Psoriasis
Psoriasis forms thick plaques with clear edges and silvery scale. Elbows and knees are common spots.
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Dermapedia / CompareConditions
Psoriasis vs Rosacea
Psoriasis is thick, scaly patches with a sharp edge. It sits on elbows, knees, scalp and lower back, and you can feel where the patch stops. Rosacea is flushing and lasting redness on the middle of the face. Rosacea can also cause bumps and pustules. Flushing may come and go before facial color changes become persistent.
At a glance
| The difference | Psoriasis | Rosacea |
|---|---|---|
| What it is | Skin cells made too fast | Blood vessels that overreact |
| What it looks like | Raised patches with silvery scale | Redness, and small bumps |
| Treatment | Steroid and vitamin D creams first | Trigger control and prescription creams |
| What each treatment does, and does not do | Psoriasis creams flatten the plaque while you use them. | Rosacea creams reduce the bumps while you use them. |
Rosacea
Rosacea causes lasting redness across the cheeks and nose, sometimes with visible vessels.
Side by side
The differences that matter
What it is
Psoriasis
Skin cells made too fast
The immune system speeds up skin cell production. Cells pile up before the old ones shed, and the patch thickens into a plaque. It runs in families.
Rosacea
Blood vessels that overreact
Vessels in the central face widen too easily and stay widened. Inflammation follows, and in some people that adds bumps and pustules.
How it works, illustrated
Psoriasis
In healthy skin, a cell made at the base of the epidermis takes about a month to reach the surface. By the time it arrives it is flat and dead, and it sheds one cell at a time, so nothing piles up. The immune system stays quiet unless there is something to fight.
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Immune cells in the skin switch on when there is nothing to fight and release signals such as TNF, interleukin-17 and interleukin-23. These are the messages that tell the skin it is under attack, and they are what biologic injections are built to block.
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Inflammation brings increased blood flow to the area.
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Told to behave as though the skin is injured, cells at the base of the epidermis divide far faster than normal. A journey to the surface that should take about a month is finished in a few days, so the cells arrive immature and still stuck together.
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The immature cells pile up instead of shedding invisibly, which builds the raised plaque and the silvery scale. Blood vessels underneath multiply and widen, which is why picking the scale off leaves pinpoint bleeding, and why plaques crack over joints.
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Rosacea
The blood vessels in the middle of the face open when you are hot, embarrassed or eating something spicy. The immune system stays quiet, the vessels close again within minutes, and the color goes back to normal. Nothing stays visible.
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Sun, heat, spicy food, alcohol and stress reach skin that is already wired to overreact. Fair skin and a family history make that wiring more likely. The same warm room that does nothing to someone else starts the whole chain here.
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The skin pours out too much of an alarm protein called cathelicidin, and breaks it down the wrong way. That switches inflammation on and keeps it on. This is the step most prescription creams are aimed at.
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Inflammation makes the vessels open wider, and over years the skin grows more of them. That is the flushing, the redness that stops fading between flushes, and the fine visible threads across the cheeks and nose.
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The redness stops going away, the skin burns and stings with products other people tolerate, and some people get red bumps and pus-filled spots on top of it. Almost everything on the lists below is pushing on one of these four steps.
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What it looks like
Psoriasis
Raised patches with silvery scale
Thick plaques with dry white or silvery flakes on top. On brown and black skin they often look purple, grey or dark brown rather than red.
Rosacea
Redness, and small bumps
Flushing over the cheeks, nose, chin and forehead, with fine visible blood vessels in it. Bumps and pustules appear in some people, with no blackheads among them.
Across skin tones
Psoriasis
Psoriasis on light skin
On light skin plaques are the textbook salmon-pink to red, with silvery-white scale on top and a sharp border. The trap here is a faint plaque on naturally ruddy skin, where the pink blends in and only the scale gives it away. Scale on the scalp or the elbows often gets called dry skin or dandruff for a long time before anyone calls it psoriasis.
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Psoriasis on medium skin
On medium skin the same plaques read dusky pink to pink-brown, and the silvery scale stands out more than the color underneath does. The sharp border and the thickness are still easy to feel. This is where judging severity by redness alone starts to go wrong, because a plaque that looks quiet can still be thick, scaly and widespread.
