COSMETIC SOLUTIONS:

1 ) Use a concealer (like Maybelline) for a masking effect before applying sunless tanner, then roll up pieces of tissue, dab them in water  and remove sunless tanner from DSAP spots. Sunless tanner seems to come right off when in contact with water or damp tissue. You'll be very impressed with the results! Be sure to apply a LOT of concealer. Some of the concealer will inevitably come off as you carefully rub in the sunless tanner, but it still helps to mask DSAP spots. Then wait at least 6 hours or longer and then wash off. Rub in some Apricot Kernel oil to get all of the residual concealer off if you wish. You can then re-apply concealer and adjust with tissue if your DSAP spots are very red. If you have been avoiding the sun for several years then re-applying concealer is probably not going to be necessary. It takes a little practice but you'll be looking relatively normal!

2) Avoid the sun! Even if you're driving in your car you should wear sunscreen, and throw a shirt over skin that may be directly exposed to the sun. I've read that wearing a long sleeve shirt is only considered to be about the equivalent of wearing SPF - 30 sunscreen. I suggest wearing Neutrogena SPF-100 if you go outside on sunny days, but avoid direct sunlight as much as possible.

3) DesOwen Cream (generic name: Desonide Solution) DesOwen is a form of steroid. I DO NOT recommend using this drug for cosmetic effect. For post-flouruoracil treatment I was given DesOwen Cream to supposedly speed up healing. But I held on to it for cosmetic purposes. This DesOwen seems to perhaps inhibit blood circulation(?) and thus cause redness to go away. Too bad it's only temporary, and it has a sort of reflex action (when it wears off). A few days after cessation of use (perhaps 2 or 3 days and continuing for about a week) the spots where DesOwen was applied will actually look redder than normal. This reflex action makes DesOwen only worth using on rare occasions. I have noticed that this DesOwen stuff has diminishing effectiveness if you try to use it continuously. Each time I use DesOwen it has less effect and takes longer and more applications to hide the hyper pigmentation of DSAP. 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 only use DesOwen once in a long while when I absolutely need to look normal. 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! If you wish ask your doctor for a prescription. If he says "no" then try another doctor or maybe attempt to order online if possible.

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? It's worth wearing SPF-50 sun screen on your face too. If you insist on living in hot climates then consider becoming more of a night owl. ALSO: you are being exposed to ultra-violet rays from just reflective sunlight beaming into your living room! I've read that everyday healthy people actually 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. 

I can't stress how important it is to avoid the sun (or at least use full protection) and NOT wait for more trouble! Just because it may have taken you 30 years to develop 10 DSAP spots doesn't mean that it will take 30 more years to develop 10 more spots. Your skin has reached the end of it's rope.

Your body naturally produces vitamin D when exposed to sunlight. Since you will be avoiding the sun, don't forget to compensate by taking vitamin D supplements.

4) Sunless tanning creams? From my experience the characteristic outer borders of DSAP spots absorb MORE of the cream and retains it longer, thus making DSAP spots stand out a bit. But (as mentioned above) the combination of sunless tanner and concealer makeup on DSAP spots can actually have you looking pretty good. By the way there is only one common active ingredient that is FDA approved for sunless tanners. So don't bother paying more for some silly exotic brands. They all use the same active ingredient.

Reader recommendation: "Sally Hansen Air Brush Legs (spray on panty hose) – this works MUCH better for me than self tanners. Does not sweat off during the summer months. Plus, it does not make spots darker. Apply a moisturizer, and then use the Air brush legs. I can't spray evenly, so i spray in my hands and rub it on my legs. It washes off in shower, but you have to use soap to remove it. Very little smell with this as compared to a self tanner. You can purchase this at Walgreens. I think Amazon sells a similar product, but I have not tried it. I use Cetaphil lotion every day. This is a really good moisturizing lotion. Daily use of this has really helped me, especially my legs. I use this and the Air Brush legs together during the summer."