Grover's disease (syn. transient acantholytic dermatosis)

Patient Information Leaflet
Link: Grover's disease

https://pcds.org.uk/patient-info-leaflets/grovers-disease

Grover's disease is a relatively common, itchy skin condition, predominantly affecting the trunk in middle-aged or elderly people. Although it is referred to as ''transient'', symptoms can be more persistent.

This chapter is set out as follows:

• The cause is unknown
• Heat and sweating are predisposing factors, however, it can also arise in relatively dry skin
• It is more common is hospitalized patients

• More common in middle-aged or elderly white patients, although it may be seen in other ethnic groups
• Men are affected three times more often than women
• Itch is the predominant symptom
• Many patients have a chronic relapsing course with episodes lasting for weeks or several months. Patients with underlying UV-damaged skin may have persistent symptoms

Distribution

• The trunk, especially the lower chest and upper back
• Patients who are severely affected may have widespread involvement, including the neck, shoulders, arms, and legs

Morphology

• An acute eruption of erythematous to red-brown papules or papulovesicles
• There may be background signs of UV-damaged skin

• If the diagnosis is unclear a biopsy may be needed
• Histology shows focal acantholysis with or without dyskeratosis. Spongiosis is also commonly observed

Step 1 - general measures

• Remain cool, as sweating may induce more itchy spots
• Cooling emollients containing menthol can help 

Step 2: topical steroids (and other topical treatments)

• Apply a moderate to potent topical steroid once to twice a day
• Calcipotriol cream has been reported to be of benefit in some patients 

Step 3: treatment in Secondary Care

• For more troublesome symptoms, a number of treatments can be considered:
  • Phototherapy can be helpful, although in a few it may provoke symptoms
  • Oral retinoids such as acitretin or isotretinoin, as well as systemic steroids have been reported to be helpful. However, they have important side effects and should only be considered if other treatments have not been successful