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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 have had this condition for many years. I am now 71. I keep looking for a successful treatment. Right now I am using a 12% alpha hydroxy cream that is supposed to be successful with keratosis pilaris. I have no idea if it will work. Right now it seems to be aggravating the condition, but maybe it has to get worse before better?? I try to cover up in the sun, especially my face and arms. I do wear capris while golfing, but use heavy duty spf sunscreen on legs, arms, and use golf sleeves also. I've tried golfing in long pants, but the heat in Sacramento is miserable in the summer, so I do the capris. I think I am doomed to live with this condition and may as well toss the shorts.....





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I have had DSAP since I was about 40. I'm now 64. My Doctor told me right away what it was. I also loved the sun but I haven't been in the sun since I found out what it was. My doctor said there is no cure yet. I just wear pants, and long sleeve shirts, and sunscreen. My spots don't get red because I always cover up and wear sunscreen. I'm going to try Natural Glow sun tanner and the Sally Hansen leg makeup. Thanks for the tip about the leg makeup. I am also grateful that DSAP is mostly harmless. I do hope they find a cure soon because it does alter your life and causes embarrassment! Unfortunately, it will take someone famous to have this disorder to bring awareness and funding for a cure.





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I have a few entries on this website. I sought out another Dermotologist. Two biopsies from my arm indicated some sort of eczema condition. I had a previous biopsy from my front side of my thigh that came back as DSAP. The second DERMA also thought that the rashes looked like an allergic reaction to something. His wife just happened to be an allergist. So I went thru a battery of patch tests and blood tests etc. They came back negative for food allergies. However, some tests came back positive for 6 chemical and dyes frequently found in clothing treatment for 'easy care' and 'wrinkle free'. A formaldehyde resin. Also positive for diasperse orange 3 dye. Two other substances regularly found in tooth paste, detergents, soap, topical lotions (propylene glycol). I have started TO AVOID THESE SUBSTANCES AND it is remarkable how many of my lesions are clearing up. Check out a site 'MYPATCHLINK'. there ARE MANY VIDEOS showing pictures of lesions etc and explanations for allergic conditions. Maybe you are allergic to something???





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I have this condition and also DO NOT wear shorts or skirts as it is worse there that on my arms. I wear hose in the winter but it is so hot in the summer. I have found that wearing Sally Hanson leg makeup helps hide the condition a bit. I do make sure my legs have a moisturizing lotion before I apply the makeup and I apply more moisturizer during the day too to keep the spots from drying out. The makeup is less than $10.00 so you may want to give it a try.





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I'm paranoid to wear short sleeves, shorts, and even a dress lately. I live in NC and it is extremely hot and humid during to summer. I have just recently ordered something called Solar-x, it is all naural. I read where one man has had some success with it along with taking Vitamin A and Flaxseed or Flaxseed oil. I'm going to give it a try, it can't hurt.





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Please, please ask a pharmaceutical company to work on a cure. I feel like a leper. I will worship your company like I used to worship the sun. :(





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Kelly, I know the feeling. What treatments have you tried? Look forward to hearing from you, Debbie

i have had a lesion biopsied by my dermatologist. The microscopic description is Disseminated superficial actinic porkeratosis. This is my first experience at age 76. The only lesion first appeared this past winter ,was itchy and was resistant to topical steroids. Unlike DSAP's described in other comments, this lesion appeared in a location where "sun exposure was not a problem". The area seems to have calmed down, is not itchy, but still slightly present. Am wondering if the biopsy was accurate?





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ok





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I've had porokeratosis on my arms and lower legs for the last 10 years, I am very self conscious of it and dread the summer. I have had numerous treatments, I started treatment with a low dose steroid cream, then progressed on to a high dose steroid cream, the next treatment was cryotherapy, then the treatment that I was told had always worked - PDT (photodynamic therapy), after the 2nd treatment of this on the same area, I was devastated to be told it had made no difference at all, and told that was it - all options had been tried, there was no other treatment option available. As I had the PDT treatment 5 years ago, I wrote to the Dermatology Unit to see if there was any new treatment for this condition - they didn't respond to me, so I went to see my Dr (last year)to ask him to write - he did get an answer - NO new treatments for this condition. I am 49, fair skinned, I've never been a real sun worshiper, I suppose as a kid in the 70's I was outside all the time, I don't recall my mum using suncream, I know that I had sunstroke when I was in my late teens. When the summer comes I usually wear long skirts & cover up as much as possible. By now I am used to the comment "oh my god what's happened to your legs" etc - I hate the look of them. I'm very fortunate that I did go to the Red Cross who showed me how to cover marks with make-up, it's a real faf, but if I'm going to something special it is worth it - but I couldn't do it every day. Although I'm still very conscious of the marks, over time I now think that at least I can cover it up most of the time with clothing, I could have it on my face or neck. I also have the rest of my health for which I am grateful, when you look at others and what they have to cope with, red scaly spots, whilst not nice are not really the end of the world.





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I can empathise with everything you mention. I am now 48 and was diagnosed with DSAP 11 years ago. My father also had the condition but he never bothered to get a diagnosis. Thankfully I have no discomfort, but the lesions are unsightly and I find I find the condition embarrassing. To make matters worse I work in a short sleeve tunic with the public all day and often have to explain the marks on my arms. I am very self conscious. I have however found having a spray tan useful for holidays etc as the marks look more like large freckles and appear less red. The whole thing makes me thoroughly miserable. Although, as you quite rightly said, many people have far worse conditions to live with. I have never met anybody else (apart from dad) with DSAP

I find that self tanners make my spots darker, but Sally Henson has a leg makeup that covers very well and is easy to apply. It stays on and doesn't rub off, but you will want to have a shower before bed. It's a good idea to exfoliate first. I make up my own sugar scrub with baby oil and add almond extract because I like the smell. I'm 47, and wish I hadn't spent time in the tanning beds forcing my fair skin to tan. I' m just glad I at least covered my face. Thankfully my husband says my spots just look like freckles to him.





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Hi Amy, do you find that exfoliating makes the lesions worse? I am worried about doing that because I don't want to get sore.





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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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