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Psoriasis on brown skin
On brown skin plaques are frequently violet or gray-brown instead of pink, and the scale looks silvery-gray against them. Because severity scores were built around how red skin looks, psoriasis here is routinely rated milder than it is and treated less firmly. Thickness, the amount of scale, how much of the body is covered and how much it affects daily life are the more reliable measures, and it is fair to ask whether severity was judged on redness alone.
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Psoriasis on deep skin
On deep skin a plaque can be dark brown and close to the color of the skin around it, so the scale and the raised edge are what mark it out. Diagnosis is often delayed, and by then more of the body is involved, with the scalp usually the most extensive. After clearing, flat dark marks are common in the same outlines and can take six to twelve months to even out. That is normal healing, not treatment failing, and daily sunscreen helps them fade faster.
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Rosacea
Rosacea on deeper skin tones
Rosacea happens in every skin tone, but the sign it is usually diagnosed from is redness, and on deeper skin tones the inflammation reads as dusky, violet, brown, or simply as an area that looks darker than the skin around it. Fine vessels are also much harder to see. The clues that stay reliable are warmth in the middle of the face, swelling, stinging with skincare or sun, and a history of the face heating up with hot drinks, spice, alcohol or exercise.
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Bumps without blackheads
When the redness is hard to see, the bumps are often the first thing noticed, and rosacea on deeper skin tones is commonly treated as acne for years. The check that settles it is the same one used on any skin tone: rosacea does not produce blackheads or whiteheads. Bumps and pus-filled spots on the central face with no comedones point to rosacea, not acne.
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Granulomatous rosacea
A less common pattern of rosacea that is described more often on deeper skin tones. Instead of pus-filled spots it produces firm, dome-shaped brown or reddish-brown bumps, usually around the mouth and the eyes, on skin that may not look inflamed at all. It is easily mistaken for other bumpy conditions, and it is one of the reasons a biopsy is occasionally needed.
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Marks left behind on deeper skin
Rosacea inflammation on deeper skin tones leaves flat dark patches where the bumps were, and they can take many months to fade. That is why calming the inflammation early matters more than treating the marks afterward, and why daily sunscreen is part of the plan. Laser and light treatment for vessels and redness is possible on deeper skin tones, but ask a practitioner how often they treat skin like yours and ask for a test patch.
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The edge of the patch
Psoriasis
Sharp, and you can feel it
Run a finger across and there is a clear step up onto thickened skin, with normal skin right beside it.
Rosacea
Blurred
The redness fades into normal skin. There is nothing raised to feel.
Where it shows up
Psoriasis
Elbows, knees, scalp, lower back
Also the belly button, the buttock crease and the nails. Psoriasis can appear on the face, but it is rarely only on the face.
Rosacea
The middle of the face
Cheeks, nose, chin and the centre of the forehead. It spares the skin around the eyes and the sides of the face.
Where it appears
Psoriasis
The outside of the elbows and knees
The classic sites, and the way it sits is part of the diagnosis: on the outside of the joint, not in the crease. Eczema does the opposite. It is usually symmetrical, so if one elbow is involved the other normally is too.
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Scalp and hairline
The scalp is involved in about half of people, and the plaques often run past the hairline onto the forehead and behind the ears — which is one of the things that separates it from dandruff, and the reason a hairline edge is worth looking at.
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Lower back and the crease between the buttocks
The lower back and the crease between the buttocks are common and easily missed. So are the folds, the palms, the soles, the face and the genitals — those sites matter more than their size suggests, because they affect daily life out of proportion to the area involved. Nails are affected in a large share of cases.
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Rosacea
The middle of the face
Rosacea sits on the central face: the cheeks, the nose, the chin and the skin between the eyebrows. It usually leaves the sides of the face and the skin right around the eyes alone, and that sparing is one of the things that separates it from other facial rashes.
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The eyes, and less often the ears, neck and scalp
The eyes are involved in a large share of cases — gritty, dry, red lids — and that can start before anything shows on the skin. Less often it reaches the ears, the neck, the upper chest or the scalp.
