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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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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

Kelly, I feel the same way! I started getting my spots in my mid-30's (I'm now 46) and it's amazing the looks I get (mostly from women) when I wear a bathing suit or shorts. Sometimes I hide it with pants/long skirts, sometimes I don't. I guess I need to grow a thicker skin in order to not care! There could be worse things in life, right?

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.

I am 68 and can remember as a child looking at my grandmother's legs with horror and thinking I hope I never get skin like that. Little did I know as a young adult woman trying to tan and loving the sun I was developing exactly the same thing. My sister also suffers with it - hers was misdiagnosed a skin lupus until recently. I wish I could be encouraging but I've tried every kind of cream a dermatologist prescribed, including one which cost $1,000 a tube. It didn't touch me. I've simply concluded I'll keep lotion on it for softness and wear long pants and sleeves. It is definitely embarrassing but when I think of all the terminal and painful conditions so many have, I feel thankful. DSAP is not dangerous. So, I'm counting my blessings and wearing long pants!





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I am a 52 year old female with the condition. My dermatologist has given me salicylic acid cream 6% to apply every day. It is just a lotion and I rarely have itching. The only issue I have is I hate the way my arms and legs look. Others tell me they just look like freckles, but I hate them. I am going to try the jergens natural glow tanning lotion that was suggested above.





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Hi, l have had DSAP for about 10 years. l have changed my diet as l discovered l am gluten intolerant and did notice an initial improvement in my skin. Unfortunately the improvement did not continue, however, my skin is no longer itchy. l have also noticed that when l am ill the condition worsens and l seem to develop more spots. On the larger rough spots l use a large flat nail file to make the skin look and feel better. l also find that the DSAP is less noticeable when l am tanned so apply Jergens Natural Glow gradual tanning lotion a few of time a week. This is the best poduct l have found so far.Hope this helps others.





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I have had dsap for 10 years it is getting really bad can anyone help me with what cream will help me reduce the redness. It looks so bad thank you.





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I am in my 70s and have had DSAP for some 30 years. At first they appeared like little round craters with thin translucent skin, mostly on my lower legs and I absent mindedly used to scratch them which caused them to bleed. Eventually I saw my GP and got a referral to hospital when a powerful (unknown) skin cancer cream was prescribed which I later decided to discard. The specialist told me that the condition resulted from solar effects and was probably attributed to the sunray treatment I had as a wartime child in north London, with poor health. Then about 12 years ago I moved away from the Midlands and saw a new GP, a dermatologist who advised me that the only effective treatment was good management which included avoiding exposure to strong sun and using an emolument (aqueous cream)which they prescribed. Trousers used to rub and cause itching so I adopted my wife's suggestion to use knee length pop socks under normal socks to cover the affected areas and this has been very successful. Over the years the 'craters' became larger, uneven red blotches and the surfaces hardened which made them less prone to bleeding. A few years ago my GP decided to prescribe another emollient cream called Zerobase and I now live with the condition quite happily without any itching - well, they don't look good so it's rather put me off exposing them such as at swimming pools, but at least for much of the time I can forget them. Oh, and my siblings have them as well as does my daughter now in her mid 40s so mine are definitely inherited.

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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My DSAP showed up all of a sudden, also; around Thanksgiving last year. However, the itchy bump that was biopsied, showed Contact Dermatitis. A Skin-Patch test was done, and I am allergic to a lot of things, that are in almost everything. As I stay away from my allergens, the itchy red spots are fewer, and come and go according to what allergens I eat or come in contact with. I still had a few crusty spots, and the circles, that itch quite often. Yesterday the Dermatologist told me those were not connected to my allergies, that they are the DSAP from my past sun exposure (I am 69), and there is no cure. Actually the Stasis Dermatitis that has been on my ankles for years, like my Father's, might actually be some of the DSAP as well, according to the photos.... just not crusty yet. Anyway, just in case that some of your bumps might be from allergies, wouldn't hurt for you to have a Patch-test done; it might end up narrowing the number of itchy spots down to a fewer number. Good luck.





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