deeply pruritic "rash"

Sometime several months ago, a patch of skin on my lower shin became deeply pruritic (for no apparent reason I think, other than the fact it was dry maybe, but no different than the skin on the rest of my body).  I started to scratch at it and the more I did, the worse it got- the area eventually became hyperpigmented.  Looking in the mirror it is this large patch/block of hyperpigmented/scarred/purplish reddish skin.  Problem is, it randomly gets itchy and so I am forced to scratch at it more, and when the scratching starts it is very VERY hard to stop- I'm sure this is part of the reason it scarred/hyperpigmented.  I'm a med student and I've learned that eczema is the "itch that rashes"- which sounds like what this could be, considering the itching started first, and then rash looking thing followed....but at the same time there's no scaliness nor is this my elbows, knees etc.  I've put hydrocortisone a few times but haven't been religious about it.  I think the biggest problem is the pruritus, because were it not for that I wouldn't feel the need to scratch at it and cause it to become hyperpigmented.  Do you think a antihistamine would be better so I don't scratch it as much?  What does this condition sound like?  Also, do you think the hyperpigmentation will go away with time?  I've added a picture to better depict what I have.
Thanks for your help.

[Bhupinder Kaur, MD]

Hello,

From the symptoms that you have described,it looks like eczema. It is a form of chronic dermatitis (rash).Allergic reaction is one of the important causes of eczema.Darkening of the skin has occurred  due to scratching leading to lichenification.Wash the areas several times with fresh water. Do not use any cosmetic products at the sites. You can apply some calamine lotion at the rash as it will help in soothing the skin. You can take some OTC oral antihistamine medications like Benadryl or Claritin and see if it helps.

For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone as dermacort), whilst more severe cases require a higher-potency steroid (e.g. clobetasol propionate, fluocinonide).

Eczema can be exacerbated by dryness of the skin. Use good quality moisturizers to prevent moisture loss from the skin.

If still the symptoms do not improve then pls get a clinical examination done by a dermatologist.Other possibilities like ringworm,psoriasis and pityriasis rosea have to be ruled out.

Hope it helps. Take care and pls do keep me posted on how you are doing or if you have any additional queries.Kind regards.