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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.

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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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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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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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I am surprised that more of you are not talking about the vicious itching that accompanies this hideous problem. My itching occurs mostly, but not exclusively, at night, deprives me of sleep, and is HORRIBLE. Any suggestions? I first noticed this disease when I was 48. Am now 77. Got no help for years. Six years ago I changed docs and I was put on 10mg of doxepin each night. Within three days I was cleared of a terrible outbreak, and I have not had trouble since until a few days ago when I developed a case of acute dermatitis. Doc put me on prednisone and after a few days I broke out with my first case of dsap in six years. The doxepin does not seem to be helping as it as for the last six years. But I am still taking the doxepin, 10 mg three times during the day and 20 mg before bed. At 77, the aesthetics of this problem does not bother me; it is the itching at night that drives me crazy. I am aware, of course, that the doxepin does not "cure" the dsap, but it alleviated the infamous itching that goes along with mine. I had lots of sun exposure growing up. As far as I know neither of my parents had this stuff.





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Walt, its the itchiness that gets me too. I have it on my arms and legs. I'm male and 66 and have had it since I was about 47 but only recently have my doctors given me a name for it. Different ones have thought it ordinary keratosis or basel skin cancer and have frosen off some. Curiously a recent series of an antibiotic for another complaint had the affect on the skin of itchness and all the dried keratosis dropping off and the red blotches lighting up like car tail lights. My doctor has me back using a cortidol cream containing betametasone valerate and a bit of chloroceresol. It sometimes settles the itch. The best thing I've used is a mosturiser which has neem oil in it as well as some aloe vera. I've also used straight neem oil mixed with sweet almond oil 10% neeem 90% sweet almond. Neem oil is a traditional product from the Neem tree in India. I'm in one of the neo-European countries (Australia) 3 parts English one part Irish. 3 of my 7 siblings have it. We grew up in the tropics though I haven't lived there for 50 years. We think we got it through our Irish grandfather.

I am 59. I started noticing the spots on my arms about 4 years ago.I moisturized. They seemed to be getting redder and deeper this year. Also, three family members commented " What's that on your arms?" " Are you sick?'. My doctor prescribed Betaderm, it has taken the redness away. Now they look like brown liver spots. Makeup does not cover them. For years I have stayed out of direct sun as much as possible. My family can't believe it is from the sun. They are out all day and love deep dark tans. In comparison, I do look sick!





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How often do you apply the bleach? Every day? How often is this necessary? Also, I wondered what type exfoliator you use and how often. Also, have you found any type of makeup/concealer that can be used that doesn't make the spots more noticeable, that looks natural? Thanks for any help you may offer!!





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I am 42 and was recently diagnosed with DSAP. It runs in my family. I am fair skinned and have light eyes. I have noticed that the sun makes DSAP worse and chlorinated pool water makes it better. I also have a severe vitamin D deficiency in which I have to get a prescription for. Would be interested in knowing if anyone has tried bee venom therapy?





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How often do you apply the bleach? Every day? How often is this necessary? Also, I wondered what type exfoliator you use and how often. Also, have you found any type of makeup/concealer that can be used that doesn't make the spots more noticeable, that looks natural? Thanks for any help you may offer!!





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It looks like no one else has asked this question, so please fill in the rest of your details below.





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