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transient acantholytic dermatosis (Grover's disease)

Pruritic dermatosis primarily affecting middle aged men, pincipally on the trunk occurring as crops of discrete papular & papulovesicular lesions. Etiology: (precipitating factors) 1) heavy, sweat-inducing exercise 2) excessive solar exposure 3) persistent fever 4) exposure to heat or ionizing radiation 5) may also occur in bedridden patients with heat & sweating as preciptiating factors Epidemiology: 1) uncommon 2) middle-aged & older, mean age 50 years 3) males > females 4) fair-skinned individuals Pathology: 1) acantholysis & spongiosis 2) focal acantholytic dyskeratosis with different patterns occurring at the same time 3) superficial infiltrate of eosinophils, lymphocytes & histiocytes in the dermis * histopathology images [5] Clinical manifestations: 1) generally abrubt onset, following precipitating event 2) pruritus 3) papules, papulovesicles & erosions 4) normal skin color to grayish pink to red 5) distribution: trunk, back 6) may be exacerbated by heat & sweating 6) course is variable - self limited, waxing & waning, or chronic & persistent * images [5,6] Laboratory: skin biopsy Differential diagnosis: 1) Darier-White disease 2) heat rash (miliaria rubra) 3) papular urticaria 4) scabies 5) dermatitis herpetiformis a) grouping of lesions b) symmetrical distribution of lesions 6) Pityrosporum 7) eosinophilic folliculitis 8) insect bite 9) drug eruption Management: 1) general measures - reassurance - cooling 2) pharmacologic agents - topical corticosteroids under plastic occlusive wrap - oral glucocorticoids - oral dapsone - dupilumab 600 mg initial dose, then 300 mg every other week [] 3) retinoids for resistant lesions - vitamin A 50,000 IU TID for 2 weeks, then QD for total of 12 weeks - isotretinoin 40 mg/day for 2-12 weeks 4) PUVA photochemotherapy for resistant cases 5) prognosis - acute & chronic relapsing forms - mean duration: 47 weeks

Interactions

disease interactions

Related

acantholysis Darier-White disease; keratosis follicularis dermatitis herpetiformis; Duhring-Brocq disease eosinophilic folliculitis insect bite Malassezia (Pityrosporum) miliaria rubra (prickly heat) oral psoralen & ultraviolet (UV) A light (PUVA) scabies urticaria (hives)

General

vesiculobullous dermatitis

References

  1. Color Atlas and Synopsis of Clinical Dermatology, Common and Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 108-109
  2. Cortland Forum, March 2006 http://www.cortlandforum.com
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  4. Parsons JM. Transient acantholytic dermatosis (Grover's disease): a global perspective. J Am Acad Dermatol. 1996 Nov;35(5 Pt 1):653-66 PMID: 8912557
  5. Zabawski EJ, Elston DM (images) Medscape: Transient Acantholytic Dermatosis http://emedicine.medscape.com/article/1124347-overview
  6. DermNet NZ. Transient acantholytic dermatosis (images) http://www.dermnetnz.org/scaly/grovers.html
  7. Butler DC, Kollhoff A, Berger T. Treatment of Grover Disease With Dupilumab. JAMA Dermatol. Published online January 27, 2021 PMID: 33502456 https://jamanetwork.com/journals/jamadermatology/fullarticle/2775572