Although in some cases the rash comes first, as in the little tyke below, for many eczema sufferers, myself included, the itch precedes the rash. (A mild case like this child has can often be treated by keeping the skin hydrated, using a hypoallergenic moisturizer. If needed, OTC hydrocortisone can be added, either 0.05 or 0.1% on a once or twice daily basis.)
Back to the itch. As soon as the itchy skin is rubbed or scratched, the eczematous rash appears. Scratching will ALWAYS make it worse. I know from personal experience. A few little bumps can turn into cropful within minutes. The appearance differs, depending on the location. On the hands, it often appears on the edges of the fingers. Although this is not truly an allergic rash, many things can irritate it - grass or weed exposure, pets, chemicals, soap, sweating, breathing. Avoiding known triggers is vital. Taking a shower after exposure to an irritant can negate the need for medicine at times.
This poor guy has scratched his arm raw. Notice how the rash is in the form of linear abrasions. Sometimes poison ivy appears similar, but with poison ivy the streaks are from being scratched by a twig or stick.
If I washed dishes in harsh detergent, my arms would look like this person’s (below). She has signs of lichenification, or thickening and cracking of the skin that resembles a lichen, which occurs with prolonged atopic dermatitis (eczema).
Many times eczema starts as a little bump. When the bump is scratched, the top comes off easily, moreso than on normal skin. Some patients find doing something that hurts (applying very hot water or alcohol) relieves the itch for awhile – the pain is more tolerable than the itch. However, both these treatments can dry the skin further, counterproductive in the long run.
Dyshidrotic eczema is horribly itchy and occurs on the hands, usually the fingers. It will require a strong prescription steroid, avoidance of any possible triggers, and antibiotics if it becomes infected. Hydrating the hands can sometimes prevent the rash from taking hold, but a non-irritating cream is essential.
Save money by trying these tips. You may still need a prescription from your doctor, but ask for one on your formulary or the $4 list. Be diligent in using the creams. They work best at the first sign of an outbreak. Take an antihistamine if it helps keep you from scratching. And if all else fails, don’t scratch with your fingernails – I find a hair brush causes less tearing of the skin (but don’t tell your dermatologist I said so.)