Lasers, Liquid Nitrogen Freezing (AKA Cryotherapy, Cryosurgery)

The most common route DSAP patients go (if they choose to try to go with any treatment at all) seems to be a simple technique of freezing. When liquid nitrogen is used to freeze a cotton swab and then applied to a DSAP spot, the top layer of skin is killed off, thus HOPEFULLY causing healthy, normal or at least more normal skin tissue to grow back. HOPEFULLY months later there isn't MORE redness (scarring). If you wish to try freezing be sure and proceed with caution! Find a doctor who has treated DSAP patients before and who is experienced with freezing. You should probably call around and screen all of the doctors in your area. Apparently, the key is finding a doctor who is very experienced at freezing. Too little depth in freezing and the DSAP just returns. Reports (below) are that too much leaves a white scar, although this may be acceptable for those with lighter skin. You may have mixed results with certain limbs. For example, I froze a red spot on my shin, that didn't really leave much of any redness after a few months. Very happy with the results! However, I've found that red scars on upper legs don't heal up very well. This underscores the importance of experimenting with freezing just a spot or two to start.

I personally tried having a test spot lightly frozen by a doctor, but the DSAP simply grew right back. However, I believe that the doctor simply did not freeze deep enough. I later tried freezing a spot on my own with reasonable success. How did I do this on my own? First, for about 5 minutes, I held a rounded corner of an ice cub against the DSAP spot that I intended to freeze. Then I quickly held a can of compressed air (such as Xtreme Klean Duster) upside down and sprayed it into a (pre-frozen) glass jar, saturating a Q-tip inside. This creates sub-zero cold liquid. Then I pressed the Q-tip against the DSAP at least until it sizzles, and maybe a second or more longer. Then release. DISCLAIMER: I am not a doctor. Speak to your doctor before trying. If you try this self-freezing method, then do so at your own risk. Duster spray may be toxic when applied to skin for all I know. Liquid nitrogen (obtained from your local liquor store) would be a better DIY option. Assume that everything I say is misinformation, unreliable, and dangerous. Wear eye and skin protection when spraying into the glass jar. Use outdoors or in well ventialted area. Try one test spot to start. Wait perhaps about 7 months to judge the results.

Other notes: Liquid Nitrogen is actually pretty painless. The doctor sprays some spots or uses a cotton swab and you're out the door on your way. But, forget about having these spots seen in public for probably months! While the texture of skin heals up within about 3 weeks, the redness takes months to subside. One study found that scar redness takes about 7 months to fade. With DSAP, I think it might take a year or more for the redness to subside as much as it can. Thus, you should have freezing done at the beginning of winter time. Again HOPEFULLY the end result will be an improvement. Again, with DSAP spots that are permanently red, I think you will find improvement.

Here's some feedback I've received regarding freezing:

"I found that the freezing technique works well only if the doctor is adept at it and does not freeze too deep, which causes a permanent white scar, or too shallow which doesn't do anything. There is an extreme variance in how good doctors are at this procedure."

"With freezing, I had some done 7 years ago from a very competent dermatologist, the result is [the DSAP spots] are completely gone and have not grown back, or very slightly hyper-pigmentation. I just had 20 more frozen off, but this time from a skin specialist... he did not go deep enough and most of them appear to be grown back."

"I have tried freezing, it does not work. I am very faired skin and that may be why."

"I would say freezing would not be a viable option if the goal is to make it look better... at least for me, since I have very light skin."

"I have some minor white spots where they were frozen off"

"It's been 2 years since freezing... it is still totally gone in those spots, just a bit white scar color. Better than the redness with threads."

"Freezing took away the roughness and itchiness but left a worse reddish purplish spot in its place."

"Have had some freezing done which is somewhat effective but leaves brown spots."

"The doctor tried freezing a few spots – but it didn't clear up."

"...the only treatment [I tried] was with liquid nitrogen to freeze the larger problem ones off which is painful at the time. Worse has been the lasting scaring effects of that treatment leaving patches of skin on my arms that are white with no pigmentation...."

