Psoriasis vs. Scabies: Pictures and 4 Differences | MyPsoriasisTeam

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Psoriasis vs. Scabies: Pictures and 4 Differences

Medically reviewed by Steven Devos, M.D., Ph.D.
Written by Sarah Winfrey
Posted on March 12, 2024

When your skin is itchy, discolored, flaky, or inflamed, you need to know what is going on with it as soon as possible so you can get treatment and feel better. If you’ve been diagnosed with psoriasis, it’s easy to think that every itchy rash or patch is related to or caused by your psoriasis.

However, other skin conditions can cause similar symptoms, like eczema. Scabies, too, can be mistaken for psoriasis — and if you develop both conditions at the same time, which is entirely possible, getting a clear diagnosis can become more difficult. “Has anyone ever been misdiagnosed with scabies vs psoriasis?” asked one MyPsoriasisTeam member. “I know it’s psoriasis because I have had many confirmations. So now I am being treated for both.”

By knowing about skin conditions that can be confused with psoriasis, you’ll be equipped to talk to your doctor and advocate for any testing and treatment you need. Here’s what you should understand about how psoriasis and scabies are different.

1. Psoriasis and Scabies Have Different Causes

No one knows the exact cause of psoriasis, but it’s an autoimmune disease where skin cells grow faster than they should. Genetics seem to play a role in who gets psoriasis, as do certain factors in the environment. These factors include:

  • Certain infections
  • Alcohol use
  • Smoking
  • Exposure to certain types of weather
  • Certain medications
Sarcoptes scabiei, pictured above under a microscope, are tiny bugs that cause scabies. They burrow into a person’s skin and lay eggs. (CC BY-SA 3.0/Kalumet)

Importantly, psoriasis is not contagious, meaning it can’t be spread from person to person through physical contact or any other means.

Scabies, on the other hand, is caused by a tiny bug called sarcoptes scabiei —or the human itch mite. It burrows into the skin and lays eggs, which causes symptoms on the skin’s surface. Most people develop scabies after coming into contact with an object that has an infestation of scabies mites, like clothing or a towel, or when they come into close contact with another person who already has scabies.

Getting scabies may increase your chances for developing psoriasis later on. One research study showed that people who had scabies were more likely to develop psoriasis within seven years compared to those who hadn’t had scabies. While this finding alone is not conclusive, it gives you something to talk to your dermatology team about.

2. Psoriasis and Scabies Have Different Risk Factors

Although anyone can get psoriasis, some people are more likely to develop it. These include people who have one or two parents with the condition, as it has a genetic component and tends to run in families. People who smoke are also more likely to get psoriasis, as are people who are exposed to the other environmental factors mentioned above.

The risk factors for scabies are different. There’s no genetic component, and the environmental factors in which it spreads are not the same as those that can trigger psoriasis. People who have a lot of skin-to-skin contact with others are the most likely to develop scabies. This includes young children and their mothers, people in the hospital or other care facilities (like nursing homes), and people who have a lot of sexual contact with different partners.

If your immune system is compromised, you may be more likely to get scabies. Some medications for psoriasis can decrease your immune system’s ability to fight off infections. You may be more likely to get scabies if you’re exposed to them while taking these medications, though there is no good research indicating how frequently this might happen.

3. Psoriasis and Scabies Have Some Differences in Symptoms

Symptoms for these two conditions are difficult to discuss because they can vary based on the type of each condition you’re dealing with. This discussion includes the most common symptoms of both conditions and some important caveats.

In plaque psoriasis, scales may appear like reddish, raised, scaly patches of skin. (CC BY-NC-ND 3.0 NZ/DermNet)
Psoriasis scales can affect different parts of the body, including the neck and scalp, and may appear purplish in darker skin tones. (CC BY-SA 4.0/Masryyy)

Although both conditions can produce itchy skin lesions, the itching with scabies is often very intense, while some people with psoriasis don’t experience much intense itching. People living with scabies especially tend to experience itching at night.

