Psoriasis or Eczema? How to Tell the Difference on Hands and Feet

I Thought It Was Eczema, Until My Skin Got Worse

"I spent two years treating what I thought was eczema. Creams helped for a while, but then the cracks on my heels started bleeding, and the rash on my palms turned into thick, painful plaques. It wasn't until I saw a dermatologist that I heard the word 'palmoplantar psoriasis' for the first time. I wish I had known sooner because eczema treatments weren't working for what I actually had."

If you've ever wondered whether the red, flaky, itchy patches on your hands or feet are eczema or psoriasis, you're not alone. These two conditions can look incredibly similar, especially when they show up on the palms or soles. But the difference between them matters. Choosing the wrong treatments, delaying proper care, or misunderstanding your symptoms can make things worse.

In this guide, we'll help you spot the key differences between eczema and psoriasis as they appear on the hands and feet. We'll break down symptoms, show you how they look and feel, explain what triggers each condition, and share real-life stories from people who were misdiagnosed, sometimes for years.

By the end, you'll know what signs to watch for, how to talk to your doctor, and how to move forward with more confidence.

Misdiagnosed for Years? Here's How to Spot the Difference Between Psoriasis and Eczema

Both psoriasis and eczema affect the skin, but they stem from different causes and behave differently, especially on the hands and feet.

Psoriasis (Palmoplantar Type)

Psoriasis is an autoimmune condition, which means your immune system mistakenly attacks your own skin. In palmoplantar psoriasis, the skin on the palms and soles thickens rapidly, forming plaques that crack, flake, and sometimes bleed.

• Cause: Overactive immune response speeds up skin cell turnover.
• Common triggers: Stress, infection, skin injury, weather changes.
• Feel: Burning, tight, sometimes painful; less itchy than eczema.

Appearance: Thick, red plaques often covered with silvery white scales. Skin may crack deeply.

Reddit users often describe the pain as “like walking on broken glass” when flare ups hit their soles. Others mention the skin “feels like it’s shrinking and splitting at the same time.”

Eczema (Hand and Foot Dermatitis)

Eczema, also called atopic dermatitis, is a chronic inflammatory condition tied to skin barrier dysfunction and environmental triggers like allergens or irritants.

• Cause: Often genetic; skin’s barrier weakens, allowing allergens to irritate.
• Common triggers: Soaps, detergents, fabric, allergens, stress.
• Feel: Itchy, inflamed, raw; may burn if cracked.

Appearance: Red, itchy patches, sometimes weepy or crusted. Skin may thicken over time from scratching.

One Reddit user with hand eczema wrote, “It starts as an itchy spot on my fingers, then spreads and gets wet and cracked. No matter what I put on it, the itching drives me crazy.”

Symptoms Comparison Table, with an easy-to-understand breakdown plus analysis and real-world context from the psoriasis community.

Psoriasis vs. Eczema on Hands and Feet: What to Look For

When you’re trying to figure out what’s going on with your skin, it helps to look at symptoms side by side. While psoriasis and eczema can both cause discomfort, their appearance, triggers, and sensation often differ, especially on the hands and feet.

Here’s a simplified comparison to help you spot the difference:

Let’s Break This Down:

Location matters. While both can affect hands and feet, psoriasis is more likely to form symmetrical plaques on both palms or soles. Eczema may appear more scattered or increases and webs between fingers or toes.

Sensation clues. Reddit users with psoriasis often describe the pain as a “burning split,” while eczema sufferers say it “itches so badly you want to rip your skin off.”

What you see. If your skin looks shiny and scaly, it may lean psoriasis. If it’s moist, cracked, or has small blisters, eczema is more likely.

Treatment differences. Eczema often improves quickly with barrier creams and allergen avoidance. Psoriasis tends to require targeted treatments like coal tar, salicylic acid, or biologics.

What It Looks Like on Hands and Feet

Psoriasis and eczema can both show up on your hands and feet, but they rarely look or behave exactly the same. By paying attention to how symptoms appear in these areas, you can get closer to identifying the correct condition.

Psoriasis on Hands

Typical appearance: Thick, red plaques with silvery or white scales. Often located on the center of the palms or along the base of the fingers.

• Texture: Skin is usually rough, cracked, and may split open during flare-ups.
• Feel: Burning, stinging, or tightening. The sensation is more painful than itchy.
• Extra signs: Nails may be involved, showing pitting, thickening, or detachment (onycholysis).

A Reddit user described their palms during a flare as: “It looks like dried-up clay breaking open. It hurts to grip anything, even a toothbrush.”

