Thank you for the photographs. These bumps are not typical of any one condition and a few possibilities would need to be considered. The possibilities I would keep are a hypersensitivity reaction to arthropod bites (HSAB), Endogenous Eczema (EE), Airborne Contact Dermatitis (ABCD), Pruritis secondary to an internal problem and Prurigo Simplex (PS). A skin biopsy along with allergy testing needs to be done to help differentiate these.
HSAB is a condition where a bite on any part of the body leads to a generalised allergic response and itching, scratching produces the bumps which can last weeks.
EE consists of conditions such as Follicular Eczema which are basically itchy skin conditions that occur without a cause.
ABCD is an allergic reaction of the skin to an airborne allergen - often parts of flowering plants but sometimes things like saw dust and cement particles from construction sites.
Pruritis is skin itching that is caused due to an internal disturbance. This requires blood work to assess. A complete hemogram (blood count) with peripheral smear, lymph node examination, thyroid profile, liver and kidney function tests form part of the basic workup. More detailed tests require a chest X ray, abdominal ultrasound, dental checkup, serum IgE levels, ANA, HBsAg, Anti-HCV, urine and stool examination and an allergy screen (contact/inhaled/ingested).
Prurigo is a condition caused by overactivity of the itch nerves. This causes unbearable episodic itching and the rash is secondary to scratching.
For immediate relief I think he needs a course of oral steroids. I would start with Prednisolone 60 mg once a day for at least 7 days tapered by 10-20 mg every week over the next 3-4 weeks and then stopped. Along with this I would start a patient like him on a steroid lotion or cream twice a day, e.g Betamethasone Dipropionate. Both of these should be discussed with a doctor in person since they require a prescription.
Till you can do here is an over the counter regimen that can help:
1. Jergens Naturals Ultra Hydrating Daily Moisturizer applied three to four times a day. Mix 1% Cortizone cream with the morning and night time application of the moisturizer.
2. Tab Claritin 10 mg twice a day.
3. Avoid soaps - use a soap free moisturizer like Nivea Soap free body wash instead.
NOTE: All of the above are available without a prescription.
Please feel free to ask if you have any queries. I will be happy to continue further and do everything I can to provide you with the service you seek.