Background
Transient acantholytic dermatosis (Grover disease) is not an uncommon condition, but, surprisingly, it was not thoroughly characterized until Grover did so in 1970. [1] Transient acantholytic dermatosis is characterized by papulovesicular eruptions on the trunk and proximal extremities. Transient acantholytic dermatosis is a reactive skin condition that resolves over a period of weeks or months, but it is more likely to be persistent (chronic). While generally accepted to be a benign, self-limited disorder, it is often persistent and difficult to manage; hence, the description of transient is misleading. [2] The presentation can be subtle, or it may closely resemble other pruritic dermatoses. A high index of suspicion for this disease is necessary if the diagnosis is to be made correctly. Furthermore, the histologic features of transient acantholytic dermatosis (Grover disease) closely resemble those of several other conditions that are clinically distinct, which may add to potential diagnostic confusion.
Pathophysiology
The etiology of transient acantholytic dermatosis (Grover disease) is unknown. However, a number of factors have been suggested as being potentially causal or exacerbating. The most frequent association is with heat or sweating, and the obstruction of sweat ducts has been postulated to be responsible, although this association has been challenged, citing research that demonstrates that most patients with transient acantholytic dermatosis (Grover disease) present in winter, not summer. [3] This is particularly noteworthy given the fact that xerosis is a potential cause of transient acantholytic dermatosis and is exacerbated by cold weather.
Many patients describe preceding exposure to sunlight, although exposure to artificial ultraviolet radiation has not been shown to reproduce the process. Transient acantholytic dermatosis (Grover disease) seems to occur more frequently in patients with atopic dermatitis and asteatotic dermatitis, although many individuals with these conditions never develop it. Viral, bacterial, and other pathogens have also been proposed, but no causative role has been established. A number of transient acantholytic dermatosis (Grover disease) case reports have described an association with lymphoma, but these seem to be in the extreme minority. [4, 5] The exact pathogenesis has not been elucidated. Melanoma therapy with CTLA-4 inhibition has been associated with the disease. [6, 7] Similarly, a number of case reports have focused on describing a direct relationship between autoimmune antibodies and transient acantholytic dermatosis, and while there is a positive correlation between autoimmune antibodies and transient acantholytic dermatosis, it is unclear whether the autoimmune antibodies cause transient acantholytic dermatosis or if they increase as a result of transient acantholytic dermatosis. [8, 9]
Epidemiology
Frequency
Exact numbers regarding the prevalence of transient acantholytic dermatosis (Grover disease) are not available. Because of the clinical similarities with other entities and variable histopathologic findings, the disease is underdiagnosed in nondermatologic settings and probably underdiagnosed overall. Since transient acantholytic dermatosis has been linked to immobilization occlusion, it is likely that a growing number of cases have gone undetected in the hospital setting.
Race
Transient acantholytic dermatosis (Grover disease) most commonly affects middle-aged white men, although it may be seen in other ethnic groups, such as Hispanics and blacks.
Sex
Men are affected three times more often than women.
Age
Transient acantholytic dermatosis (Grover disease) most commonly affects middle-aged men; however, it has been in reported in children.
Prognosis
Generally, transient acantholytic dermatosis (Grover disease) is a self-limited disorder that resolves over weeks to months, but it can be persistent and may repeatedly recur for years.
Patient Education
Transient acantholytic dermatosis (Grover disease) is not curable, and the cause is unknown. Although the symptoms can frequently be controlled, some cases are refractory to treatment and difficult to manage. Current methods of treating symptoms include topical steroids, retinoids, methotrexate, and 5-aminolevulinic acid photodynamic therapy (ALA-PDT).
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A 54-year-old man with a pruritic eruption on the trunk. Notice the slight lichenification and significant erythema from rubbing that is localized to the central part of the torso. Also note the red-brown papules in the abdominal region.
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Close-up view of the abdominal area of a patient with a pruritic eruption on the trunk. Multiple, small, discrete, red-brown papules characteristic of Grover disease are present.
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Histopathology of Darier-type Grover disease. A focus of acantholytic dyskeratosis is present in the epidermis with slight epithelial hyperplasia and hyperkeratosis, a sign of rubbing as a consequence of the pruritic nature of the disease (hematoxylin and eosin, original magnification X40).
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Higher magnification reveals the acantholytic dyskeratosis to better advantage. Note the corps ronds and grains (hematoxylin and eosin, original magnification X400).
