Continued DSAP Discussion.....

My treatment:

Liquid nitrogen: (AKA Cryosurgery) I tried a light freezing with liquid nitrogen on a test spot. This resulted in a somewhat worsening of the redness. Texture wise I can't say for sure if the DSAP has slightly improved or not. It's been about 9 months since the freezing. With fair skin this hyper pigmentation is a big concern for me. But my doctor also mentioned that Retin-A may help with hyper pigmentation problems. However he said you don't see any results until perhaps 6 months later or longer. 

Retin-A Micro: This version is more powerful than regular Retin-A. I tried using Retin-A Micro recently. After about 4 weeks (of using it once per day) some of the DSAP spots seemed to begin to erupt into a scabs. I had to stop. My doctor said to use Retin-A Micro AS TOLERATED, which will mean using it less frequently. NOTE: I have to wonder if using Retin-A to the point of scabbing might induce some remission (as one would hope for from use of Efudex). ? CONCLUSION: I don't recommend using Retin-A for DSAP.

Fluorouracil (AKA Flouroplex, Efudex): Recently my doctor recommended Flouroplex Cream(Fluorouracil 1%) rather than Efudex (Fluorouracil 5%).  The 1% takes longer (approx. 6 weeks) but is supposed to be less likely to scar. If my skin wasn't so light (and prone to hyper pigmentation) I'm sure he would have put me on the 5% instead. Reading on Internet message boards I've unfortunately heard of 2 Doctors speaking of patients not having much luck with Fluorouracil for DSAP. However my doctor mentioned one patient of his who didn't have much luck with the 1st treatment BUT DID had some good results after a 2nd treatment. OVERVIEW: Keep in mind that Fluorouracil was originally designed to attack cancer cells, which happen to mutate much FASTER than DSAP. DSAP cells do not mutate as fast as say solar keratosis cells. Thus do NOT expect to get the same reaction from treatment. In fact many dermatologists are ignorant of this fact. The truth is that there is no SET reaction to flouruoracil. It was never specifically designed for treatment of DSAP. UPDATE: My flouruoracil 1% treatment is done. After 6 weeks I can say that the "threadlike boarders" and hardened pores of some DSAP spots have been sort of "filed down" by this treatment. My skin feels smother. BUT I wonder if in a few months DSAP "threadlike borders" and hardened pores will grow back to the previous state. I definitely did NOT see any of reaction that is typical of the reaction that patients with solar keratosis get. DSAP cells don't grow as fast. Flouruoracil was designed to be sucked up by FAST growing pre-cancerous cells like solar keratosis ...NOT for DSAP. During treatment the DSAP spots became redder. DSAP spots that previously had NO hyper pigmentation became pink after 1 week of treatment. It stayed like this for 5 weeks. For the last week of treatment the reddening almost seemed to subside a little bit. I probably should have done the F-5% instead. I think that my DSAP was aggravated by the whole treatment and hyper pigmentation is worse! Some spots that previously had no hyper pigmentation are NOW visible after treatment. It seems that hyper pigmentation gets worse from not just the sun but from scratching and medical treatments. CONCLUSION: I don't recommend using Flourouracil, Flouroplex or Efudex for DSAP.

DesOwen Cream: For post-flouruoracil treatment I am taking DesOwen Cream (generic: Desonide Solution) to supposedly speed up healing. DesOwen is a form of steroid. About 5 hours after careful application (to DSAP spots only) my skin looks cured. No more hyper pigmentation. This DesOwen seems to inhibit blood circulation thus causing redness to go away. Too bad it's only temporary. I have noticed that this DesOwen stuff does have diminishing effectiveness. Each time I use DesOwen is has less effect and takes longer to kick in. About 1 1/2 days after application (when it wears off) there seems to be a "reflex action" whereby spots get redder than normal. By the 3rd or 4th time I use DesOwen (every other day) it doesn't seem to really be WORTH using anymore. But I nevertheless hold on to this Desnowen stuff to use when I REALLY need to wear short sleeves (at night or INDOORS of course!). I have found that it works for me to use DesOwen every other week during hot months. I apply it about 15 hours before I need to wear short sheeves, then again about 7 hours and 4 hours before. The result is that I look totally normal for a night - and sometimes 2 nights! My doctor says that DesOwen is pretty harmless to use! It can even be used while using other medications like Retin-A and Tazorac!

