DEAR DR. GOTT: I am a healthy 52-year-old female who has suffered from DSAP (disseminated superficial actinic porokeratosis) most of my adult life. I have hundreds of bright red spots on each arm and leg. Many people steer clear of me, thinking it’s some type of contagious disease, and many will say, “Oh, you’ve been in poison oak,” or something similar. I have to wear long pants in the summer, even at the beach.
There appears to be very little information about DSAP, and my dermatologist says that my case is one of the worst she’s ever seen. No treatment seems to help. I’ve used Retin-A, Efudex, and every other prescription cream and ointment that my dermatologist knows of. We even tried freezing them with liquid nitrogen. I have actually had as many as 25 done on each arm and leg at one office visit, but they inevitably come back. My spots are generally bright red and itch, and seem to be inflamed after exercise. Any type of lotion makes them even redder.
I am very cautious when going outside, use a sunscreen religiously, and visit my dermatologist every three months to check on the spots. Is there anything you can suggest? Perhaps others may have some home remedies that have been successful.
DEAR READER: Unfortunately, there is little I can tell you that you don’t already know.
Disseminated superficial actinic porokeratosis (DSAP) is an uncommon skin condition that is caused by abnormal sun sensitivity. This leads to pre-cancerous skin cells developing wherever sun damage has occurred. It primarily appears on the arms and legs, as these are the most sun-exposed areas of the body. It is most often diagnosed in fair-skinned individuals, middle-aged and older.
The lesions develop only after the damage has occurred and appear as reddish-brown, scaly spots. Once formed, the spots then spread and form a ring or circle. Following sun exposure, the affected areas may itch or appear to grow.
While it is uncommon for these pre-cancerous lesions to develop into true skin cancer, it is important to have regular exams by a dermatologist. Any lesion that becomes red, crusty or scaly needs a prompt exam and possible biopsy to determine if the change is due to cancer.
There is little in the way of treatment, no long-lasting results and no cure. Current recommendations are that sufferers avoid further sun damage by wearing long sleeves and pants and using high SPF sunscreen. The prescriptions Retin-A, Tazorac, Efudex and Aldara may offer some help, albeit slight and typically short-lived.
Cryosurgery (freezing) may be an option, but it can cause hypopigmentation (loss of skin color). It is usually reserved for the largest lesions. Photodynamic therapy — a photosensitizing drug applied to the skin, followed by exposure to a certain type of light — creates activated oxygen molecules that destroy nearby cells; however, it has been used with mixed results.
DSAP isn’t contagious. In fact, most cases are inherited, while others appear to be caused by an immune system that isn’t working as well as normal.
I am not aware of any home remedies. You appear to have run the gamut of available treatments. My recommendation is to stick with your current regimen and follow your dermatologist’s advice.
Readers who are interested in learning more about skin disorders can order my Health Report “Dermatitis, Eczema and Psoriasis” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order for each report to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title(s), or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.