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Does it itch or sting
Psoriasis
Itches, and can crack
Plaques itch, and they sometimes split over joints. Cracks are sore and slow to heal.
Rosacea
Stings and burns
Skincare products sting on contact, the face feels hot during a flush, and eyes can feel gritty and dry.
What sets it off
Psoriasis
Stress, infection and skin injury
Strep throat, some medicines, and cold dry weather. A cut or a scratch can grow a new plaque in exactly that spot.
Rosacea
Heat, sun, alcohol, spicy food
Also hot drinks, exercise, cold wind and stress. Most people can name their own triggers within a few weeks.
What to check elsewhere
Psoriasis
Nails and joints
Small pits in the nails, a brown-yellow patch under the nail, or a nail lifting from its bed. Morning stiffness in the fingers matters too, because psoriasis can involve the joints.
Rosacea
Eyes
Gritty, watery or sore eyes come with rosacea often enough to have their own name. Nails stay normal.
Treatment
Psoriasis
Steroid and vitamin D creams first
A combination of calcipotriol and betamethasone works better than either alone. Widespread or stubborn psoriasis has light therapy, tablets and injections.
Rosacea
Trigger control and prescription creams
Sunscreen and gentle cleansing come first. Metronidazole, azelaic acid or ivermectin cream treat the bumps, and laser or intense pulsed light treats fixed redness and visible vessels.
Psoriasis
Salicylic Acid
Lifts and dissolves the scale on top of a plaque. That matters because no medicated cream can reach the skin through a thick crust, so this is often the step that makes everything else work. It does nothing to the immune signal underneath, and on large areas it should not be used long term.
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Coal Tar
An old treatment that genuinely still works, slowing the overactive turnover of skin cells. It is most useful as a scalp shampoo left on for several minutes, and on stubborn plaques on the body. The reasons people give it up are the smell and the staining of clothes and bedding rather than the results.
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A thick plain moisturizer
Plain petroleum jelly or a thick unscented ointment, used daily, reduces cracking, itching and scale and helps prescription creams absorb. Apply it after a bath while the skin is still damp. It will not clear a plaque on its own — this is the base everything else is built on, not the treatment.
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Urea
Softens hard, thickened skin and helps shift scale, which makes it useful on the palms, soles and the thickest plaques. Higher strengths work better here than the low ones sold for dry skin. It can sting on cracked skin, so it goes on intact plaques rather than open fissures.
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Hydrocortisone 1%
The mildest steroid you can buy, and it is honestly too weak for a thick plaque on an elbow or knee. Where it does help is thin skin — the face, the eyelids and the body folds — used for short stretches. If nothing has changed after two weeks, the answer is a stronger prescription rather than more of this.
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Phototherapy
Narrowband UVB, given two or three times a week in a clinic, is one of the most effective options for psoriasis that covers too much skin for creams. It suppresses nothing in the rest of the body, which is why it suits pregnancy and people who cannot take systemic medicines. The commitment is the difficulty: it means repeated trips over two to three months.
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Excimer Laser
Delivers the same kind of UVB light, but aimed only at the plaques, so a higher dose can be used and normal skin is spared. It suits a handful of stubborn patches, or psoriasis on the scalp, elbows and knees, rather than widespread disease. It usually takes several short sessions.
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Cortisone Injection
A small amount of steroid injected directly into one thick plaque that has refused to shift, or into the nail fold for nail psoriasis. It works where cream cannot get through. It is used sparingly, because repeated injections can leave a dent or a pale mark in the skin, and it is not a treatment for anything widespread.
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LED Light Therapy
Home red and blue LED devices are not the same thing as narrowband UVB, and there is little evidence they clear plaques. Tanning beds are not a substitute either, and they carry a skin cancer risk. If light treatment is the right direction, the version worth having is the medical one, prescribed and dosed.
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Risankizumab (Skyrizi)
A biologic that blocks interleukin-23, given as four injections a year once the starting doses are done. It is where most people begin now: it clears skin as completely as anything available, it holds that clearance over years, and the dosing is the easiest of the group to live with. Tuberculosis and hepatitis screening happens before starting, and there is a real but modest increase in some infections.
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Bimekizumab (Bimzelx)
Blocks interleukin-17A and interleukin-17F, two signals instead of one. In head-to-head trials it leaves more people with completely clear skin, and gets there faster, than any other biologic it has been tested against. The trade-off is oral thrush, which is common enough that it is discussed before starting, and like the other interleukin-17 drugs it is avoided in inflammatory bowel disease.
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Secukinumab (Cosentyx)
Blocks interleukin-17A, and it clears skin fast — often within weeks rather than months. Ixekizumab (Taltz) works the same way, and the choice between the two is mostly practical. Either is a common pick when the scalp, palms, soles or nails are badly affected, and both treat psoriatic arthritis, but they are avoided in inflammatory bowel disease, which they can worsen.
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Ustekinumab (Stelara)
An older biologic that blocks interleukin-12 and interleukin-23, given four times a year. It does not clear skin as completely as the newer options, which is why it is seldom first choice now, but it has the longest safety record of the group and biosimilar versions have made it one of the cheapest ways to be on a biologic at all.
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Adalimumab (Humira)
The oldest of the group, blocking TNF, injected every two weeks. Newer options clear skin more completely, so it is rarely the first choice for skin alone, but it has decades of safety data behind it, it treats psoriatic arthritis well, and biosimilar versions have made it cheap. Screening for tuberculosis and hepatitis is done before starting.
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Deucravacitinib (Sotyktu)
A once-daily tablet that blocks one specific step in the psoriasis signal. It clears skin better than the older oral options and needs no routine blood monitoring, which is why it is increasingly chosen when creams are not enough. It is not a biologic injection, and it does not treat joint disease as well as they do.
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Methotrexate
A long-established once-weekly tablet that damps down the immune overactivity, and it treats psoriatic arthritis at the same time, which is often why it is chosen. It needs regular blood tests for the liver and blood count, and folic acid alongside it. Alcohol is limited, and it is not used in pregnancy — ask your doctor.
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Cyclosporine
The fastest-acting option, which makes it the rescue treatment for a severe flare or erythrodermic psoriasis. It works within weeks. It is deliberately short-term, usually under a year, because it raises blood pressure and can damage the kidneys, and both are checked throughout.
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Apremilast (Otezla)
A twice-daily tablet that clears skin less completely than the newer options but needs no blood monitoring at all, which suits people who cannot or will not have regular tests. It is often used for scalp, palm and sole psoriasis. Nausea, loose stools and headache are common in the first few weeks and usually settle.
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Acitretin
An oral retinoid, most useful for pustular psoriasis on the palms and soles and often combined with light treatment. It does not suppress the immune system, which suits people who cannot take something that does. It causes dry lips and eyes and raised cholesterol, and it must not be used by anyone who could become pregnant for three years afterward.
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Prednisone
Steroid tablets clear psoriasis quickly and then it comes back worse, sometimes as the pustular form, when they are stopped. For that reason they are not used to treat psoriasis. They are on this list because they are still occasionally prescribed for a flare, and because you should never stop a course on your own — ask the doctor who prescribed it.
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Calcipotriene with a steroid
The standard first prescription for plaques: a vitamin D analog that slows the fast cell turnover, combined with a steroid that settles the inflammation. The two together work better than either alone and allow less steroid overall. It comes as an ointment, a foam or a scalp solution, and it is usually used once a day.
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Clobetasol Propionate
A very strong steroid for thick, stubborn plaques on the elbows, knees, palms, soles and scalp, where milder ones simply do not get through. It is used in short bursts of two to four weeks, not continuously. It should never go on the face, the eyelids or the body folds, where it thins the skin quickly.
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Tapinarof
A once-daily steroid-free cream that calms the immune signal in the plaque. Its appeal in psoriasis is that it can be used on the face and folds and for long stretches without the skin thinning, and improvement often lasts a while after stopping. It can cause folliculitis and itching where it is applied.
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Roflumilast Cream (Zoryve)
Another steroid-free once-daily cream, and one of the few licensed for the body folds, where inverse psoriasis is smooth, sore and difficult to treat safely. It is not greasy, which suits scalp and visible areas. Cost and insurance cover are the usual obstacles rather than how well it works.
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Triamcinolone Acetonide
A mid-strength steroid for plaques on the trunk, arms and legs — the everyday workhorse between hydrocortisone and clobetasol. It is often alternated with a vitamin D cream so that the steroid is not used every day. Plaques usually return within weeks of stopping, which is why maintenance is planned rather than improvised.
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Tazarotene
A retinoid gel that thins the plaque and reduces scale, and its benefit tends to hold longer after stopping than a steroid's does. It is irritating on its own, so it is usually paired with a steroid or used every other night. It is not used if you are pregnant or planning to be — ask your doctor.
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Tacrolimus (Protopic)
A steroid-free ointment used on the face, eyelids, genitals and body folds, where psoriasis is thin and smooth and steroids cannot be used for long. It does not thin the skin. It stings or feels warm for the first week or so, which settles, and it works less well on thick plaques elsewhere.
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Desonide
A mild prescription steroid for psoriasis on the face and in the folds when hydrocortisone is not enough. It is used for short courses and then stepped down to a steroid-free option for maintenance. On elbows, knees and scalp it is too weak to do much.
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Rosacea
Azelaic Acid
The one over-the-counter active with real evidence behind it in rosacea. At 10 percent it reduces the bumps and some of the redness, and it is better tolerated by reactive skin than acids or retinoids. Start every other night over moisturizer. The 15 percent prescription gel works better if this is not enough.
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Niacinamide
A mild anti-inflammatory that also helps the barrier hold water, which is the part of rosacea it is most useful for. Some people find it takes the edge off redness and stinging. It will not clear bumps and it does nothing for visible vessels, so treat it as support rather than treatment.
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Green Tea Extract
Sold widely for facial redness on the strength of small studies. It is soothing, it is unlikely to irritate, and some people like how their skin feels on it. There is no good evidence it changes flushing, bumps or visible vessels, so do not let it delay a prescription that would.
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Warm compresses for the eyes
For ocular rosacea: a warm compress held over closed lids for several minutes, then gentle cleaning along the lash line, done daily. It unblocks the oil glands in the lid margin, which is where the grittiness and the repeated styes come from. It is unglamorous and it has to be kept up, but it is the single most useful thing for the eye side of rosacea.
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Scrubs, brushes and strong acids
Included because so many people arrive already doing it. Rosacea skin has a damaged barrier, and scrubbing, brushing or layering acids strips it further, which increases redness and stinging. This is not a treatment that works slowly — it makes rosacea worse. Almost everyone improves when the routine gets gentler instead of stronger.
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Pulsed Dye Laser (V-Beam)
The treatment of choice for visible thread veins and settled background redness — the parts of rosacea that creams and tablets do not touch. It targets the blood in the vessel and closes it. Expect a course of about three sessions rather than one, expect bruising for a few days at stronger settings, and expect occasional top-ups, because rosacea carries on making new vessels.
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IPL (Intense Pulsed Light)
Light rather than laser, and about as effective as pulsed dye laser for diffuse redness across the cheeks, with less bruising. It is often the better choice when the problem is a general flush rather than a few distinct threads. It needs an experienced practitioner and a test patch on deeper skin tones, because the wrong settings can cause lasting pigment change.
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Nd:YAG Laser
A longer wavelength that reaches deeper, larger vessels — the thicker blue-red threads beside the nose that pulsed dye laser sometimes leaves behind. It is also the device more often chosen for deeper skin tones, because it passes over surface pigment more safely. It is less useful for general background redness.
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Fractional CO2 Laser
Used to reshape a nose that has thickened, by removing the excess tissue layer by layer. This is the answer for rhinophyma, since creams and tablets do not reverse it. It is a real procedure with real downtime of a couple of weeks, and results are strongly dependent on who does it.
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LED Light Therapy
Asked about constantly, usually as a home device. Red and near-infrared light is mildly anti-inflammatory and it is very unlikely to do harm. There is no good evidence it clears rosacea bumps or removes vessels, so it is a pleasant addition rather than a substitute for the treatments that do.
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Botox (Botulinum Toxin)
Very small amounts injected into the surface of the skin, not the muscle, to reduce flushing and background redness. Early studies are encouraging and dermatologists do use it for stubborn flushing. It is off-label for rosacea, it is not usually covered, and it wears off in a few months.
