Psoriasis and rosacea: What is the difference?
Psoriasis results from a problem with the immune system. The skin grows too quickly, and extra cells collect on the skin's surface, causing it to become thick and scaly.
This rash can also be painful or itchy. It can affect only a small area or it can be widespread throughout the body.
According to the National Psoriasis Foundation, the condition affects over 8 million people in the United States, and it usually starts between the ages of 15 and 25 years.
Unlike psoriasis, rosacea mainly affects the face and eyes, though it can spread to the neck, chest, and back. Facial flushing comes and goes, but there may be persistent redness and enlarged blood vessels.
Some types of rosacea can involve papules, pustules, and thickening of the skin.
What is psoriasis?
Psoriasis involves flaky, silvery plaques.
Psoriasis is a multisystem autoimmune disorder that speeds skin cell growth. When skin cells grow too quickly, they push to the skin's surface too fast and do not shed quickly enough.
In healthy skin, the cells take about 1 month to form and reach the surface. In a person with psoriasis, this happens in just a few days.
As the cells build up, they form patches of scaling, inflamed skin, known as plaques.
The exact cause is unclear, but scientists believe that a combination of genetic and environmental factors play a role.
Even if a person has the genetic features that make psoriasis more likely to appear, the condition is unlikely to develop without a trigger. Common triggers include infections, stress, and the use of some medications.
There are five types of psoriasis, and a person can have more than one.
Plaque psoriasis is the most common form. The plaques may be:
- redder or darker than the surrounding skin
- covered with silvery white scales
Guttate psoriasis involves small blotches that develop on the torso. It tends to occur during childhood, and it often appears after an illness, such as strep throat.
Inverse psoriasis appears as red patches of inflamed skin. It usually develops in skin folds, such as around the armpits, the groin, and the breasts.
Erythrodermic psoriasis is a rare but severe type. It causes a peeling, painful, or itchy rash to cover the body, and it can be life-threatening.
Different genetic factors underlie the different types, but some types can also share genetic features. The triggers appear to be the same for every form of psoriasis.
Among people with psoriasis, there is a higher incidence of:
Current guidelines recommend regular screening for these conditions in people with psoriasis.
What are the different types of psoriasis rash, and what do they look like? Find out more.
What is rosacea?
A person with rosacea will have facial redness and flushing
Like psoriasis, rosacea is a long-lasting, inflammatory skin disorder.
The first symptom is often a tendency to blush or flush more easily than most people. As the condition progresses, there may be a burning or tingling sensation with the redness and flushing.
A person may also notice areas of slight facial swelling, pimples, and thickened skin. Redness and swelling can become permanent in the center of the face.
Causes and triggers
The exact cause is unclear, but experts suggest that rosacea may result from immune and neurovascular dysfunction. There may also be a genetic component, and it may run in families.
Other triggers for rosacea could include:
- drinking hot beverages, such as coffee or tea
- drinking alcohol, including wine and hard liquor
- using spices and seasonings that contain capsaicin, such as hot sauce, cayenne pepper, or red pepper
- eating foods containing cinnamaldehyde, such as tomatoes, chocolate, or citrus
There are several types of rosacea. They include:
Erythematotelangiectatic rosacea: This causes redness, flushing, and visible blood vessels in the face, neck, and chest.
Papulopustular rosacea: This involves painful acne-like breakouts with redness and swelling on the face.
Phymatous rosacea: The affected skin thickens and develops a bumpy texture, in addition to redness. This often affects the nose.
Ocular rosacea: A person will have redness and irritation in the eyes and eyelids. The eyelids may also swell and develop stye-like lesions.
Common comorbidities — conditions that often occur alongside rosacea — include:
- respiratory diseases
- urogenital infections
- hormonal changes
- high blood pressure and other aspects of metabolic syndrome
Having rosacea may also increase a person's risk of other inflammatory conditions, such as diabetes, muscular sclerosis, and rheumatoid arthritis.
Differences between rosacea and psoriasis
Psoriasis and rosacea both affect the skin and can involve inflammation, but they are different conditions.
