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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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A friend is treating a different skin condition by going gluten-free, and he has had some success. Does anyone know if there is a correlation between gluten and skin problems, especially dsap?





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I am very interested in any dietary changes that may help, however I have gone gluten and sugar free for 3 months and have not seen any improvement. I have also seen more spots appear even while being covered from sun all winter. I wonder if any large does of vitamins would a difference. I recently tried a pro fractional laser treatment and there was no improvement. I am a 42 year old female and noticed this condition begins about 10 years ago.

Hi. I went gluten and dairy free for over a year and it made no difference to the lesions; it has continued to accelerate. In UK we are told it is cosmetic and for that reason if we want to try any lasers etc we must pay. One dermatologist quoted £10,000 to me! I walked out of that hospital in despair. I now just take care of my skin as best I can and for me, that is purely smoothing it and moisturising it.

In reply to Johnny I looked up milkweed once and there were so many but none that looked like my milkweed. I have just searched again and have found the name and pictures of it on wwwgrowyouthful.com Euphorbia peplus. This has a lot of information as to use and what happens. I have just started using it again on the other side of my face on my cheek and I noticed that the red does seem to spread out past where you apply it so be very careful near your eyes. My Dr had a patient who used it on a big sore on his face and he was surprised how good it cleared up. I use it for other things as well. I had a fingernail that was sore. The nail had a ridge up it and it was excruciatingly sore in the quick (not sure of spelling) and it formed a hard crust. Once that crust came off it was OK for a while then started again. The Dr said it was the root and the only thing he could do was remove the nail. I decided to use milkweed even though I didn't think it would work being the root but it did and although the ridge still grows up the nail I have not had that sore bit since. Don't be scared to try it.





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Thanks so much Iris

Hello im Richard from the Netherlands and i got dasp and pppd for 13 years now (im 44).people here are only talking about cure/improvement but how about psychologigal problems ???? excuus for my poor english.





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I live in North Central Texas and noticed my first spot at the age of 15. No doctor was able to diagnose me. So I found my answers on the internet at the age of 25. I am now 43 and am amazed at how rare this skin condition is. I do have Type 1 diabetes and a rare blood clot disorder. So immunity is an issue. I have tried creams, lotions, oils and scrubs to no avail. I do notice that the appearance improves when on antibiotics. I am an outdoor person. I now wear an SPF 100 and re-apply frequently. It seems to help the appearance of my lesions. Nothing else has worked for me.Was wondering if anyone has tried the heliocare sunscreen supplement that boosts your natural tolerance to the sun?





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Hi Gary, use them together or separately, it doesn't matter. It's simply a case of keeping the skin as moisturised as you can. If the lesions dry out too much then your skin will itch/





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I am from London and I have DSAP. I was back and forwards to the GPs for over three years. Different GPs told me I had psoriasis or eczma andI was given different strengths of steroid creams that didn't help at all One day we have a newly qualified GP and he referred me straight away to the dermatologist at Guys. Unfortunately they said they couldn't do anything for me. They burnt a few off the first time I went. Those particular lesions improved after about 3 months but they didnt want to try any more as they take a long time to repair themselves on legs and I could have ended up with ulcers where they burnt them. I was sent to the Camaflauge Clinic. I spent a while there try to get make up for my legs. I was given a prescription for two lots of make up (the people were very nice by the way) unfortunately the chemist had my prescription for 6 months, I got one of the colours but they couldn't gat the other colour even though I kept popping in every months to see if they were able to get the make up. I have to say the doctors at the hospital were very nice but all I can do is cover up and use a high factor sunscreen. I usually wear long skirts or jeans which is annoying in the summer. I have read hair, blue eyes and pale freckly skin

How many people here are from UK? I know that DSAP is more common in hot climates but here it's still rare. I have found the dermatologists in UK no help at all and in some cases made to feel like I was wasting their time, even though I was paying for their time! Just interested to know how UK DSAP sufferers feel about how they have been treated by the medical profession. Thanks





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my sister in law has DSAP, she lives in the uk but goes on three foreign holidays a year. She has told me her (NHS) dermatologist was very rude to her at first. But on her next visit she burned off a couple of legions for her and referred her to the camouflage dept. I went with her today, they were quite unprofessional, but she has been given camouflage make-up and open appointment for six months, so she can return after her next holiday, because her skin will be a different colour !

I was diagnosed with DSAP three years ago at the time I was told I could only go outside after dark or before sunrise. I have kept my arms and legs covered but have noticed an increase in lesions especially on my legs and back. Something else I have begun to notice is that when I do happen to go out during the day for shopping etc i suffer flu like symptoms and feel quiet lethargic afterwards....does anyone else find this? Living in Australia staying out of the sun completely can be difficult I also do not know anyone else with this condition which makes me feel isolated sometimes too.





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Hi. I was diagnosed with dsap over 12 years ago. Never told to stay out of the sun so carried on going away on holidays to hot climates, using high spf but still on the beach, around the pool etc. I'm a runner so didn't do anything to cover up when running in the sunshine. As a result my dsap has got much much worse even though for the past 4 years I havnt exposed my skin to uv rays. Living in UK it's easier to do this but still it IS limiting. No more holidays in the sun, what is the point and now use spf 50 under longs sleeves and trousers but still it gets worse. there is NO cure and in this country NO help whatsoever. My health is good so in answer to your question re lethargy, no I do not ever feel that way. Bonnie

Try this group for support. There are lots of people there from Australia/NZ/USA and other hot climates...as well as the few of us from UK!! http://groups.yahoo.com/neo/groups/DSAPskin/info

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Has anyone tried efudex?





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yes i have, I'm 46 yr old female and due to 20 yrs of horse riding with exposed arms and no sunscreen my DSAP is significant. Efudex made no impact. My brother uses Efudex to treat sunspots and it works well on them.

Used Efudex for 4 weeks as prescribed, condition flared up as expected and then reduced to slightly better than when the treatment was started. Stayed about the same for 4 years and has just flared up again. have a doctors appointment but will try the Sanctuary Salt Scrub suggestion in the mean time as I have also noticed an improvement after being in the sea.

Apparently there is little that can be done re dsap appearance. Any recommendations to relieve or eliminate the itching??





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Hi Gary. Try coconut oil and pure cocoa butter. My skin never itches since using those and I use them as often as I can, daily activities permitting.

Thank you for your feedback. I will give it a try. Do I mix the oil and butter and apply to my skin or do I apply separately? Thanks.

I have had this for about 20 years but I have so many on my arms and legs they are like sandpaper. I have used all those creams with no success. I have had some of the bigger ones done with dry ice and it seems to work. We have in New Zealand a weed by the name if milkweed which I have used. It comes up into an inflamed sore but then drys up into a scab and comes off and the skin clears up. I did a big patch on my face which looked awful but now the skin is soft and smooth. The plant has a leaf that looks like the picture on the Aldara cream. The only trouble is each stem when broken only has a very minute amout of milky substance so one needs a lot of plants.





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I am in NZ too - So the milkweed made the spot disappear completely? I have heard of milkweed being used to get rid of warts too - thanks for the advice I will try this!

Which milkweed plant so many if you know ? Thanks Johnny





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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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