart — Med-Surg
Psoriasis vs Eczema Chart
Two chronic inflammatory skin diseases that the exam loves to contrast. The fastest discriminators: silvery plaques on the outside of joints (psoriasis) vs an intensely itchy rash in the creases (eczema).
Educational use only. Presentations overlap and a dermatologist confirms. Treatment intensity is individualized. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side by Side
| Feature | Psoriasis | Eczema (atopic dermatitis) |
|---|---|---|
| Lesion | Well-defined plaques with thick silvery-white scale | Ill-defined dry red patches; weepy (acute) or thick/lichenified (chronic) |
| Distribution | EXTENSOR surfaces (elbows, knees), scalp, sacrum, nails | FLEXURAL folds (antecubital, popliteal); cheeks/scalp in infants |
| Itch | Variable (may itch or not) | Intense — itch is the defining feature |
| Hallmark signs | Auspitz sign (pinpoint bleeding), Koebner phenomenon, nail pitting | Lichenification from chronic scratching; atopic triad |
| Mechanism | Accelerated keratinocyte turnover (immune-mediated) | Defective skin barrier + inflammation; itch-scratch cycle |
| Triggers | Stress, strep infection, skin trauma, cold/dry, beta-blockers/lithium | Irritants/allergens, dry air, heat/sweat, stress |
| Treatment | Topical steroids + vitamin D analogs, phototherapy, methotrexate/biologics | Emollients (foundation) + topical steroids/calcineurin inhibitors, dupilumab |
Exam Traps
- ✦EXTENSOR + silvery scale = psoriasis; FLEXURAL + intense itch = eczema.
- ✦Auspitz sign (pinpoint bleeding when scale lifts) and Koebner (lesions at trauma sites) = psoriasis.
- ✦Lichenification (thick leathery skin) = chronic eczema from scratching.
- ✦Psoriasis is systemic — link to psoriatic arthritis and cardiometabolic risk.
- ✦Moisturizers are the foundation of eczema care; neither disease is contagious.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →