transient acantholytic dermatosis (Grover's disease)
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Introduction
Pruritic dermatosis primarily affecting middle aged men, pincipally on the trunk occurring as crops of discrete papular & papulovesicular lesions.
Etiology
(precipitating factors)
- heavy, sweat-inducing exercise
- excessive solar exposure
- persistent fever
- exposure to heat or ionizing radiation
- may also occur in bedridden patients with heat & sweating as preciptiating factors
Epidemiology
- uncommon
- middle-aged & older, mean age 50 years
- males > females
- fair-skinned individuals
Pathology
- acantholysis & spongiosis
- focal acantholytic dyskeratosis with different patterns occurring at the same time
- superficial infiltrate of eosinophils, lymphocytes & histiocytes in the dermis
* histopathology images[5]
Clinical manifestations
- generally abrubt onset, following precipitating event
- pruritus
- papules, papulovesicles & erosions
- normal skin color to grayish pink to red
- distribution: trunk, back
- may be exacerbated by heat & sweating
- course is variable
- self limited, waxing & waning, or chronic & persistent
Laboratory
Differential diagnosis
- Darier-White disease
- heat rash (miliaria rubra)
- papular urticaria
- scabies
- dermatitis herpetiformis
- grouping of lesions
- symmetrical distribution of lesions
- Pityrosporum
- eosinophilic folliculitis
- insect bite
- drug eruption
Management
- general measures
- reassurance
- cooling
- pharmacologic agents
- topical corticosteroids under plastic occlusive wrap
- oral glucocorticoids
- oral dapsone
- dupilumab 600 mg initial dose, then 300 mg every other week []
- retinoids for resistant lesions
- PUVA photochemotherapy for resistant cases
- prognosis
- acute & chronic relapsing forms
- mean duration: 47 weeks
More general terms
Additional terms
- 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)
References
- ↑ Color Atlas and Synopsis of Clinical Dermatology, Common and Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 108-109
- ↑ Cortland Forum, March 2006 http://www.cortlandforum.com
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
- ↑ Parsons JM. Transient acantholytic dermatosis (Grover's disease): a global perspective. J Am Acad Dermatol. 1996 Nov;35(5 Pt 1):653-66 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8912557
- ↑ 5.0 5.1 5.2 Zabawski EJ, Elston DM (images) Medscape: Transient Acantholytic Dermatosis http://emedicine.medscape.com/article/1124347-overview
- ↑ 6.0 6.1 DermNet NZ. Transient acantholytic dermatosis (images) http://www.dermnetnz.org/scaly/grovers.html
- ↑ Butler DC, Kollhoff A, Berger T. Treatment of Grover Disease With Dupilumab. JAMA Dermatol. Published online January 27, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33502456 https://jamanetwork.com/journals/jamadermatology/fullarticle/2775572