If you’re living with psoriasis and notice discolored, irritated patches on your face, it’s natural to assume your condition is the cause. But in some cases, rosacea — another chronic (long-term) skin condition — may be to blame.

Psoriasis and rosacea are both long-term inflammatory conditions that can cause itchy, discolored patches on the face. However, they differ in their causes, how they appear, and how they’re treated.

What Is Psoriasis?

Psoriasis is a chronic skin condition that causes inflammation and plaques, which are discolored patches of thick, scaly skin that can itch, crack, and bleed. Plaques can affect the entire body, including the face. Psoriasis plaques appear red on lighter skin tones. On darker skin tones, patches can appear purple, gray, or brown. Psoriasis plaques are often 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 remission (a period of few or no symptoms).

A mild case of psoriasis on the 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.

Other psoriasis symptoms include:

• Itching or burning skin
• Dry, cracked skin
• Nail changes, including pitting and crumbling
• Joint pain (psoriatic arthritis)

What Is Rosacea?

Rosacea is a relatively common chronic skin condition. However, rosacea typically affects only the face and doesn’t cause flaking or scaling. Rosacea symptoms include flushing and visible broken blood vessels — or spider veins — often on the center of the face. In some cases, rosacea leads to breakouts of tiny, discolored, pus-filled bumps resembling pimples, which can be mistaken for acne or eczema.

Rosacea is often more noticeable on lighter skin, but it can affect people of all skin tones. Like psoriasis, rosacea symptoms vary in color based on a person’s skin tone. On lighter skin, rosacea typically shows up as redness across the cheeks and nose. On darker skin, it can cause patches of brown, purple, or violet discoloration.

Other symptoms of rosacea include:

• Skin that feels hot or tender to the touch
• Rhinophyma — Thickened, bumpy, and discolored skin on the nose, a symptom more common among men than women, according to Mayo Clinic
• Ocular rosacea — A burning or irritating sensation around the eyes

Types of Psoriasis That Might Be Mistaken for Rosacea

Generally, there are two kinds of psoriasis that might be mistaken for rosacea — plaque psoriasis and guttate psoriasis.

Plaque Psoriasis

Plaque psoriasis is the most common type of psoriasis by a wide margin, affecting 80 percent to 90 percent of people with the condition. Plaque psoriasis can involve the entire body, including the face and scalp.

Guttate Psoriasis

Like plaque psoriasis, guttate psoriasis can cause discoloration and itching. But, rather than appearing as hardened patches, this form of psoriasis shows up as tiny pink bumps or teardrop-shaped lesions. Symptoms most often appear on the trunk, arms, and legs. People also develop bumps on the face, scalp, and ears.

Causes of Psoriasis and Rosacea

Researchers aren’t entirely sure what causes psoriasis or rosacea. Both conditions are linked to inflammation, and neither is contagious or caused by poor hygiene.

Certain factors may trigger or worsen the symptoms of both conditions.

What Causes Psoriasis?

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 ones, resulting in the thick, scaly patches characteristic of psoriasis.

This skin condition tends to run in families. Scientists have identified additional risk factors that may trigger or worsen psoriasis flare-ups, including:

• Smoking
• Heavy drinking
• Stress
• Skin injuries
• Certain medications

Causes of Rosacea

Some research suggests that rosacea may be genetic or stem from Helicobacter pylori (H. pylori), a type of bacteria that causes intestinal infection. However, neither cause has been definitely proved. However, doctors have noted rosacea symptoms can be triggered by certain factors, such as:

• Sunlight and sunburn
• Wind
• Exercise
• Cosmetics
• Emotions, including stress and anxiety
• Spicy foods
• Alcohol

Diagnosis and Treatment of Psoriasis and Rosacea

The type of treatment you receive will depend on whether you’re diagnosed with psoriasis or rosacea.

There’s no single test to diagnose rosacea. A doctor will review your symptoms and examine your skin. If they think another condition — such as psoriasis — could be causing your symptoms, they may order tests. Blood work can help rule out autoimmune disease, while a skin biopsy (examining a small skin sample) is rarely needed.

Psoriasis is diagnosed by examining your skin, scalp, and nails. Your doctor will ask you questions about your family and medical history. They may also perform a biopsy to rule out other conditions and determine the type of psoriasis you have.

Psoriasis Treatments

The treatment you receive for your psoriasis will depend on the severity of your symptoms and circumstances. You may need to work with your dermatologist for weeks or months to find the right fit for you.

Treatment options may include topical treatments, systemic treatments, phototherapy, and moisturizers.

• Topical steroids — Low-strength corticosteroids are used for facial psoriasis to reduce inflammation and discoloration.
• Nonsteroidal topicals — Several types of nonsteroidal topicals may be appropriate for your face, including phosphodiesterase 4 (PDE4) inhibitors and aryl hydrocarbon (AhR) agonists. These options may be more tolerable than topical steroids.
• Systemic treatments — Immune-suppressing medications are sometimes used to treat facial psoriasis.
• Biologics — Biologic drugs target a specific part of the immune system that causes inflammation. These drugs are injected or infused.
• Phototherapy — This treatment uses ultraviolet light to slow skin cell growth. Phototherapy is usually done under the supervision of a dermatologist, but at-home options are also available.
• Moisturizers — Over-the-counter moisturizers help keep your skin hydrated. You can look for products that have received the National Psoriasis Foundation’s Seal of Recognition.

Rosacea Treatments

Treatments for rosacea include topical and oral medications and, in some cases, laser therapy.

Topical options can help reduce facial flushing and control acne associated with rosacea. Oral options may include antibiotics — some approved by the U.S. Food and Drug Administration (FDA) for rosacea — and certain acne medications.

Find Your Community

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Do you have questions about what’s causing your skin symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.