UPDATE: A DSAP patient has informed me that her doctor has her taking DesOwen cream as a way of "getting through the summer". I guess this is for cosmetic purposes.

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DSAP patients might try using vitamin E for relief from the dryness of DSAP. This may help ease any itching that you may have as well.  10,000 I.U. or 20,000 I.U. vitamin E works best. But Apricot Kernel Oil does essentially the same thing for much cheaper. I love this stuff...

Forget all of those high priced moisturizers that contain traces of solvents. For $5.63 you get 16 ounces of Apricot Kernel oil that will last you about a year! Plus there's no detectable solvents in this stuff. Very mild!

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The Skin Cancer Foundation does acknowledge that sunscreen alone is not
enough: Sunscreen may actually contribute to skin cancer. It prolongs people's
time in the sun by preventing the only natural melanoma warning system
human skin has—sunburn.

One thing for sure is AVOID THE SUN! I mean COMPLETELY avoid the sun whenever possible. Even if you're in the shade or driving in your car the reflective sunlight can really make DSAP look worse. Ideally you should wear sun screen AND a long sleeve shirt, or throw a towel over your sun exposed arm. I've read that wearing a long sleeve shirt is only considered to be about the equivalent of wearing SPF - 30 sunscreen or something like that. I suggest wearing SPF-65 AND a long-sleeve shirts if you go outside on sunny days. Keep in mind that 15% of DSAP patients have it on the FACE. Why chance it if you have DSAP on legs and /or arms? Wear SPF-75 sun screen on your face too! ALSO: you are being exposed to ultra-violet rays from just reflective sunlight beaming into your living room! I've read that many women actually can show signs of aging from years of merely being exposed to REFLECTIVE sun light in their living rooms! So draw the shades when you're indoors too. If all of this seems extreme just consider that many dermatologists will tell you that you should be doing this ANYWAY. Before sunscreen was invented (1940's?) people HAD to wear long-sleeve shirts when outside for extended periods of time.

UPDATE: Tacalcitol -- A woman from England has relayed to me that after 5 months of using Tacalcitol (once a day) she has had NO improvement. (CARL'S NOTE: Keep in mind that patients all react differently form this medication.)

UPDATE: Dovonex -- Patients seem to be genetically predisposed to their reaction to D3 analogues. It may WORK to one degree or another on one individual while it may NOT work at all on another patient. My doctor said that the medication can't hurt so he let me try it. I have been doing a test patch for 5 months that has done nothing. I hope to get hold of some Tacalcitol (from Europe) to try out. As mentioned above, it is only SLIGHTLY different than Dovonex. But I will leave no stone left unturned.

Chinese Medicine? Detoxification?

I've read on other message boards that detoxification did nothing for DSAP. NO word on for how long they tried a detoxification. However one person E-mailed me and said that at least the ITCHING of DSAP ceased. I tried a detoxification for 18 days. Although I have no DSAP on my face, my face became very clear of oil. But the detox did nothing for DSAP.

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There are doctors of varying competence just as there are good and bad mechanics, etc. Here's a list of the first 4 Southern California area "doctors", including 2 dermatologists who MISDIAGNOSED my DSAP. Just what were these "doctors" doing in medical school???

1994 - A family physician - Confidently called it "a fungis" - He prescribed Lotrimin (used for Athletes foot)!

1995 - Dermatologist - "nothing"

1999 - Dermatologist - "Actinic Keratosis, Solar Keratosis"" - He made this diagnosis while sitting about 3 feet away from me and never making an up close examination. After 2 weeks of Efudex treatment failed to produce a harsh reaction (that would be expected with Solar Keratosis treatment) he looked rather stumped and surprised and declared that I didn't have as much sun damage as he previously thought. On THIS visit I asked him to take a close up look at a non-pigmented DSAP spot. He said it was "nothing".

2000 - Dermatologist - "Follicullitis, Seborrheic Keratosis" - This doctor suggested a light chemical peel. I cringe thinking what THIS may have done for DSAP!!!

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