Transient Acantholytic Dermatosis of Grover

đź’ˇ
Grover’s disease (GD) is a common acquired skin disorder characterized by a pruritic papulovesicular eruption of the trunk, whose histopathologic hallmark is acantholysis of the epidermis.
 
History
  • Described in 1970 by Ralph W. Grover as “transient acantholytic dermatosis”
 
Epidermiology
  • Underestimated

Etiology: unknown
  • Acquired
  • Causal relationship with heat and sweating has been postulated
  • Electron microscopic studies demonstrated that dissolution of desmosomal attachment plaques is the likely cause of acantholysis in Grover disease
    • “Eccrine acrosyringeal acantholytic disease → obstruction of sweat glands leads to escape of sweat urea into the epidermis with dissolution of desmosomal attachment plaque and acantholysis?”
 
Clinical presentation: subtle
  • Acute to subacute monomorphous skin eruption of slightly flesh colored to erytematous, edematous papules and/or vesicles
    • May gave keratotic component - papulosquamous lesions
    • Described as “pseudoherpetic”
  • Usually on the trunk, may extend to the extremities
    • Acral and mucosa spared
  • Exacerbated by
    • Sweating
    • Heat exposure
    • Bedbound hospitalization
    • Sunlight
    • Ionizing and UV radiation
 
Comorbidities
  • Hematologic malignancies (13%)
    • Is Grover a paraneoplastic phenomenon or associated with antineoplastic agents, excessive perspiration, fever, occlusive immobility or ionizing or ultraviolet radiation?
  • Concurrent dermatitis
    • Asteatotic eczema, allergic contact dermatitis, atopic dermatitis, irritation from adhesive tape
  • AIDS
 
Histology
  • Epidermal acantholysis
  • Predominant histologic patterns
    • Pemphigus vulgaris-like
    • Darier disease-like
    • Spongiotic
    • Pemphigus foliaceus-like
    • Hailey-Hailey disease-like
  • Infiltrate
    • May have eosinophils → Acherman postulated that the intensity of the pruritus is roughly proportional to the number of eosinophils in the dermal infiltrate
 
DDx
  • Miliaria rubra
  • Folliculitis
  • Papular urticaria
  • Maculopapular drug reactions
 
Treatment
  • General measures
    • Remove and avoid possible triggers (i.e. excessive sweat, high temperature, prolonged bedding and xerosis)
    • Use emollients to prevent xerosis
  • High to moderate potency topical corticosterpoids (1st line)
  • Systemic retinoids (2nd line)
    • Isotretinoin, acitretin
  • Systemic corticosteroids (2nd line)
  • Adjuvants
    • Topical calcineurin inhibitors
    • Topical antibiotics (erythrommucin, clindamycin)
    • Topical retinoids (tretinoin)
    • Topical vitamin D derivatives (calcipotriol/tacalcitol)
  • Alternatives
    • Dapsone (only 1 patient responded out of 10)
    • PUVA
    • UVA1
    • Cyclosporine
    • Etanercept
    • ALA-photodynamic therapy
    • Rituximab
    • Total skin electron beam therapy
    • Topical TCA
    • Topica 5-FU
 
Prognosis
  • Spontaneous resolution without any treatment in 1-8 months in 42% of cases
  • Persistence or recurrence is not infrequent
  • 3 courses:
    • Transient eruptive
    • Chronic asymptomatic
    • Persistent pruritic