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Conditions

Disseminated Superficial Actinic Porokeratosis

DSAP on legs

Disseminated superficial actinic porokeratosis (DSAP) is a rare inherited skin condition that causes dry, itchy lesions on the arms and legs. However, some people can develop DSAP as a result of immunity problems. It usually affects fair skinned people over the age of 35, and it is more common in women than in men. About half of the children of those with DSAP will have the condition, but accumulated sun exposure is needed to bring this tendency out.

The lesions usually begin as a small brownish-red spot which can expand to a diameter of 10mm. No sweating occurs in these lesions, but exposure to the sun can cause these to itch. DSAP usually affects the lower arms and legs, but in rare cases it can also affect the forehead and cheeks.

The best way to stop the lesions from growing is to avoid exposure to the sun. This is especially important as whilst development of skin cancer in people with DSAP is uncommon, many patients with the condition have already experienced a significant exposure to the sun so it is important to have yearly check-ups on the lesions.

Unfortunately treatment of DSAP does not usually improve the condition dramatically. Creams can offer some slight help with cryotherapy also often being prescribed. Cyrotherapy is when the lesions are removed by freezing them using liquid nitrogen, but this can sometimes lead to areas of hypo-pigmentation. Other treatments include ointments and oral medicines.. However, some people can develop DSAP as a result of immunity problems. It usually affects fair skinned people over the age of 35, and it is more common in women than in men. About half of the children of those with DSAP will have the condition, but accumulated sun exposure is needed to bring this tendency out.

The lesions usually begin as a small brownish-red spot which can expand to a diameter of 10mm. No sweating occurs in these lesions, but exposure to the sun can cause these to itch. DSAP usually affects the lower arms and legs, but in rare cases it can also affect the forehead and cheeks.

The best way to stop the lesions from growing is to avoid exposure to the sun. This is especially important as whilst development of skin cancer in people with DSAP is uncommon, many patients with the condition have already experienced a significant exposure to the sun so it is important to have yearly check-ups on the lesions.

Unfortunately treatment of DSAP does not usually improve the condition dramatically. Creams can offer some slight help with cryotherapy also often being prescribed. Cyrotherapy is when the lesions are removed by freezing them using liquid nitrogen, but this can sometimes lead to areas of hypo-pigmentation. Other treatments include ointments and oral medicines.

Comments and Questions

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I visited my psrents in Ocala FL a few weeks ago for a 3-4 day period. I must have allergic to something in their home. A fur dog or something else. After a day there, I had the worst outbreak of the rash I have ever had, along with other allergic symptoms. Swollen eyes and face. It was pretty bad. Did not make a connection until 2-3 days later. It seems some allergen in the home exacerbated the usual DSAP RASH. iT TOOK 2 WEEKS TO GET BACK TO ITS USUAL SELF. Best Regards, Ray





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I think I am in my 2-3rd year of having porokeratosis. Visited a dermatologist. I was initially treated for about 4 months with various prescription crèmes, took oatmeal baths. The baths felt great but nothing touched the lesions. The Dr. took a biopsy and it was identified as porokeratosis. I have been using triamcinolone ointment and Lubriderm cream - together they keep it under control, but no cure. I agree about the itching which is really uncomfortable and leads to open wounds from scratching, especially at night. I take claritan 24 hour daily and it help with some of the itching. I will occasionally go w/o treating it for a day or two. Sometimes it actually looks like it is going away and then BAM. It is back with a vengeance. Last winter, December - January, it seemed like it did go away, however, in early March-April, it was back. Looking forwar to some feedback etc. Best Regards, Ray G.





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Could being on steroid pills for bee sting casue bad outbreak? Mine have look so good for awhile BAM all the sudden awful !i am wondering if steroid pills I took for bee sting start this outbreak?





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Has anyone tried essiac or colloidal silver for treating these DSAP spots? I'm considering doing this. I am a 61 yr old female who stayed in the sun much too long when younger. My spots are mostly on lower legs but some on arms & upper legs too. Thanks for any responses.





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I find a good quality, professionally applied spray tan is great for concealing the appearance of the markings. It's obviously temporary, but a great idea for special occasions.





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Do those of you with DSAP have what I call "outbreaks" of the disease, after awhile subsiding but never disappearing? My "outbreaks" are when the small "craters" appear, red, itchy, and inflamed. After 3 weeks or a month the "outbreak" subsides, the itching is no more, and the lesions, while still present, are not nearly as ugly and angry looking. I find no rhyme or reason to the "outbreaks." If this is your experience with the disease, do you have a guess about what causes the "outbreaks," other than sun exposure. I am 77 and do not spend a lot of time in the son. Walt

I want to add two comments to my most recent post. First, I am very grateful for this site. I have a hunch that patients sharing their experiences may be an avenue to hope and even cure. The docs surely don't seem to know much, and, from all accounts, not much medical research is given over to the disease. Second, In my most recent "outbreak" of DSAP (I was dormant for six years), my doc prescribed Acetretin and Triamcinolone for 30 days. I honestly don't know if these were the cause of my improvement, but I have improved. BUT, I always improve after 3 or 4 weeks. Have any of the rest of you been on these two treatments and did they help you?

