Psoriasis and rosacea are both irritating skin conditions that affect many people. Both lead to visible rashes and skin swelling. Both may require a doctor’s diagnosis and treatment, but the similarities end there.

Psoriasis affects more than 7.5 million Americans by causing the skin to grow too quickly. When skin grows too quickly, it can cause a red, scaly, painful, or itchy rash. A psoriasis rash can be confined to one spot on the body but is often widespread.

More than 14 million Americans have rosacea. Unlike psoriasis, rosacea mainly affects the face and eyes, though it can spread to the neck, chest, and back. It causes redness, flushing, acne-like breakouts, and thick skin on the face and eyelids.

What is psoriasis?

Plaque psoriasis is the most common form of psoriasis.

In healthy skin, skin cells take about a month to form and reach the surface of the skin. In psoriasis, this process happens in a few days.

Exactly what causes psoriasis is unclear, but it may be due to an immune system problem. T cells are a specific kind of white blood cell. White blood cells defend the body from bacteria and viruses. In patients with psoriasis, T cells overproduce, and they attack healthy skin cells.

This overactive immune response and increase in T cells and skin cells causes a range of symptoms. The symptoms lead to different types of psoriasis. These include:

• Plaque psoriasis: A common form of psoriasis. It accounts for 80 to 90 percent of psoriasis cases. It causes itchy or painful plaques, or areas of inflamed red skin covered with silvery white scales.
• Guttate psoriasis: Features small blotches on the torso. It tends to occur during the childhood years, and it often appears after an illness, such as strep throat.
• Inverse psoriasis: Appears as red patches of swollen skin around the armpits, groin, and breasts.
• Pustular psoriasis: Widespread areas of pus-filled blisters and pustules. These often appear all over the body, accompanied by fever, chills, extreme itching, and, diarrhea.
• Erythrodermic psoriasis: The least common type of psoriasis. It blankets the whole body with a peeling, painful, or itchy rash.

What is rosacea?

A common symptom of rosacea is facial redness and flushing.

Like psoriasis, rosacea is a long-lasting, inflammatory skin disorder.

The first sign is often a tendency to blush or flush more easily than most people. As it progresses, there may be a burning or tingling sensation with the redness and flushing.

There may be areas of slight facial swelling, pimples, and thickened skin. Over time, redness and swelling may become permanent in the center of the face.

The exact cause of rosacea is unclear, but it may be an immune response that is influenced by genetics. One suggestion is that a person with rosacea does not process a protein that normally protects the skin. The body may overreact to this protein, causing redness. Some research also suggests a link between rosacea and common bacteria in the gut, known as H. pylori.

Rosacea has symptoms other than facial flushing and redness. The symptoms are varied, and they are classified into different types.

These are:

• Erythematotelangiectatic rosacea: This causes redness, flushing, and visible blood vessels in the face, neck, and chest.
• Papulopustular rosacea: Involves painful, acne-like breakouts, with redness and swelling on the face.
• Phymatous rosacea: When the affected skin thickens and develops a bumpy texture, in addition to redness. This often affects the nose.
• Ocular rosacea: Affects the eyes and eyelids, which become red and irritated. The eyelids may also swell and develop stye-like lesions.

Differences between psoriasis and rosacea

They both present with facial redness and swelling, but many symptoms are different.

Psoriasis symptoms vary widely and include the following:

• Red patches of skin
• Silver scales on red, inflamed skin
• Dry, cracked skin that may bleed
• Itching or burning skin
• Swollen and stiff joints
• Patches of plaque common on the joints, legs, lower back, hands, feet, nails, and face

Common symptoms of rosacea include:

• Facial redness and flushing that may spread to the neck, chest, and back
• A feeling of burning or tingling with flushing
• Thickened skin
• Red eyes and eyelids
• Acne-like rashes
• Pustules on eyelids

Psoriasis is often more widespread than rosacea. Psoriasis may affect the face, but typically affects the joints, hands, scalp, and nails.

Rosacea mainly affects the face and eyelids, but it may spread in more severe cases.

Treatment options

Topical medicines may be used for both psoriasis and rosacea.

A dermatologist can help patients with psoriasis or rosacea. Both conditions involve redness and sensitivity, so the treatments may be similar.

Medicinal and lifestyle remedies may help to manage psoriasis or rosacea.

Treatment for psoriasis often includes:

• Corticosteroids applied directly to the outbreak to decrease inflammation and itching
• Topically applied vitamin D cream
• Retinoids
• Injections
• Light therapy, including exposure to sunlight or UV therapy
• Oral medications including biologics, methotrexate, or retinoids

Rosacea treatments include:

• Topical medicines to reduce redness and inflammation
• Oral and topical antibiotics for severe cases
• Laser treatments to erase lines
• Daily use of sunscreen to protect delicate skin

From time to time, symptoms of both psoriasis and rosacea flare up or worsen temporarily. To help manage a flare-up, patients should avoid:

• Stress
• Cold weather
• Wind
• Excessive alcohol consumption
• Smoking

Medications that can make the condition worse include beta-blockers and some drugs for bipolar disorder.

Spicy food and skin products that are not designed for sensitive skin can worsen the symptoms of rosacea.

Dealing with psoriasis and rosacea together

Some people have both psoriasis and rosacea.

A dermatologist can offer advice about managing both conditions without aggravating either. They may be able to recommend medications that can benefit both conditions.

Other skin conditions that may cause similar symptoms

Psoriasis and rosacea are not the only skin conditions that cause facial redness, pain, and swelling.

Other conditions with similar symptoms include:

• Lupus, an autoimmune disorder that can present with a butterfly-shaped red rash over the cheeks and nose.
• Seborrheic dermatitis, a skin condition that involves a greasy, yellow, scaling rash in the center of the face and chin.
• Demodex dermatitis, a reaction to a microscopic parasite that lives on the skin. Reactive individuals may experience scaling and flaking on the face.
• Contact dermatitis is when an irritant or an allergen can lead to a rash on contact. This rash resembles rosacea or psoriasis.
• Eczema refers to an inflammation that leads to swollen, red, itchy skin. Like psoriasis, it may appear on multiple parts of the body.
• Fungal infections can mimic psoriasis plaque and cause similar symptoms.

Anyone experiencing these symptoms should see a doctor to rule out other possible causes so that the correct treatment can be given.

Written by Jenna Fletcher

References

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Bikowski, J., & Del Rosso, J. Q. (2009, January). Demodex dermatitis: A retrospective analysis of clinical diagnosis and successful treatment with topical crotamiton. Journal of Clinical and Aesthetic Dermatology, 2(1), 20-25. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958185/

Mayo Clinic Staff. (2016, April 27). Chronic cough: Symptoms and causes. Retrieved from http://www.mayoclinic.org/diseases-conditions/chronic-cough/symptoms-causes/dxc-20201783

Mayo Clinic Staff. (2015, June 17). Psoriasis: Treatments and drugs. Retrieved from http://www.mayoclinic.org/diseases-conditions/psoriasis/basics/treatment/con-20030838

Psoriasis. (n.d.). Retrieved from https://www.aad.org/media/stats/conditions/psoriasis

Questions and answers about rosacea. (2016, April). Retrieved from http://www.niams.nih.gov/health_info/rosacea/

Rosacea. (n.d.). Retrieved from https://www.aad.org/public/diseases/acne-and-rosacea/rosacea

The many faces of rosacea. (n.d.). Retrieved from https://www.rosacea.org/patients/faces.php

What is rosacea? (2014, November). Retrieved from: http://www.niams.nih.gov/health_info/rosacea/rosacea_ff.asp