Psoriasis on Feet

Typical appearance: Thickened skin on the heels, balls of the feet, or arches. Lesions may be large and well-defined.

• Texture: Deep, painful cracks or fissures are common.
• Mobility impact: Pain while walking or standing is often significant.

One community member shared: “I used to think it was athlete’s foot. The flakes turned into deep splits that bled when I walked.”

Eczema on Hands

Typical appearance: Red, itchy patches. May include small blisters, oozing, or raw skin.

• Texture: Softer, inflamed, and moist during active flare-ups.
• Feel: Intense itching, sometimes followed by burning from broken skin.
• Where: Often appears between fingers, on knuckles, and wrists.

Eczema on Feet

Typical appearance: Red, inflamed patches, sometimes with tiny blisters.

• Texture: Skin may be thickened from scratching or rubbing, but usually not scaly.
• Moisture link: Eczema can worsen with excess sweating, tight shoes, or synthetic socks.

Real Stories from the Community

Sometimes, reading symptoms on a chart isn’t enough, you need to hear what it actually feels like. These short real-life experiences show just how confusing it can be to live with skin problems on your hands or feet and what a difference the right diagnosis can make.

“I Thought It Was Just Dry Skin”
“I was using hand creams like crazy, but the patches kept coming backthicker and redder each time. I figured it was just dry skin or maybe eczema from hand soap. It wasn’t until I went to a dermatologist that I was diagnosed with palmoplantar psoriasis. Turns out the creams I was using were actually making it worse because they had fragrance in them.”
Takeaway: Even gentle-sounding products can aggravate psoriasis. Unscented, targeted treatments work better.

“It Looked Like Athlete’s Foot, But Didn’t Go Away”
“At first, I thought it was a bad case of athlete’s foot, peeling skin and itching between the toes. But none of the antifungal sprays helped. Then the cracks on my heels got worse, and standing for long shifts became unbearable. It was psoriasis all along.”
Takeaway: If antifungal treatments aren’t working and the skin thickens or cracks deeply, it’s time to rule out psoriasis.

“I Had Eczema, Then Developed Psoriasis Too”
“I’ve had hand eczema since I was a kid, so I knew the drill. But in my 30s, the flares started changing, less itchy, more burning, and the skin was forming weird plaques. My dermatologist said it was now psoriasis, not eczema. I didn’t even know you could have both.”
Takeaway: It’s possible to have both conditions, or for one to evolve into the other. Regular reevaluation helps.

These stories are reminders: If your skin isn’t improving or if the symptoms change, don’t assume it’s the same condition you’ve always had.

Sometimes, reading symptoms on a chart is not enough; you need to hear what it actually feels like. These short real-life experiences show just how confusing it can be to live with skin problems on your hands or feet and what a difference the right diagnosis can make.

I Thought It Was Just Dry Skin

I was using hand creams like crazy, but the patches kept coming back, thicker and redder each time. I figured it was just dry skin or maybe eczema from hand soap. It was not until I went to a dermatologist that I was diagnosed with palmoplantar psoriasis. Turns out the creams I was using were actually making it worse because they had fragrance in them.

Takeaway: Even gentle-sounding products can aggravate psoriasis. Unscented, targeted treatments work better.

It Looked Like Athletes Foot But Did Not Go Away

At first, I thought it was a bad case of athlete's foot, peeling skin and itching between the toes. But none of the antifungal sprays helped. Then the cracks on my heels got worse, and standing for long shifts became unbearable. It was psoriasis all along.

Takeaway: If antifungal treatments are not working and the skin thickens or cracks deeply, it is time to rule out psoriasis.

I Had Eczema Then Developed Psoriasis Too

I have had hand eczema since I was a kid, so I knew the drill. But in my 30s, the flares started changing, less itchy, more burning, and the skin was forming strange plaques. My dermatologist said it was now psoriasis, not eczema. I did not even know you could have both.

Takeaway: It is possible to have both conditions, or for one to evolve into the other. Regular reevaluation helps.

These stories are reminders. If your skin is not improving, or if the symptoms change, do not assume it is the same condition you have always had.

How to Tell Which One You Have And Why It Matters

When your skin flares up, it is tempting to self-diagnose. But when it comes to psoriasis and eczema, especially on the hands and feet, getting it wrong can mean months or years of frustration and failed treatments.

Here is how you can start narrowing it down, and when to seek a dermatologist's help.

Clues It Might Be Psoriasis

• Plaques instead of patches – If the affected area is thick, raised, and covered in silvery scales, it is more likely psoriasis.
• Symmetrical patterns – Palmoplantar psoriasis often appears on both hands or both feet at the same time.
• Burning and cracking – Painful fissures and deep skin cracks are more common in psoriasis than eczema.
• Slower to respond – If over-the-counter eczema creams stop working or never worked at all, it might not be eczema.

I knew something was different when the eczema spot on my foot did not itch, it just split open and bled, shared one Reddit user.

Clues It Might Be Eczema

• Intense itch – Eczema is often so itchy it wakes people up at night.
• Oozing or weeping – If the area blisters or gets moist, eczema is more likely.
• Worsens with contact – Flare-ups after touching detergents, metals, or specific fabrics suggest contact dermatitis, a form of eczema.
• History of allergies or asthma – Eczema often runs in families alongside other allergic conditions.

When to See a Dermatologist

If you are unsure, or if symptoms persist more than a couple of weeks despite treatment, it is time to seek medical advice. A dermatologist may:

• Perform a skin biopsy to confirm diagnosis.
• Review your personal and family history.
• Recommend patch testing for eczema or more targeted psoriasis treatments.

Pro Tip: Keep a photo log of flare-ups and jot down what you were exposed to, such as soaps, foods, stress, or weather changes. This helps doctors spot patterns faster.

Psoriasis vs. Eczema Treatments: Why the Right One Matters

The way you treat psoriasis is not the same as how you treat eczema. What works for one can actually aggravate the other. That is why getting the right diagnosis is not just helpful, it is critical.

Let us break it down:

Psoriasis Treatment Overview

Psoriasis, especially the palmoplantar type, is often stubborn. It usually requires targeted, long-term care to manage flare-ups and slow skin cell turnover.

Topical Treatments

• Coal tar and salicylic acid help soften and remove thick plaques.
  • Nopsor Shampoo and Pomade, for example, combine these ingredients for exfoliation and nighttime relief.
• Topical corticosteroids: Stronger formulas are often needed for hands and feet.
• Vitamin D analogs like calcipotriol help regulate skin growth.
• Light Therapy
  • Narrowband UVB and PUVA therapy can help with resistant cases on palms and soles.
  • Requires medical supervision and regular sessions.

Systemic and Biologic Medications

For moderate to severe cases, doctors may prescribe:

• Biologics like adalimumab Humira, Stelara, or Cosentyx.
• Oral medications like acitretin or methotrexate.

These work by targeting inflammation deep within the immune system.

Eczema Treatment Overview

Eczema is more about repairing the skin barrier and controlling inflammation caused by irritants or allergens.

Moisturizers and Barrier Creams

Thick emollients like petrolatum, ceramide-rich creams, or colloidal oatmeal lotions are key.

Apply frequently, especially after washing hands or showering.

Topical Steroids

• Mild to moderate corticosteroids help reduce redness and itching.
• Used in short bursts during flare-ups to avoid thinning the skin.

Lifestyle Adjustments

• Avoid triggers such as scented soaps, nickel jewelry, rough fabrics.
• Wear gloves for wet work and use fragrance-free detergents.

Allergy and Itch Control

• Antihistamines or topical calcineurin inhibitors like tacrolimus for long-term use.
• Some cases benefit from patch testing to identify allergic triggers.

Important Warning: Do not Mix Up the Treatments

Using eczema creams on psoriasis might provide no relief or even make things worse.

Likewise, coal tar or strong exfoliants used on eczema-prone skin can lead to burning or irritation.

I kept using eczema ointments and got no results. The steroid even made the cracks worse because I did not know I had psoriasis, shared one frustrated Redditor.

When to See a Dermatologist

If you have been treating your skin with over-the-counter creams and nothing seems to help, or things are getting more painful, it is time to get professional help. Dermatologists have the tools to give you a proper diagnosis and guide you to the right treatment.

Here are signs it is time to stop guessing and see a specialist:

Red Flags That Warrant a Visit

• Your flare-ups are not improving after two to four weeks of treatment.
• You are experiencing deep cracks, bleeding, or severe pain.
• The skin looks thicker, more plaque-like, or is spreading.
• You have developed new symptoms, like nail changes or joint stiffness.
• Treatments that once worked are now doing nothing or making it worse.

One Reddit user shared, The minute I mentioned my cracked heels and itchy palms, the doctor knew to check for palmoplantar psoriasis. I wish I had not waited a year.

What a Dermatologist Can Do

• Examine your skin visually and take your full medical history.
• Order a skin biopsy if the diagnosis is unclear.
• Check for comorbidities like psoriatic arthritis or allergies.
• Customize a treatment plan that actually fits your condition.

Tip: Keep a photo diary of your skin during flare-ups and write down what products or exposures preceded them. This helps your doctor connect patterns faster.

Even if you have lived with eczema or psoriasis for years, symptoms can change and sometimes a fresh set of eyes and a biopsy is the best step forward.

Do Not Guess. Know What You Are Dealing With.

It is easy to confuse psoriasis and eczema, especially when the symptoms show up on your hands and feet. The burning, the itching, the flaking, the cracking, they overlap just enough to leave you guessing. But the way these conditions behave, and how they respond to treatment, is very different.

If your skin is not healing the way you expected or if the treatments you have been using just are not working, it is time to ask a new question: Could it be something else?

Let us recap the key differences:

• Psoriasis often burns more than it itches, forms thick plaques with silvery scales, and needs deeper immune based treatments.
• Eczema tends to be itchier, can ooze or blister, and usually improves with barrier repair and allergen control.
• Both can affect hands and feet, but their triggers, sensations, and healing patterns are distinct.
• Most importantly, you do not have to figure it out alone. Dermatologists see cases like yours every day. A proper diagnosis can change everything; from the products you use to the relief you feel.

Next Steps

1. Keep a photo journal of your skin.
2. Track your triggers.
3. Talk to a specialist and do not settle for probably eczema or just dry skin.
4. You deserve answers and relief.

Further Reading on Nopsor Blog

• Palmoplantar Psoriasis: Symptoms, Causes, and Treatments
  A detailed guide to how palmoplantar psoriasis appears on hands and feet, its causes, and how it's diagnosed and treated.

• Palmoplantar Pustulosis vs. Palmoplantar Psoriasis: Spot the Difference
  Clarifies the differences between two commonly confused conditions affecting hands and soles, with visuals and symptom comparison.

• Best Treatments for Palmoplantar Psoriasis
  Explores effective treatment options including coal tar, salicylic acid, topical steroids, and lifestyle strategies tailored for palms and soles.

• Natural Remedies & Lifestyle Tips for Palmoplantar Psoriasis
  Offers reader-tested home remedies, skincare routines, and dietary suggestions specifically for supporting skin health in hand and foot psoriasis.

• Living with Palmoplantar Psoriasis: Work, Shoes & Daily Life Tips
  Practical advice on managing symptoms in daily life—from choosing the right shoes to adapting work and home routines.

References

1. Stobaugh, A. & Strober, B. (2022). Psoriasis on Hands & Feet: Causes and Treatment Options. WebMD. Retrieved July 31, 2025, from https://www.webmd.com/skin-problems-and-treatments/psoriasis/hands-feet
   – Provides symptoms, causes, and treatment overview of palmoplantar psoriasis, including topical therapies, phototherapy, and biologics. 

2. Self Staff. (2022, February 7). Hand Psoriasis: Everything You Need to Know About the Condition. Self. Retrieved July 31, 2025, from https://www.self.com/story/hand-psoriasis
   – Describes how psoriasis can be confused with eczema, impact on daily life, triggers and treatments. 

3. Verywell Health Editorial Team. (2007, October 20). Eczema vs. Psoriasis: Understanding the Differences. Verywell Health. Retrieved July 31, 2025, from https://www.verywellhealth.com/psoriasis-vs-eczema-2788336
   – Reviews differences in causes, symptoms, diagnosis, and treatment of eczema and psoriasis. 

4. Navodaya Medical College Dermatology Team. (2022). Comparison of Dermoscopic Findings of Chronic Hand Eczema and Palmoplantar Psoriasis: A Cross-sectional Study. Journal of Clinical and Diagnostic Research, 16(10), WC01–WC06. https://www.ncbi.nlm.nih.gov/books/NBK448142/
   – Examines dermoscopic criteria and visual differentiation between hand eczema and palmoplantar psoriasis.

5. Patient.info Editorial Group. (2023). Psoriasis of Hands and Feet (including Palmoplantar Pustulosis). Patient.info. Retrieved July 31, 2025, from https://patient.info/doctor/psoriasis-of-hands-and-feet-including-palmoplantar-pustulosis
   – Covers clinical presentation, diagnosis, and treatment considerations specific to palmoplantar psoriasis.

6. Inspire Community Members (anonymous). (2025, February). Eczema vs. Psoriasis: Stories of Diagnosis, Misdiagnosis, and Treatment. Inspire. Retrieved July 31, 2025, from https://www.inspire.com/groups/invisible-disabilities-association/articles/eczema-vs-psoriasis-diagnosis-and-treatment/
   – Real-life patient accounts reflecting confusion, misdiagnosis, and the importance of correct diagnosis.