What are the other Names for this Condition? (Also known as/Synonyms)

• DSAP (Disseminated Superficial Actinic Porokeratosis)

What is Disseminated Superficial Actinic Porokeratosis? (Definition/Background Information)

• Disseminated Superficial Actinic Porokeratosis (DSAP) is the most common subtype of porokeratosis, an uncommon skin condition that results in the manifestation of small patches of lesions of varying sizes on skin
• Disseminated Superficial Actinic Porokeratosis is generally seen during young to middle adulthood. The specific predisposing factors for the condition include light therapy and exposure to sun
• The cause of development of Disseminated Superficial Actinic Porokeratosis is not identified yet. It may be due to certain genetic mutations that are yet to be well-characterized
• The condition is seen as numerous brownish-red lesions that appear in various parts of the body. A diagnosis of Disseminated Superficial Actinic Porokeratosis is made by studying the presenting symptoms and skin biopsy (microscopic examination of the skin lesions)
• Following its diagnosis, the condition may be treated using topical creams and gels, oral medications, and laser therapy. In general, the prognosis of Disseminated Superficial Actinic Porokeratosis is good with appropriate treatment, since it is mostly benign

Who gets Disseminated Superficial Actinic Porokeratosis? (Age and Sex Distribution)

• Most cases of Disseminated Superficial Actinic Porokeratosis are observed in adults in the 30-40 years’ age range
• Both males and females may be affected, although a female predominance is noted (female-male ratio is 2:1)
• Individuals of all racial and ethnic background can be affected

What are the Risk Factors for Disseminated Superficial Actinic Porokeratosis? (Predisposing Factors)

The specific risk factors for Disseminated Superficial Actinic Porokeratosis include:

• Phototherapy or light therapy
• Radiation therapy
• Sun exposure: It is an important trigger factor in over 50% of the cases

However, the risk factors for porokeratosis, in general, may include:

• Individuals with light skin are more prone to porokeratosis than dark-skinned individuals
• Some subtypes of porokeratosis are known to run in families, which may indicate a genetic linkage
• Exposure to ultraviolet radiation
• Weakened immune system
• Chemotherapy
• Skin trauma
• Skin infections; hepatitis C infection
• Skin burns
• Chronic liver failure
• Presence of certain autoimmune disorders such as rheumatoid arthritis (RA) and psoriasis
• Poorly-controlled diabetes
• Long-term systemic and topical steroid therapy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Disseminated Superficial Actinic Porokeratosis? (Etiology)

The exact cause of development of Disseminated Superficial Actinic Porokeratosis (DSAP) is unknown.

• In general, porokeratosis may be due to certain genetic factors. Presently, the specific genes causing the skin condition are under study
• It is important to note that DSAP is non-contagious and it cannot be transmitted from one individual to another

What are the Signs and Symptoms of Disseminated Superficial Actinic Porokeratosis?

The signs and symptoms of Disseminated Superficial Actinic Porokeratosis (DSAP) include:

• Numerous skin lesions that occur in any part of the body
• The lesions are usually pink to brownish-red in color
• DSAP may be itchy, leading to bleeding from scratching
• Large areas of the body skin may be involved
• The lesions are generally observed on skin areas exposed to sun. It typically gets worse in summer, and better in winter
• The skin patches may have a scaly appearance

How is Disseminated Superficial Actinic Porokeratosis Diagnosed?

A diagnosis of Disseminated Superficial Actinic Porokeratosis may involve the following:

• A thorough medical history assessment and complete physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood test to diagnose underlying autoimmune disorders, if any
• Culture studies to rule out any infection
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. On examination of the specimen, certain characteristic features may be noted

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Disseminated Superficial Actinic Porokeratosis?

In many cases, Disseminated Superficial Actinic Porokeratosis is a benign condition, and it does not cause any significant complications. However, the following factors may be a cause for concern in some individuals:

• The presence of large areas of skin affected with multiple lesions may result in cosmetic issues (especially when it involves the face or exposed skin areas)
• This may result in emotional stress
• Bleeding from scratching may result in secondary bacterial and fungal infections
• In some individuals, more than one subtype of porokeratosis is observed
• Very rarely, skin cancers are known to develop at the lesion sites

How is Disseminated Superficial Actinic Porokeratosis Treated?

There is currently no definitive cure for Disseminated Superficial Actinic Porokeratosis (DSAP). However, the condition may require no treatment if the symptoms are mild. In such cases, regular observation/monitor by the healthcare provider may be sufficient treatment. However, in case they are at a body site that causes discomfort and/or present significant cosmetic worries in the individual, they may be treated accordingly.

The treatment adopted for Disseminated Superficial Actinic Porokeratosis may include the use of the following measures:

• Topical 5-fluorouracil medication therapy
• Oral isotretinoin
• Cryotherapy
• Dermabrasion
• Laser therapy
• Photodynamic treatments
• If the cause of DSAP is an underlying autoimmune disorder, then treatment for the same is necessary
• If superimposed infections are observed, then antibacterial or antifungal medications may be prescribed
• In general, DSAP is very treatment resistant

Follow-up care with regular screening and check-ups are important and encouraged.

Note: Any medications containing isotretinoin, which is a known teratogenic agent (having the potential to cause fetal defects), should be avoided during pregnancy.

How can Disseminated Superficial Actinic Porokeratosis be Prevented?

Currently, there are no known methods to prevent the occurrence of Disseminated Superficial Actinic Porokeratosis (DSAP). However, protecting oneself from the harmful ultraviolet rays of sun through the following measures (below) may avoid aggravation of the condition, especially in the case of DSAP.

• Use of sunscreens with high sun-protection factor, wide brimmed hats, and protective clothing
• Being aware of the hazards of prolonged sun exposure and take steps to protect yourself
• Individuals, who are regularly exposed to the sun, or work directly under the sun, should get their skin periodically examined by a physician
• Avoid excessive sunbathing

What is the Prognosis of Disseminated Superficial Actinic Porokeratosis? (Outcomes/Resolutions)

• The prognosis for Disseminated Superficial Actinic Porokeratosis (DSAP) is usually good, in a majority of cases, since it is a benign condition that may only present some cosmetic issues. However, in many individuals, even if treatment is provided, it may not get better
• DSAP, in some cases, may be associated with malignancy; and hence, close clinical monitoring is necessary

Additional and Relevant Useful Information for Disseminated Superficial Actinic Porokeratosis:

• Do not pick or pop the blisters, for doing so can affect the healing process and may result in secondary infections
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse