According to the National Psoriasis Foundation, roughly 3 percent of people are living with psoriasis worldwide, while the British Journal of Dermatology reports that rosacea’s global prevalence is about 5 percent.
Both psoriasis and rosacea are chronic inflammatory conditions that cause patches of inflamed, itchy skin to appear on the face. But beyond their most recognizable symptoms, the conditions are very different, diverging in their causes, features, and treatments.
Psoriasis is a chronic skin condition that causes inflammation and the accelerated production of skin cells. For people with psoriasis, the skin builds up more quickly than it can shed, resulting in patches of thick, scaly skin that can itch, crack, and bleed. Inflammation causes these patches, or plaques, to appear red on lighter skin tones. On darker skin tones, patches can appear purple, gray, or brown. Scales associated with psoriasis are commonly silver in color.
The severity and appearance of psoriasis can vary from person to person. While some might only see mild flaking in one or two areas, others may have hardened, scaly, and irritated patches across much of their body. Symptoms tend to occur in cycles, appearing during flare-ups, then fading after a few weeks or months during periods of remission.
A mild case of psoriasis affecting one’s face can look similar to rosacea. However, whereas rosacea is limited to the face, psoriasis is not. It often appears in other areas, including the elbows, knees, legs, feet, lower back, scalp, and palms.
Like psoriasis, rosacea is a relatively common chronic condition. However, people with rosacea typically only have symptoms on their face and don’t experience flaking or scaling. The condition causes redness on lighter skin tones or dusky brown coloring on darker skin tones. Roseacea also includes visible broken blood vessels or spider veins — often at the center of a person’s face. In some cases, rosacea can cause breakouts of tiny, pus-filled bumps in affected areas, which can be mistaken for acne or eczema.
The characteristic symptoms of rosacea and psoriasis appear to overlap at first glance. After all, both can cause redness, itching, and discomfort. However, even these seemingly similar symptoms differ on close inspection.
For example, the discoloration caused by rosacea often appears alongside visible broken blood vessels, and sometimes pus-filled bumps on the forehead, scalp, cheeks, chin, neck, and chest. The condition typically causes redness in the center of the face covering the cheeks and nose.
In some cases (particularly in men), rosacea can also cause thickened, swollen, bumpy, and discolored skin on the nose, known as rhinophyma. Some people with rosacea may feel a burning or irritating sensation around their eyes, known as ocular rosacea.
In psoriasis, that characteristic skin discoloration manifests differently. Most people with psoriasis experience plaques (thick, itchy, red or purple patches of skin), which are often covered with silvery-white scales. These are rarely confined to the face. A person’s symptoms may vary even further depending on the kind of psoriasis they have.
Plaque psoriasis is the most common type of psoriasis by a wide margin, affecting up to 90 percent of people with the condition. The plaques seen in this type of psoriasis can vary in size and intensity. Some people may only have a few mild, coin-sized plaques, while others might see individual reddened plaques that connect and span to cover large patches of skin. Other symptoms of plaque psoriasis may include itching, stinging, burning, pain, or tightness.
Like plaque psoriasis, guttate psoriasis can cause redness and itching. But, rather than appearing as hardened patches, this form of psoriasis presents as tiny bumps or teardrop-shaped lesions on the affected areas. Although symptoms most often appear on the torso, arms, and legs, guttate psoriasis can also affect the face, scalp, and ears.
Psoriasis is an autoimmune disease, meaning it occurs when the immune system mistakenly sends T cells (white blood cells that attack viruses) to target healthy skin cells. This leads the body to produce new skin cells at a highly accelerated rate. The skin does not shed quickly enough to keep up, resulting in the thick, scaly skin patches characteristic of psoriasis. This immune-system dysfunction can also lead to arthritis in the joints.
Scientists have identified a few risk factors that may trigger or worsen psoriasis flare-ups, including:
If your psoriasis symptoms seem to be worsening from any of the above, you may want to ask your doctor for medical advice on shifting your lifestyle to help prevent flares. As one member of MyPsoriasisTeam advised, “Don't forget what your triggers are; they'll remind you in the worst ways. Don't be your own worst critic about your skin. You and your doc will find a solution.”
That said, doctors have noted a few factors that can trigger rosacea symptoms, such as:
The type of treatment you receive will depend on whether you are diagnosed with psoriasis or rosacea.
There is no specific test used to diagnose rosacea. Rather, a doctor will use your signs and symptoms, as well as a skin exam, to determine whether you have the condition. The doctor may order testing if they suspect that another condition, such as psoriasis, may be behind your symptoms. A skin biopsy (an analysis of a small skin sample) is not usually performed, but blood work may be ordered to rule out autoimmune disease.
Psoriasis may be diagnosed using skin, scalp, and nail examinations. A doctor may also perform a biopsy to rule out other conditions and determine the type of psoriasis you have.
The treatment you receive for your psoriasis will depend on the severity of your symptoms and circumstances. You may need to work with your dermatologists for weeks or months to find the right fit for you.
“Different drugs or treatments work for different people. Keep searching for the right one. I went from topicals all the way through different biologics,” recommended a MyPsoriasisTeam member.
Doctor-recommended treatments generally fall into three categories: topical, phototherapy, and systemic.
Topical treatments refer to medications applied to the affected skin in forms such as creams or ointments. Corticosteroids — which can be found in the forms of medicated ointments, lotions, gels, shampoos, sprays, and creams — are often recommended for mild to moderate cases of psoriasis. Vitamin D and vitamin A analogs may also be used topically, along with coal tar.
During phototherapy, a dermatologist will expose affected areas of skin to specific types of natural or artificial light over multiple sessions. Generally, doctors recommend this approach if your skin does not respond well (or at all) to topical creams.
Systemic treatments are injected or oral medications that are typically used only in moderate to severe cases when topicals or phototherapy haven’t provided relief. Systemic treatments include steroids, immunosuppressants, and biologics. Newer biologics are very effective at clearing the skin.
Learn more about treatment for psoriasis.
The treatments used for rosacea vary across cases. Some people might find that topical creams or gels that constrict blood vessels are enough to reduce redness. Creams with metronidazole, ivermectin, or azelaic acid are commonly used. Other people may need oral antibiotics or acne drugs to address severe rosacea pustules.
As with psoriasis, people with rosacea who don’t find relief through topical means may benefit from repeated laser-therapy sessions to reduce enlarged blood vessels.
If you feel isolated or unsure because of your psoriasis, know this: you are not alone. MyPsoriasisTeam is the social network specifically designed to connect and support people living with psoriasis. It’s a community that has a firsthand understanding of the daily challenges psoriasis poses. Becoming a member will allow you to start conversations, ask and give advice, and connect with others who understand.
Do you have questions about what’s causing your skin symptoms? Start a new conversation thread on MyPsoriasisTeam, or let us know in the comments below.