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I AM 61 AND HAVE BEEN DIAGNOSED WITH DSAP. I FIRST NOTICED THESE SPOTS RIGHT AFTER I HAD MY FIRST DAUGHTER AT THE AGE OF 34. I WONDERED IF I HAD PICKED UP SOME FUNGAL INFECTION FROM THE HOSPITAL SHOWER. NOPE, THAT WOULD HAVE BEEN CURABLE. I STRUGGLE WITH THE ITCHINESS AND IF FACT SCRATCH THEM UNTIL THEY ARE SORES, WHICH EVEN MAKES IT WORSE. I WISH THERE WAS SOMETHING I COULD DO. I HAVE STARTED PUTTING SUNSCREEN ON EVERY MORNING. I FOUND A SPRAY THAT IS EASY TO JUST SPRAY AFTER I TOWEL DRY AFTER MY SHOWER. IT SEEMS TO BE HELPING ALITTLE BIT. AND OF COURSE I TRY TO EXFOLIATE AND MOISTURIZE. IT IS UNGLY AND I CAN IDENTIFY WITH PEOPLE ASKING ABOUT IT AND IT BEING EMBARRASSING. I GUESS IT IS BETTER THAN BEING RUDE OR STUPID, THOSE THINGS ARE RARELY CURABLE EITHER.





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Hi, I am a 53 yr old female. I've has this now for about his10 yrs :(. I found using water babies screen helps the best for me. It contains the highest amount of zinc oxide that I've found yet. The zinc oxide seems to really clear them up. I use the Cetaphil cleansing & Cetaphil moisterizer also. This treatment works well for me. I also use the zinc oxide cream called Baza moisture barrier cream. It contains 12% zinc oxide .I really think I'm on to something with the zinc oxide. It really does help:) Best of luck!

Hi Pat I've been newly diagnosed and its horrible,itchy and my doctor has no information on it. But I will try the zinc oxide. Many thanks for helpful post.

I have used DermaBlend as a coverup. It's waterproof and doesn't rub off easily. Make sure you try it at the makeup counter and see if the color matches your skin. Mine doesn't match by a long shot but it is something to try.





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I really want to try the Derma Blend. As for last week I started to develop them on my nose & face. My worse nightmare:(

Hi Getting straight to the point of this awful skin problem. I am now 57,started noticing DSAP at about 42. It is horrible,have inherited this from my Father. Have been dealing with it by Keeping out of the sun and always using SPF(I live in Australia ,in a very warm climate)I exfoliate with a rough pumice/foot paddle and use the ENVIRON HYDRATING LOTION( AHA)every day. This helps exfoliate the dry skin and hydrate at the same time . ENVIRON is a South African cosmoceautical(google the company to locate stockists) Also cover it up with a make up used by cosmetic skin Drs its called LYCOGEL (AGAIN GOOGLE IT ,AN AMAZING PRODUCT)nOTHING CURES THIS SKIN PROBLEM ,ITS ALL ABOUT MANAGEMENT!!!Keeping the skin cool and calm .Have not tried the bleach ,but will give it a go /chlorine.Im a retired nurse and have worked in the skin industry . Skin is the MOST difficult thing to deal with!!One mans meat can be another mans poison !!So not all things work for everybody.But being a nurse ,Im quite happy to experiment with wotever might help. Hope I have given some ideas ,we ae all struggling!!!





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It is inherited, it's hard to tell people that it's " not your fault". I just cover up alot, it's easier than talking about it. My daughters have it, also one of my sisters and multiple cousins. I think that my Paternal Grandmother also had it ( German). I am dark and have olive skin ( my father is half American Indian). I have had good luck with Dovonox ( expensive) and Retin A ( mixed together) I have recently tried hot tubs ( loaded with bleach) and the lesions have really improved.





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I also have DSAP which I inherited from my mother. Dry itchy sores, almost lesions. Started using coconut oil as a moisturiser when my mother's aged care nurse recommended it for solar keratosis(the common sun spots). My old active angry spots of 10 years plus are actually HEALING. Alo new ones which come up in a lump, heal very quickly without scarring. Exfoliation in combination with coconut oil application is needed to get the hard crusty, scabby layers removed so the sore can heal from the inside. I ran out of coconut oil and didn't use it for about one week and the itchiness came back even though I was using other bath oils as often. Rub in after a show when your skin is wet. Dab skin dry with a towel. I must mention that I have a very mild case of DSAP. The coconut oil makes the spots a bit redder at first. I thought initially, that this may have been an allergic reaction or irritation but now I see it as part of the healing process. I wish you all luck with your treatments.





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