eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Transient Acantholytic Dermatosis

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

Introduction

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.

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.

Frequency

United States

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 3 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.

Clinical

History

• One of the hallmarks of transient acantholytic dermatosis (Grover disease) is pruritus, and all individuals who are affected experience variable degrees of itching, sometimes severe in nature.
• The clinical appearance does not always correlate to the degree of pruritus; for example, some patients with limited cutaneous disease complain of severe itching, whereas others with many lesions have few or no symptoms.
• No systemic symptoms are associated with transient acantholytic dermatosis (Grover disease), but oral lesions can develop that resemble aphthae and may be slightly painful.⁶

Physical

• The transient acantholytic dermatosis (Grover disease) process usually begins as an eruption of the skin on the anterior part of the chest, the upper part of the back, and the lower part of the rib cage (see Media Files 1-2).⁷

• Patients who are severely affected may have disseminated disease affecting the neck, the shoulders, the arms, and the legs.
• The scalp is usually not affected, and the palms and the soles are almost always spared.
• Individual lesions are erythematous to red brown keratotic papules that remain discrete and do not usually tend to coalesce.
• Occasionally, lesions may be acneiform, vesicular, pustular, and rarely even bullous. Although the most common presentation is that of widespread scattered papules, unusual distributions, including zosteriform or unilateral, may occur.⁸

Causes

The etiology of transient acantholytic dermatosis (Grover disease) is unknown.

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