Voltaren Gel (diclofenac sodium topical gel 1%)

Voltaren Gel (diclofenac sodium topical gel 1%) - January 2015 - Someone emailed me with a story about how a dermatologist has a "cure" for DSAP when applied nightly. It takes 6 months to a year for "amazing results". This patient who emailed me only started using this med in early 2015. Apparently there is no harsh reaction /skin eruption (ala Efudex). I am hopefull that they will report back with positive results. Until then and more information is fuzzy until others email with their results. If anyone else has used this med please email me to report your results.

I tried testing out using 5% Diclofenac on some test spots. After 11 months it did nothing. For the last 8 months I even increased test spot applications to twice per day.

SOLARAZE® Gel - One patient reports using but "found no improvement".

Fluorouracil / Fluoraplex / Carac Gel / Efudex

Fluorouracil (varients include Fluoraplex, Efudex, Carac) - Some doctors prescribe Flourouracil for DSAP and I think it's a huge mistake. This drug was actually designed for actinic keratosis. AK cells grow faster than DSAP and this drug only targets fast growing cells. Thus by itself, I don't believe that Flourouracil kills off DSAP cells as would be the goal. Instead DSAP just gets "irritated" and red. My opinion is that by itself this drug is an aggravating waste of time for DSAP. AVOID this drug for DSAP!

I am told via emails from patients that doctor(s) at UCLA as well as on the East Coast are now prescribing a combination of Retin-A and Efudex for DSAP. Apparently this combination causes the "skin eruption" necessary to kill off DSAP cells, whereas Efudex alone does not cause the eruption. I have yet to receive any feedback from patients as to the effectiveness of this combination. As with any treatment that causes a harsh reaction I suggest only trying a test spot first to see what happens, especially long term. My opinion is to avoid this treatment also because I don't understand how the long term end result would be any different than freezing.

Triamcinolone topical cream and Prednisone

In late 2012 I received an interesting email report of a patient being prescribed oral Prednisone steroid and Triamcinolone topical cream to be used in combination to fight another skin condition. As a "side effect" this patient reported to me that the DSAP cleared up after 6 weeks.

As it turns out this was a case of misdiagnosis. It was actually psoriasis that cleared up -- Not DSAP. Sorry for the false hope. Misdiagnosis is very common.

Nevertheless it is common that doctors prescribe psoriasis meds to DSAP patients, as is the case with D3 analogs like Dovonex. Triamcinolone topical cream might be worth a try anyway. Ask your doctor. And please report back to me as to what kind of success or failure you have from using Triamcinolone topical cream.

Aldera for DSAP?

Someone told me that a doctor told her that Aldara had "improved" one patient's DSAP condition. So I emailed the manufacturer of Aldara (in December of 2000).

3M Pharmaceutical's response: "...As you know, Aldara is approved for use in external genital warts. However, due to its unique mechanism of action, many physicians prescribe Aldara for other skin conditions. We have no clinical data regarding the effectiveness of Aldara for DSAP. However, we recently heard from a patient who was recently started on Aldara for DSAP. She reported improvement in her lesions. She had been treated with many other modalities before her dermatologist prescribed Aldara. Because we have so little information, the proper dosing for DSAP is not known. However, we are aware that many physicians prescribe Aldara from once weekly to twice daily..."

My personal results from using Aldara for DSAP was NO results. I had absolutely no improvement, no worsening and no reaction either.

I have heard from one patient that said Aldara made her DSAP worse.

Levulan / "Blue Light" therapy for DSAP?

The FDA approved Levulan for treatment of actinic keratosis (and for the face only). However apparently some patients are getting approval from physicians to treat DSAP with Blue Light therapy on their arms and legs. My opinion and personal assessment of this drug (as used for DSAP), based on feedback from 3 patients and one researcher, is one of skepticism. Read the testimonials and decide for yourself. I have had one very positive report and three people who emailed me with negative reports regarding their use of Levulan to treat DSAP. One patient experienced promising improvement at first, but then about a year later reality set in as their skin returned to it's original state. The other experienced a worsening of DSAP. A third said that DSAP just went back to the previous state. This "treatment" is said to be a painful procedure.

