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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 was told a few years ago that I had DSAP. It wasn't too bad, I had it on my arms, but this winter I got an itchy rash on my legs and now I am covered. Three months later and It is still itchy,. The dermo said there is not much she can do. I am so depressed. Am I being ridiculous? I probably did this to myself. I am fair skinned and when I was young always tried to tan. I stopped trying at around 30ish. I am now 48 and will probably never wear shorts again. Does anyone have any words of wisdom or advice?





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I find all the advise on the different methods of treatments in the comments confusing wish there was a simple answer dread the summer having to cover up all the time I have had the condition for about 30 years my daughter also has the problem & get's very depressed with it.





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I have suffered with porokeratosis since age 19. My dad died and a few weeks later I broke out in linear lessons on my legs especially left. Biopsy concluded it was this and I'd use steroid creams and wrap my legs with Saran Wrap after applying the cream. Over the years I notice that winters make it worse but in summer the lesions are still there just not as red and raised. It has been so disheartening and when I got pregnant at age 34 I had the worse case ever : arms, legs, backside. Now I am 60 and feel so discouraged as I never have worn shorts or skirts in years. I have given up on going to a dermatologist. What creams have helped to fade it as the redness is so awful?





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My name is Alex and I am 15 years old. I have been diagnosed by Porokeratosis at the start of age 4. I've had It for 11 years now and I have had some difficult times in the summer as I can't wear any shorts so I'm stuck in leggings and trousers so my leg is away from the sun as I don't want the porokeratosis to spread and grow. As I live near a sea front it is annoying when I go down to the beach, as I see all my friends in swimming suit and I'm stuck in trousers watching them have fun swimming and I can't join them as I feel less confident with my affected leg and as I can't have that out in the sun. I would like to know if it is possible to remove it in any kind of way. I've been trying all different types of creams for is long as I can remember and none of them helped.





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Hi, Glad to find this site. I am 58 and have DSAP on my legs, arms, back, chest and face. I also have actinic keratosis lesions. It took me a while to realize that there were two separate conditions going on. I have used several cremes by prescription over the years, have had hundreds frozen as well. Nothing is great. I use tretinoin creme continuously. I apply it directly to the actinic keratosis lesions and it causes them to flame up and then go away. I mix a pea size amount with a skin creme and apply to face and arms nightly. It keeps then lesions more smooth. I also use dove gentle exfoliating soap on my arms and it does a great job of taking away the roughness without irritation. I am told it is unusual to have this on the face, but I have lesions on my nose, under my eyes and on my cheeks. These have developed in the last couple of years and fortunately they stay in remission as long as I use the tretinoin creme.





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I used Triamcinolone cream for 3 years, it did little to nothing. I use a zinc based sunscreen as I am now living in Aeizona. A week ago I visited a new Dermatologist and he prescribed Fluocinonide .05%. Within five days it has gotten 75% better!! In fact, it's almost gone. This may be the miracle that I was looking for. I am a 53-year-old female and have had this condition for four years. I am of direct European discent and my father who is extremely fair, has many skin conditions including basel and squamous cell cancer.





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Dear Anne, Where are your lesions and do they itch? Just curious. Best Regards, Ray

Hi I've had this condition for about 15 years - only present on my arms and legs and fortunately not terribly itchy, but certainly unsightly. Just wondered if anyone has had an improvement with a change in diet . I dropped dairy from my diet , and had a noticeable improvement in six weeks. Nine months on, I still have them but they continue to look a whole lot better. I'm going to trial other diet changes to see if it helps too, eg gluten, sugar . Had anyone else noticed a food link ?





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I have been gluten free, dairy free, sugar free, low histamine, soy free, grain free for a couple of years. I do not find that this has helped my DSAP at all in appearance HOWEVER, I do think the itch is much worse when I eat foods higher in histamine...I am off gluten and grains because of celiac. I have found the gold bond intense itch relieve cream to ease the itch a lot. Also I am taking Quercetin supplement once a day because it acts as a natural antihistamine. I do think this helps. I don't think the eumaid has made any improvement. I found some brown spot remover cream at walmart and am applying that with other lotions twice a ay...figure there is nothing to lose. I got a rough loofah and scrub them to smooth them some. Shaving my legs helps keep them smoother. Not much is really helping. They still ITCH every night no matter what I eat or apply. Sorry this is not encouraging to you.

Thanks Gorettia for the reply. As you say not encouraging, but great to hear from someone who has already eliminated what would be considered likely triggers if there was any diet connection. Thanks

My lower legs are horrible with DSAP, arms are pretty bad. I read the emuaid max would help. Am trying it...has been a week but for sure I don't see much improvement YET. I thought about soaking my legs in colloidal silver water. I just read a post that said zinc oxide helps. I need something to try... no creams have helped and doctors say it is hopeless. It is so ugly and it itches so bad and like all the other say, mostly at night. Wonder why the itching is worse at night? Anyone have a clue. . Is it after a warm shower or bath. I know heat gets it going. Mine itches but not for 4 or 5 hours AFTER my shower, seems like by then the "heat" is long gone from my body.





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Dear Gorettia, I take Claritan 24 hours every day, and I can tell to the hour when it is time to take again. You should try Claritan 24 hours, it really helps with the itching. If your worst itching is at night, take it an hour or two before bedtime. Best Regards, Ray

I tried Emuaid.max and although moisturising it didn't help with redness or improve the spots at all . Has anyone tried any other herbal / natural remedies ? I am holding off the freezing or trying harsh treatments at the mo but expect I will need to go down that route soon .

I am only 31 & have had this for about two years. I just had a child & noticed that it has almost doubled in amounts on my arms. I'm not sure if the increase is due to my pregnancy. Mine do not itch & are not red. I do however have tons of freckles & moles on my arms. I don't believe either parent has them & I've never been a big sun fan due to my fair skin. I am wondering if there is a certain point people have noticed they turn red? I think I'm most worried about that since mine are not really visible now but I can just feel the roughness from them.





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Hi, I first developed DSAP lesions in my early 20's. Now in my late 30's, most of mine are still rough, but not discoloured. I find that the ones which are discoloured start out as pink or red, and over time they have become more brown. I have one large sized legion on my fore arm which is brown for example. Mine don't ich either, but I do suffer from horrible dry skin which can make it worse. Lots of cream helps with the roughness a bit, but I have not found anything that completely helps. The more cream however, the less noticeable I find the spots are. My only word of caution is don't pick them or scrub to much backseat this only makes them worse and can cause them to become red.

I have tried many creams and ointments including Efudix. Most seem to make it worse (which I know is supposed to happen with many of the treatment's). I can cover up but it's the itching that drives me mad and because I'm on warfarin if the spots bleed( especially in the night) its like a scene from The Godfather! I have recently started using tar soap and it is definitely helping not just with the itching but the appearance of the spots. Because it makes my skin so soft I don't use any creams or moisturiser and that's helpful to.





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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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