" I have tried Aldara and Effudex without any result. The best results have been from freezing, although this leaves me with white marks. I have only frozen around a dozen spots. I try to leave it until they look really red. Sometimes they come back but I think this has to do with how deep they go with freezing."

"Freezing - no difference"

"As for the freezing, I think it helped the rough texture a little bit."

"I have been freezing them off my legs and it works for a year or two and then they start popping back up."

"I've had 3 or 4 freezing treatments so far and now not so sure it's worth it."

"As for the freezing--its hard to say whether those same exact spots returned, but considering I do have sections of my legs that have lesions---it has returned."

"[My doctor] began treatment by freezing a few of the spots and later used Aldera. Both treatments were only short term successful."

"...it takes like 3 months for all the frozen spots to completely heal."

"I had a lot of lesions burned off with liquid nitrogen. It was successful, but I have a lot of bright pink spots left on my arms which have not gotten lighter over a year's time."

"Dermatologist performed my Cryo and went way too deep. I now have tons of horrible deep white hypopigmented areas & scars"

THE BOTTOM LINE: Based on the above reports, my opinion is that if you have very light skin, it's worth freezing some of those spots that have turned permanently red, and such redness has not subsided for a few years, despite sun avoidance. Don't go crazy by freezing lots of spots. Just experiment by freezing perhaps 1 to 3 spots to start. Take note of how long you press the cotton swab against the DSAP spot. If the spots return or are still somewhat hyperpigmented after 6 - 9 months, then you might have good reason to believe that the swab was simply not pressed against the DSAP long enough.

What have you got to lose? If you wind up with a white spot, as some report, then that's much better than having a red spot. If you have success, then try more spots.

Laser Treatment

I read comments by doctors on a message board that DSAP spots just kept growing back after treatment with the YAG laser. However one patient told me that they like the YAG laser for the treatment of "entrenched" lesions. Apparently the YAG laser in more commonly used on legs than arms.

Here's some of the feedback I've received from patients who tried laser treatments for DSAP:

"...the laser treated area NEVER healed. It has been over 10 years and the area is still raw."

"... the only "treatment" that worked for me was YAG laser resurfacing. Today those spots are gone with no hyper- or hypo- pigmentation (and I'm very pale). However, the treatment itself was temporarily extremely disfiguring and it was only after 9 months or so that I became better off than before the treatment. (It could be that I heal unusually slowly - about five times as long as I was told it would take...) Would I do it again? Yes, if I could go hang out in a cave or wear a burka for 9 months. What didn't work for me: efudex, retin-a, aldera, lac-hydrin cream.... I also think liquid nitrogen can be beneficial but you have to go pretty deep."

"I’ve tried laser removal, effudex, tazorac, retin-a and freezings. With early laser treatment (1990’s), I had some success. Freezings with liquid nitrogen--not so much. I noticed that if the whole lesion wasn’t frozen or zapped with a laser, the lesion would come back."

"I tried creams, freezing them off, electro-whatever lazering them off. They come back with a vengeance."

"I have tried 3 different kinds of laser treatments – one left me scarred."

"I don't think those [laser treated spots] ever grew back, but the treatment did leave white scars (which I prefer)."

"About 8 years ago I had CO2 laser on my face, as I had about 11 lesions on my face that were unacceptable to me, and that worked fantastic."

"Laser (not sure what kind) - no difference."

"Treatments I've tried include Efudex and laser. Neither have provided any benefit and may have, in fact, irritated the condition."

"[THE DOCTOR DID LASER TREATMENT] FOR ABOUT SIX MONTHS AND MY LEGS ARE NOW CLEAR AND HAVE BEEN FOR ABOUT ONE YEAR."

"...had a Laser treatment on her arms about 4 years ago that MADE IT WORSE, and then she followed the advice of [renowned dermatologist] and got ALA Laser therapy on her legs and arms and IT MADE IT WORSE."