If discolored, inflamed patches develop on your face, you may automatically assume it’s due to your psoriasis. In some cases, however, you might actually be living with rosacea.
Both psoriasis and rosacea are chronic inflammatory conditions that cause patches of discolored, 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 discolored 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 skin condition. However, people with rosacea typically only have symptoms on their face and don’t experience flaking or scaling. The condition causes discoloration and visible broken blood vessels — or spider veins — often on the center of a person’s face. In some cases, rosacea can cause breakouts of tiny, discolored pus-filled bumps resembling pimples 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 discoloration, itching, and discomfort. However, even these seemingly similar symptoms differ on close inspection.
On lighter skin, rosacea typically causes redness in the center of the face covering the cheeks and nose. On darker skin, it can cause patches of brown, purple, or violet discoloration. This symptom may appear alongside these additional signs:
In psoriasis, that characteristic discoloration manifests differently, typically resulting in the following symptoms:
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 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 discoloration and itching. But, rather than appearing as hardened patches, this form of psoriasis presents as tiny pink 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.
Health experts are not entirely sure what causes psoriasis or rosacea, but rosacea is slightly more common. 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.
Certain factors may trigger or worsen the symptoms of both conditions.
Psoriasis occurs when the immune system mistakenly targets healthy skin cells. This leads the body to produce new skin cells in addition to the existing cells, resulting in the thick, scaly skin patches characteristic of psoriasis.
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 how you can shift 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.”
Some research suggests that rosacea may be genetic or stem from Helicobacter pylori (H. pylori), a bacteria that causes intestinal infection. However, neither cause has been concretely proved.
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 usually not performed, and 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.
Psoriasis 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 for people whose skin does not respond well (or at all) to topical creams.
Systemic (whole-body) 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.
Treatments used for rosacea vary across cases. Some people might find that topical creams or gels that constrict blood vessels are enough to reduce facial discoloration. Creams with metronidazole, ivermectin, or azelaic acid are commonly used. Topical tretinoin cream can also help. Other people may need oral antibiotics or acne drugs, such as isotretinoin, 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.
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