Someone has emailed me with a very promising report of another patient having great cosmetic success using Levulan to treat DSAP on her arms, after having tried all kinds of other medications and such to no avail. This had me excited. But shortly thereafter another patient contact me with some disappointing results. He lapsed back to his previous condition after what appeared to be initial optimism...

"...I have tried just about everything but have had no success. My last treatment was "Blue Light", which did make my spots less red and smooth. In fact, both my doctors were very optimistic as I was the same. However, my first time being exposed to the Summers sunlight, even though I used sunscreen, red spots reappeared as they were before and even spread to areas that were not affected before." - 06/28/02

Still another patient says that Levulan made their condition worse and biopsy revealed that it spread.

"I had treatment on my arms and legs and I have recently gotten a biopsy report that confirmed that the treatment actually spread the DSAP and now look awful to the point I can't wear short sleeves or shorts." - 7/18/07

And one more had this to say about "blue light" therapy of DSAP:

"That was awful. First of all, it really hurt. It felt like my arms were burned. The lesions really reacted to it; this made my doctor very happy at first because he was convinced that this meant they were about to die. But they didn't die. They reverted to normal. " - 2012

Here's a completely different positive report...

"I had great results from Levulan / Kerastick combined with blue light photodynamic therapy. I had a dermatologist who immediately recognized the condition on my arms and felt this would help. That was 3 years ago, my spots on my arms almost totally cleared. The treatment caused a lot of skin peeling and irritation as my damaged skin sloughed off but the skin underneath a couple weeks later was great." - May 2015

It is a 2-step process where first they apply the Levulan, which acts as a "photosensitizer", or light sensitive drug for the damaged cells. Only the damaged cells, which grow faster than normal cells, "soak up" the Levulan. You return the next day for light therapy using a non-laser fluorescent blue light source. This light therapy is supposed to take 15 minutes and is somewhat painful (a burning feeling). But at least for one DSAP patient it was well worth it.

In the Levulan Actinic Keratosis clinical trial summary “Over 90% of AK lesions cleared with Levulan® PDT. The treatment was well tolerated, gave excellent cosmetic results and would be chosen by most patients if they needed AKs treated in the future. Again this was for treatment of actinic keratosis -- not dsap.

However someone claimed in a January 14, 2003 post that phototoxic reaction of Levulan treatment can alter the skin's DNA. In this regard there are potentially serious unanswered questions. So one should definitely first read up on the "cons" on this treatment before blindly jumping in to this treatment. Try only a test spot before you jump in all the way with this treatment! And PLEASE report back with your results!

One person I got feedback from said that one doctor told her, “We have had some very nice results treating DSAP -- most impressive.” Keep in mind that the last this doctor sees of his patients are follow up visits. This doctor probably never sees his patients a year or more later! I'm sorry but I trust the patient feedback I've received -- not one doctor's feedback.

If anyone out there learns of more doctors treating DSAP with Levulan then please report back! What kind of success have they had?

Finally I have to wonder why freezing and/or lasers wouldn't essentially achieve the same thing that Levulan does (and without the possible phototoxic risks that may or may occur).

Again I am not a doctor and my opinions are based solely on emails.

Dimercine?

Monday August 6, 2001 - Researchers have developed an experimental cream (Dimercine) that may repair some sun damage. The lotion contains an enzyme that repairs sun-damaged DNA.

A bacterial enzyme called ``T4 endonuclease V'' has long been known to help repair DNA. But no one knew how to get it through skin. Then Yarosh's biotechnology company, AGI Dermatics, put the enzyme into microscopic fat bubbles called liposomes that can slip inside skin cells. There, the enzyme binds to UV-caused DNA mutations and initiates repair.

First tested were xeroderma pigmentosum patients, who have an incurable gene defect that leaves them unable to repair most UV damage. Thirty applied either Dimericine or a dummy lotion to their face and hands daily for a year. Dimericine users had a 30 percent reduction in basal cell carcinoma, and a dramatic 68 percent reduction in precancerous actinic keratoses.

It seems to me as though this new drug is a preventative drug or a "morning after" cream to use immediately after sun exposure or immediately after DNA damage. I have heard nothing about it clearing up precancerous actinic keratoses or DSAP. But you might want to ask your doctor about Dimercine.