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Low-dose Doxycycline
A 40 mg dose taken once a day, deliberately too low to act as an antibiotic — it is used purely for its anti-inflammatory effect, which means it does not drive antibiotic resistance. This is the usual next step for moderate to severe bumps when creams alone are not holding them, and it also helps ocular rosacea. It is normally stepped down to a cream once things settle.
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Minocycline
An alternative tablet for the bumps when doxycycline does not suit or has not worked. It is used at full antibiotic doses, so it is generally kept for shorter courses. It can cause dizziness, and rarely a blue-gray discoloration of the skin with long use, so it is not the first tablet reached for.
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Accutane at a low dose
Low-dose isotretinoin under specialist care, for severe bumps that tablets and creams have not controlled, or for early skin thickening. It works well, and it is not a cure — rosacea usually returns after the course. It requires strict pregnancy prevention and monitoring, so it is a considered decision rather than a routine step.
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Beta blockers for flushing
Low doses of propranolol or carvedilol are sometimes tried when flushing is the dominant problem and nothing else has touched it. The evidence is small studies rather than trials, and they lower blood pressure and slow the heart, so they do not suit everyone. Worth asking about only after triggers, laser and light have been addressed.
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Ivermectin Cream (Soolantra)
Often the best single treatment for the bumps and pus-filled spots, because it works on the Demodex mites and on the inflammation at the same time. Once a night, a pea-sized amount for the whole face. It usually beats metronidazole head to head, and it does nothing at all for flushing or visible vessels.
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Azelaic Acid 15% (Finacea)
A prescription-strength gel or foam for the bumps, and one of the better options if your skin is too reactive for other creams. It also helps the marks rosacea leaves behind on deeper skin tones. Expect stinging for the first week or two, which usually settles if you apply it over moisturizer.
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Metronidazole (MetroGel)
The longest-established prescription cream for rosacea bumps, used once or twice a day, and generally very well tolerated. It is a reasonable first choice and a common maintenance treatment once things are controlled. Newer options often work a little better, and none of them touch the redness itself.
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Minocycline foam
An antibiotic put on the skin rather than swallowed, for the bumps. It suits people who would rather not take tablets, or who cannot. It is newer and usually more expensive than the older creams, and like them it does nothing for flushing or vessels.
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Brimonidine (Mirvaso)
A gel that narrows facial vessels and takes the redness down for several hours at a time. It treats nothing — it borrows time, and everything comes back when it wears off. Some people get rebound redness worse than they started with, so test a small area before you use it on the whole face and before any event that matters.
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Oxymetazoline (Rhofade)
The same idea as brimonidine, using a different vessel-narrowing drug, applied once each morning. Rebound redness is reported less often with it, which is why some people move across after a poor experience. It still only lasts the day, and it does not stop rosacea progressing.
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Steroid creams
A steroid cream calms rosacea for a few days, then makes it worse. The redness and bumps come back stronger when you stop, so it is easy to keep reapplying and end up in a cycle. Used for weeks, steroids on the face thin the skin, bring out visible vessels and can cause a rosacea-like rash of their own. If one has been prescribed for your face, ask about coming off it rather than stopping suddenly.
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When it needs a doctor
Psoriasis
If patches spread, or joints ache
Joint stiffness alongside scaly patches is worth naming at the appointment, because treating it early protects the joints. Painful or widespread plaques need prescription treatment.
Rosacea
If redness has lasted months
Redness that keeps getting worse, gritty sore eyes, or skin on the nose that is starting to thicken all deserve an appointment.
What each treatment does, and does not do
Psoriasis
Psoriasis creams flatten the plaque while you use them. Steroid and vitamin D creams thin the scale and settle the patch. Psoriasis is long-term, so patches usually return after treatment stops.
Rosacea
Rosacea creams reduce the bumps while you use them. Metronidazole, azelaic acid and ivermectin lower inflammation. They do very little for the fixed background redness, which is what laser and light treatment are for.
Related topic illustrations
Psoriasis
Normal Skin
In healthy skin, a cell made at the base of the epidermis takes about a month to reach the surface. By the time it arrives it is flat and dead, and it sheds one cell at a time, so nothing piles up. The immune system stays quiet unless there is something to fight.