In addition, the two conditions may look different. Psoriasis usually appears as discolored spots (purplish on dark skin, and reddish on lighter skin) that develop a lighter, sometimes silvery, scaly coating on top. Scabies usually appears as a trail of small discolored spots all in a row. (This is where the mite burrowed into the skin.)

Scabies are small bumps or areas of discolored skin and are more itchy than psoriasis plaques. (CC BY-NC-ND 3.0 NZ/DermNet)

Even with these differences, the two skin rashes can be confused for one another, even by trained professionals. This is even more true with rupioid psoriasis and crusted scabies.

Rupioid Psoriasis and Crusted Scabies

Rupioid psoriasis is very rare. The scales it creates contain keratin, a type of protein, and often appear as rough patches on the surface of the skin.

Rupioid psoriasis is a rare form of psoriasis that can look similar to a severe form of scabies called crusted scabies. (Dr. Ian McColl)

Crusted scabies, or Norwegian scabies, is a severe form of scabies where crusty patches appear on the skin. They can look like the scales from rupioid psoriasis and vice versa. Research about rupioid psoriasis is limited because it’s so rare. However, one case study (an explanation of a single case of the disease) mentioned how crusted scabies could be mistaken for and misdiagnosed as psoriasis.

The symptoms of crusted scabies are similar to those of rupiod psoriasis, so the conditions may be mistaken for one another. (CC BY-NC-ND 3.0 NZ/DermNet)

4. Psoriasis and Scabies Require Different Treatments

Whenever you treat a medical condition, you want to do your best to treat it at its source. Therefore, psoriasis and scabies need different treatments because they have different causes.

While there’s no cure for psoriasis, there are several different treatment options. These include:

  • Topical treatments, including corticosteroids and vitamin D
  • Anti-inflammatory medications
  • Retinoids
  • Moisturizing creams, lotions, gels, etc.
  • Phototherapy (exposure to ultraviolet light)
  • Medications that suppress the immune system
  • Biologic medications that target specific parts of the immune system

Treating scabies involves medication that will kill the mites. This may be a topical treatment. There are several different treatments that your health care provider might prescribe for scabies — including permethrin cream — based on the severity of the scabies infection and other factors. You usually put these medications on the skin at night and then wash them off in the morning.

You may need to repeat treatment at your dermatologist’s direction. If you have a severe infection, or if those treatments don’t work, your doctor may prescribe an oral medication called ivermectin to get rid of scabies. Take this medication as directed by your physician.

Family members or others in close contact with someone diagnosed with scabies will need to be treated, too. This helps prevent an outbreak and stops the scabies rash from spreading between people.

After successfully being treated for scabies, it’s crucial to prevent re-infestation by thoroughly cleaning the environment. You'll need to use hot water to wash all the clothing, bedding, and towels used by the person with scabies. Then dry everything on a high heat setting to kill any remaining mites or eggs. Thorough vacuuming and cleaning of carpeting and furniture can also help prevent future infection.

Talk to Your Doctor for a Diagnosis

If you’re dealing with discolored patches of skin and/or itching that's significant to severe, it’s time to talk to your doctor and get medical advice. If you aren’t convinced that you’re getting the right treatment, you may need to advocate for a skin biopsy. This test can help determine whether your symptoms are caused by psoriasis, scabies, or something else. Although it’s somewhat invasive and requires a skin sample to be sent to a lab, it’s the best way to definitively diagnose both conditions.

Find Your Team

MyPsoriasisTeam is the social network for people with psoriasis, psoriatic arthritis, and their loved ones. On MyPsoriasisTeam, more than 126,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you noticed a rash but aren’t sure if it’s caused by psoriasis? Have you had both psoriasis and scabies at the same time? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on March 12, 2024
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    Steven Devos, M.D., Ph.D. received his medical degree and completed residency training in dermatology at the University of Ghent, Belgium. Learn more about him here.
    Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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