Grover disease

Background

• Also known as transient acantholytic dermatosis
• Risk factors
  • Almost always in men
  • Heat and sweating, but also cold, dry air in winder
  • Chronic kidney disease
  • Induction chemotherapy for transplantation
  • Drugs, including sulfadoxine-pyrimethamine, recombinant IL-4, BRAF inhibitor, ipilimumab, and other immune checkpoint inhibitors
  • Rarely neoplastic

Clinical Manifestations

• Self-limited, papulovesicular rash, most common in older white men
• Lesions are usually pruritis
• Can form crusts and keratotic erosions
• Affects trunk (including back) almost universally, but can also involve proximal and lower extremities, and, occasionally, neck and face
• Self-resolves over weeks to months, but occasionally can have a chronic fluctuating course lasting years
  • Can recur seasonally in winter and summer

Differential Diagnosis

• In general: Eczema, contact dermatitis, atopic dermatitis
• Rashes with histologic findings of acantholysis and dyskeratosis:
  • Darier disease: autosomal dominant with similar presentation
  • Hailey-Hailey disease: autosomal dominant with painful erosions, vesicles, and crusting in the neck, axeillae, groin, and perineum
  • Pemphigus vulgaris: autoimmune disease with flaccid bullae and painful ulcers, often including skin and mucosa
  • Galli-Galli disease: variant of Dowling-Degos disease with hyperpigmentation and pruritis, scaly papules on trunk and proximal extremities

Management

• Can include emollients (for dry skin), topical corticosteroids (for pruritus and inflammation), topical vitamin D analogues (if refractory to topical steroids), and oral antihistamines (for pruritus)
• Second-line options include oral retinoids, systemic corticosteroids, and phototherapy

Further Reading

• Aldana PC, Khachemoune A. Grover disease: review of subtypes with a focus on management options. Int J Dermatol. 2020 May;59(5):543-550. doi: 10.1111/ijd.14700. PMID: 31724740.