eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Transient Acantholytic Dermatosis: Differential Diagnoses & Workup

Author: Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
Coauthor(s): Clay J Cockerell, MD, Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center
Contributor Information and Disclosures

Updated: Apr 28, 2009

Differential Diagnoses

Dermatitis Herpetiformis
Miliaria
Folliculitis
Pityriasis Rosea
Galli-Galli disease
Scabies
Herpes Simplex
Syphilis
Herpes Zoster
Insect Bites
Milia

Other Problems to Be Considered

Clinical differential diagnoses and their key differentiating features are listed below:

  • Dermatitis herpetiformis - Vesicular; pruritus more severe; extensor distribution
  • Folliculitis - Follicular papules; pustules if lesions intact
  • Arthropod reaction - Tendency to cluster; extremities and exposed sites usually involved
  • Papular urticaria (prurigo simplex) - Primarily excoriations; unreachable areas tend to be spared
  • Miliaria rubra - History of exacerbation with heat; often more nodular lesions
  • Papular drug eruption - Papules tend to coalesce into plaques; no sparing of extremities
  • Disseminated herpes simplex or herpes zoster - Vesicular; painful; history of immunosuppression
  • Scabies - Intractable itching, worse at night; wrists, finger webs, and axillae affected
  • Papular pityriasis rosea - Herald patch, less severe or absent pruritus, collarette of scale; seasonal incidence
  • Secondary syphilis - Usually scaly, with palmar lesions; pruritus is mild or absent

  • Galli-Galli disease9

Workup

Laboratory Studies

  • A skin scraping with oil preparation to search for mites, ova, and scybala of scabies is warranted in any patient with pruritus and a rash.

Histologic Findings

The histology of transient acantholytic dermatosis (Grover disease) contains certain characteristic features, but for a precise diagnosis to be rendered, clinicopathologic correlation is needed (see Media Files 3-4). Typically, focal acantholysis and dyskeratosis are seen. Spongiosis is also commonly observed, and the presence of spongiosis and acantholysis in the same specimen should raise the possibility of transient acantholytic dermatosis (Grover disease).

Histopathology of Darier-type Grover disease. A f...

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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Histopathology of Darier-type Grover disease. A f...

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).


Higher magnification reveals the acantholytic dys...

Higher magnification reveals the acantholytic dyskeratosis to better advantage. Note the corps ronds and grains (hematoxylin and eosin, original magnification X400).

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Higher magnification reveals the acantholytic dys...

Higher magnification reveals the acantholytic dyskeratosis to better advantage. Note the corps ronds and grains (hematoxylin and eosin, original magnification X400).


Five distinct histologic patterns of transient acantholytic dermatosis (Grover disease) have been described: (1) a pattern that simulates Hailey-Hailey disease; (2) a pattern that simulates Darier disease; (3) a pattern characterized mainly by spongiotic dermatitis; (4) a pattern that simulates pemphigus vulgaris; and (5) a pattern that simulates pemphigus foliaceus. Although one pattern may predominate, each pattern may be seen in different lesions from the same patient or, in some cases, within a single specimen. The key discriminating features are described below.
  • Darier disease - Virtually identical; greater tendency to involve follicles; clinical correlation essential
  • Linear acantholytic epidermal nevus - Virtually identical; clinical correlation essential
  • Hailey-Hailey disease - Epidermis usually more hyperplastic; more diffuse involvement
  • Pemphigus vulgaris - Broad zones of suprabasilar acantholysis; mucosal involvement; involvement of adnexal structures; often abundant eosinophils
  • Primary spongiotic dermatitis (allergic contact dermatitis, nummular dermatitis) - Involvement of entire epidermis; psoriasiform hyperplasia
  • Acantholytic solar keratosis - Atypical keratinocytic proliferation in lower portion of epidermis with cytologic atypia and mitoses; alternating orthokeratosis and parakeratosis; solar elastosis
  • Solitary acantholytic keratosis - Epidermal hyperplasia; slight papillomatosis or digitation of epidermis; clinical correlation required
  • Pemphigus foliaceus/erythematosus - Broad zone of subcorneal and subgranular acantholysis; involvement of adnexal structures; often eosinophils
  • Warty dyskeratoma - Cup-shaped exoendophytic cystlike lesion; acantholytic and dyskeratotic cells lining cyst wall; pseudopapillae with acantholytic dyskeratosis lined by a single layer of basal cells
  • Familial dyskeratotic comedones - Small cylindrical invagination with epithelial lining demonstrating acantholytic dyskeratosis

