A 50-year-old man presents with red, itchy bumps on the chest of approximate six months duration. He reports that they itch mildly most of the time, but sometimes, with increased activity, they itch more.
He is otherwise healthy, taking no regular medicines (except a daily baby aspirin) and has an allergy to penicillin.
Diagnosis: Grover’s disease
Grover’s disease is an inflammatory process characterized by a pruritic, papular and, uncommonly, a papulovesicular eruption of unknown cause affecting persons over 40 years of age (and usually over 60), often in photodistribution but sometimes widespread. Although named originally “transient acantholytic dermatosis,” the condition usually persists for many months and even for years. The clinical presentation can be mild, e.g. a few scattered papules, to significant.
Integration: Clinically, papules are the common denominator of Grover’s disease, and histopathologically, the common denominator of individual lesions is the presence within the epidermis of some acantholytic cells. The papules have either a smooth or keratotic surface. Those with a smooth surface show acantholytic cells in a pattern that simulates those of pemphigus vulgaris, pemphigus foliaceus and Hailey-Hailey disease. Keratotic papules show changes that closely resemble those of Darier’s disease.
The papules of Grover’s disease are notoriously pruritic, and the most pruritic of all are those in which numerous eosinophils reside in the upper part of the dermis.
The cause of Grover’s disease is not known.
Charles E. Crutchfield III, MD
Therapy: Topical corticosteroids, local antipruritics and systemic antihistamines may be helpful in alleviating the intractable pruritus. Retinoids given systemically have sent the eruption into remission and caused lesions in some patients to involute. In my experience, reassurance is all that is needed for asymptomatic patients.
For patients with significant pruritus, I have had excellent success with triamcinolone o.1 percent cream applied twice daily for two weeks, then once daily for two to four weeks, combined with narrow-band UVB phototherapy for four to six weeks. Repeat series with flares, and most (but not all) cases will resolve in one to three years.
For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit crutchfielddermatology.com.