DISCUSSION
The patient had transient acantholytic dermatosis, or Grover's disease. Usually self-limited, the condition may persist intermittently for several months to years. Grover's disease is a focal acantholytic dermatosis with associations to Darier's disease and Hailey-Hailey disease. The cause of Grover's disease is not wellunderstood. Usually seen in older white males, Grover's disease may be triggered by heat, fever, persistent sweating, 1 sunlight,2 or chronic mechanical irritation, such as prolonged bed rest. Grover's disease may be associated with chronic renal failure, leukemia, cancer, and chemotherapy, or it can be completely idiopathic. Intense pruritus often interferes with daily activities or rest.
Folliculitis lesions, which contain a central hair, may be pustular and demonstrate fluctuance. The lesions of atopic dermatitis typically appear on flexural surfaces. Adults are more likely than younger patients to have diffuse facial lesions with an erythematous background. Tinea corporis manifests as annular plaques with advancing borders of scale, papules, or vesicles.
Diagnosis Grover's disease can be diagnosed clinically and confirmed by punch biopsy. Histology demonstrates acantholytic changes in the epidermis very similar to those of pemphigus vulgaris. 3 Focal areas of spongiosis or intercellular edema cause separation of cells. In the dermal layer, infiltration with lymphocytes and eosinophils is one of the features that distinguishes Grover's disease. Direct immunofluorescence of Grover's disease is usually negative.
Treatment Advise patients to avoid heat or prolonged bed rest, and begin topical high-potency corticosteroids and liberal use of moisturizers to relieve the pruritus. If topical treatment does not provide relief, systemic nonsedating antihistamines may be added. More persistent and intense pruritus may require corticosteroids in tapered doses, retinoids, or methotrexate. The last two modalities require monitoring for side effects. Relapse is common following oral corticosteroid therapy. Topical vitamin D analogs, such as calcipotriene, may be helpful in recalcitrant cases but may not take effect for several weeks. Phototherapy and psoralen with UVA light may offer some relief for severe, persistent cases.4 Relief of itching is key to preventing secondary infection from chronic scratching. JAAPA
Lisa Mainier is an intern with an interest in dermatology at University Hospitals, Richmond Heights, Ohio. She has indicated no relationships to disclose relating to the content of this article.
Joe R. Monroe, PA-C, MPAS, department editor
REFERENCES
1. Hu CH, Michel B, Farber EM. Transient acantholytic dermatosis (Grover's disease): a skin disorder related to heat and sweating. Arch Dermatol. 1985;121(11):1439-1441.
2. Fawcett HA, Miller JA. Persistent acantholytic dermatosis related to actinic damage. Br J Dermatol. 1983;109(3):349-354.
3. Weedon D. Skin Pathology. 2nd ed. Philadelphia, PA: Churchill-Livingstone; 2002:297-298.
4. Lüftl M, Degitz K, Plewig G, Röcken M. Bath psoralen-UV-A therapy for persistent Grover disease. Arch Dermatol. 1999;135(5):606-607.