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Overactive immune signaling
Immune cells in the skin switch on when there is nothing to fight and release signals such as TNF, interleukin-17 and interleukin-23. These are the messages that tell the skin it is under attack, and they are what biologic injections are built to block.
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Inflammation increases
Inflammation brings increased blood flow to the area.
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Skin cells multiply far too fast
Told to behave as though the skin is injured, cells at the base of the epidermis divide far faster than normal. A journey to the surface that should take about a month is finished in a few days, so the cells arrive immature and still stuck together.
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Thick scale and a damaged barrier
The immature cells pile up instead of shedding invisibly, which builds the raised plaque and the silvery scale. Blood vessels underneath multiply and widen, which is why picking the scale off leaves pinpoint bleeding, and why plaques crack over joints.
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Eczema
Both are itchy, scaly and long-running, and both turn up on the arms and legs. Eczema has soft, blurred edges, often weeps or crusts, and prefers the inside of the elbows and behind the knees. Psoriasis has sharp borders and thicker silvery scale, and sits on the outside of the same joints. Eczema almost always itches; only about half of psoriasis does.
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Seborrheic Dermatitis
On the scalp the two are hardest to separate, and some people have both. Seborrheic dermatitis is greasy yellow scale with a soft edge, and it favors the sides of the nose, the eyebrows and the middle of the chest. Scalp psoriasis is thicker, drier, silvery-white, sharply bordered, and it crosses past the hairline onto the forehead and behind the ears.
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Rosacea
Acne
This is the mix-up that costs people the most time. Both produce red bumps and pus-filled spots on the face, and plenty of people arrive certain they have adult acne. The difference that settles it is blackheads and whiteheads: acne has them, rosacea does not. Acne also spreads to the forehead, jawline, back and chest, while rosacea stays on the middle of the face and comes with flushing and stinging.
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Seborrheic Dermatitis
Both make the middle of the face red, and the two often sit on the same face at once. Seborrheic dermatitis adds greasy yellowish scale and sits in the folds beside the nose, in the eyebrows and behind the ears, and it usually itches. Rosacea is smoother, has no scale, comes with flushing and bumps, and stings rather than itches. Treating one and not the other is a common reason a face only half improves.
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Perioral Dermatitis
Both give small red bumps on a red background on the lower face, and both get worse with steroid creams. Perioral dermatitis rings the mouth, the nostrils or the eyes, and it characteristically leaves a clear rim of untouched skin right at the lip border. Rosacea covers the cheeks and nose, spares the skin around the mouth, and brings flushing and visible vessels with it.
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Neither one is contagious
Psoriasis
Psoriasis is inherited and set off by things like infection, injury and stress. It has nothing to do with hygiene, and you cannot catch it or pass it on by touch.
Rosacea
Rosacea is not an infection either. It is not adult acne, it is not caused by dirt, and washing harder makes it worse rather than better.
Further reading
Common questions
Questions Patients Ask
How do I tell psoriasis from rosacea?
Feel the patch. Psoriasis is raised, with a border you can trace and dry silvery scale on top. Rosacea often affects the cheeks and nose and may flare with heat or other triggers. It can cause bumps and pustules as well as flushing.
Can psoriasis appear on the face?
Yes, most often at the hairline, on the eyebrows and in the folds beside the nose. It is rarely only on the face, so check the elbows, knees, scalp and nails before assuming a facial rash is rosacea.
Can you have psoriasis and rosacea together?
Yes. They are two common conditions with different causes, and having one does not protect you from the other.
Does one turn into the other?
No. Psoriasis is the immune system making skin cells too fast. Rosacea is blood vessels in the central face widening too easily. Neither becomes the other.
Is a steroid cream safe for either one?
It is standard for psoriasis and a poor idea for rosacea. Strong steroids settle a rosacea flare briefly and then cause a rebound with more bumps and redness.
Which one is more likely if my nails look odd?
Psoriasis. Small pits, a brown-yellow patch under the nail, or a nail lifting from its bed all point strongly to psoriasis. Rosacea leaves nails alone.