More on Transient Acantholytic Dermatosis

Overview: Transient Acantholytic Dermatosis
Differential Diagnoses & Workup: Transient Acantholytic Dermatosis
Treatment & Medication: Transient Acantholytic Dermatosis
Follow-up: Transient Acantholytic Dermatosis
Multimedia: Transient Acantholytic Dermatosis
References
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References

  1. Grover RW. Transient acantholytic dermatosis. Arch Dermatol. Apr 1970;101(4):426-34. [Medline].

  2. Streit M, Paredes BE, Braathen LR, Brand CU. [Transitory acantholytic dermatosis (Grover disease). An analysis of the clinical spectrum based on 21 histologically assessed cases]. Hautarzt. Apr 2000;51(4):244-9. [Medline].

  3. Scheinfeld N, Mones J. Seasonal variation of transient acantholytic dyskeratosis (Grover's disease). J Am Acad Dermatol. Aug 2006;55(2):263-8. [Medline].

  4. Fujita Y, Sato-Matsumura KC, Ohnishi K. Transient acantholytic dermatosis associated with B symptoms of follicular lymphoma. Clin Exp Dermatol. Nov 2007;32(6):752-4. [Medline].

  5. Ishibashi M, Nagasaka T, Chen KR. Remission of transient acantholytic dermatosis after the treatment with rituximab for follicular lymphoma. Clin Exp Dermatol. Mar 2008;33(2):206-7. [Medline].

  6. Kanzaki T, Hashimoto K. Transient acantholytic dermatosis with involvement of oral mucosa. J Cutan Pathol. Feb 1978;5(1):23-30. [Medline].

  7. Fantini F, Kovacs E, Scarabello A. Unilateral transient acantholytic dermatosis (Grover's disease) along Blaschko lines. J Am Acad Dermatol. Aug 2002;47(2):319-20. [Medline].

  8. Liss WA, Norins AL. Zosteriform transient acantholytic dermatosis. J Am Acad Dermatol. Nov 1993;29(5 Pt 1):797-8. [Medline].

  9. Gilchrist H, Jackson S, Morse L, Nicotri T, Nesbitt LT. Galli-Galli disease: A case report with review of the literature. J Am Acad Dermatol. Feb 2008;58(2):299-302. [Medline].

  10. Helfman RJ. Grover's disease treated with isotretinoin. Report of four cases. J Am Acad Dermatol. Jun 1985;12(6):981-4. [Medline].

  11. Miljkovic J, Marko PB. Grover's disease: successful treatment with acitretin and calcipotriol. Wien Klin Wochenschr. 2004;116 Suppl 2:81-3. [Medline].

  12. Breuckmann F, Appelhans C, Altmeyer P, Kreuter A. Medium-dose ultraviolet A1 phototherapy in transient acantholytic dermatosis (Grover's disease). J Am Acad Dermatol. Jan 2005;52(1):169-70. [Medline].

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Further Reading

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Keywords

transient acantholytic dermatosis, Grover disease, pruritic dermatosis

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Contributor Information and Disclosures

Author

Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
Disclosure: Nothing to disclose.

Coauthor(s)

Clay J Cockerell, MD, Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center
Clay J Cockerell, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, International Academy of Pathology, International AIDS Society, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, Society for Investigative Dermatology, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Donald Belsito, MD, Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of Missouri at Kansas City; Private Practice, American Dermatology Associates, LLC
Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, Kansas Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society
Disclosure: Johnson and Johnson stock holder dividends; Amgen stock holder dividends; Forest Lab, Inc stock holder dividends; Galaxo Smith Klein stock holder dividends; Covidien stock holder dividends; Novartis Grant/research funds Consulting; Biolex  sub-investigator

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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