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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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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

I am 48' same, same...tried every expensive fractional laser, blue light, and medicated cream. After some success with cryotherapy but overwhelmed I visited my brilliant dermotoligist for sudden enflamed rosacea with pustules on my face. He prescribed doxycycline to calm the rosacea, which it did. Good results on the face after 1-2 months but as I continue to take the doxycycline once a day my husband and I can not believe the change in my DSAP. I'm now 6 months into it, redness of spots on my legs and arms has almost completely disappeared. The dryness of the spots and the overall feel on my forearms has noticeably improved. I have not yet exposed anything to sun but am so happy with where I am with this. Nothing to loose, no side effects.





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Lynda, I am very excited to read about your results. I plan to see if my dermatologist will prescribe doxycycline for me. Everything I have tried has made my DSAP worse or has had no effect. I have too many spots for cryotherapy to have much effect and I find cryotherapy very painful. I have always thought this is a condition that needs to be fought on the inside and the outside! Has anyone tried medical grade honey??? I know it is used for wound care - promotes healing. Just curious.

Hmmm I am also very interested in your results using the antibiotic doxycycline. Are you still seeing positive results? Do you pair this treatment with any moisturizers???

I was diagnosed with DSAP 3 years ago (29 yrs old) and the dermatologist made me promise him I wouldn't do anything (like seeing another doc for biopsy etc) and just to sun smart with 100 SPF and covering up as he said that there was no treatment. I went back to him a year later for a check up and he said still nothing I can do about it although I had a few more spots. I decided to see another dermatologist just last week and he also said it looked like DSAP but thought it was very unusual to be seen in someone my age and of my background (South American with olive skin) he did end up taking a biopsy and blood test to check my immune system is ok. The worst place I have my spots is on my chest and upper arms, which after reading a lot of comments doesn't seem to be the common place where spots are for women?? Anyone else have spots on their chest?





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hi nicolle...I also have dsap and have also got spot showing up on my chest and also on my cheeks, I also have been told that there is no cure or treatment that works!!!





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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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