Psoriasis symptoms vary widely and include:
- red or pink patches of skin, or patches that are darker than the surrounding area
- thickened skin
- silver scales on inflamed skin
- dry, cracked skin that may bleed
- itching or burning
- swollen and stiff joints
Skin changes can occur anywhere on the body, but they are most common in the:
- lower back
- palms of the hands
- soles of the feet
Common symptoms of rosacea include:
- facial redness and flushing that may spread to the neck, chest, and back
- a feeling of burning or tingling
- thickened skin
- red eyes and eyelids
- acne-like rashes or pustules
Rosacea mainly affects the face and eyelids, but more severe cases can spread.
Neither rosacea nor psoriasis is contagious — a person cannot catch or pass on either.
A dermatologist can help with psoriasis and rosacea.
Treatments that aim to reduce inflammation can be similar for both conditions. Easing inflammation can help reduce redness and sensitivity. Some lifestyle changes may also help.
Topical creams and gels can help relieve symptoms of both psoriasis and rosacea.
Treating psoriasis often involves:
- applying corticosteroid creams to decrease inflammation
- applying vitamin D cream
- using either topical or oral retinoids
- receiving corticosteroid injections
- receiving light therapy — either controlled exposure to sunlight or ultraviolet rays
- receiving laser treatment
- taking methotrexate to suppress the immune system
Biologics are a newer type of drug that is proving effective at reducing flares and the severity of psoriasis symptoms. A doctor may recommend one, and a person can take a biologic by injection, orally, or in an infusion.
Different rosacea treatments address different symptoms.
Prescription brimonidine gel or oxymetazoline hydrochloride cream can reduce redness for up to 12 hours.
Metronidazole gel, azelaic acid cream, and ivermectin cream can treat papules and pustules.
In some cases, isotretinoin can improve skin symptoms, and antibiotics, such as doxycycline, may help. Laser therapy can often reduce dilated blood vessels.
If rosacea affects sensitive areas, such as the eyes or nose, a person may require additional treatment.
Symptoms of both rosacea and psoriasis can flare, then reduce or disappear for a while, before returning.
Avoiding the following may help prevent or manage a flare of either condition:
- cold, windy weather
- high alcohol consumption
- skin care products that are not intended for sensitive skin
- some drugs, including beta-blockers and lithium, a treatment for bipolar disorder
Every day, a person with rosacea should use broad-spectrum sunscreen that has a sun protection factor — SPF — of 30 or higher. Also, wear a wide-brimmed hat when outdoors, seek shade, and avoid the midday sun.
In addition, some people with rosacea find that it helps to avoid spicy food.
Dealing with psoriasis and rosacea together
It is possible to develop both psoriasis and rosacea. A dermatologist can offer advice about managing these conditions without aggravating either.
Also, certain medications may be able to ease symptoms of both conditions.
Other conditions with similar symptoms
Psoriasis and rosacea are not the only skin conditions that can cause facial redness, pain, and swelling.
Other conditions with similar symptoms include:
Lupus: This autoimmune disorder can cause a butterfly-shaped, red rash to form over the cheeks and nose.
Seborrheic dermatitis: This can cause a greasy, yellow, scaling rash to appear in the center of the face and chin.
Demodex dermatitis: This involves a reaction to a microscopic parasite that normally lives on the skin, leading to scaling and flaking on the face.
Contact dermatitis: This causes a rash that can resemble rosacea or psoriasis, and it results from contact with an irritant or allergen.
Eczema: This results from inflammation, and it leads to swollen, red, itchy skin in multiple areas of the body.
Fungal infections: These are contagious, and symptoms can resemble those of psoriasis.
Anyone experiencing any of these symptoms should see a doctor, who will describe and recommend treatment options.
Biologic therapy looks promising for people with psoriasis. Is there something similar for rosacea?
Several advances in the treatment of rosacea in recent years have made the condition easier to live with. There are no approved biologics out there, but there are other recommended solutions, depending on the form of rosacea.
Laser treatment is effective at reducing the redness of rosacea, with effects lasting anywhere from 6 months to 1 year.
Also, you can reduce redness for 12 hours with new medications: brimonidine gel and oxymetazoline hydrochloride cream.Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.