Transient Acantholytic Dermatosis

Updated: May 08, 2017
  • Author: Edward J Zabawski, Jr, DO; Chief Editor: Dirk M Elston, MD  more...
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Overview

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] 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.

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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]

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]

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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.

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.

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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.

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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.

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