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Transient Acantholytic Dermatosis Treatment & Management

  • Author: Edward J Zabawski, Jr, DO; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Mar 31, 2016
 

Approach Considerations

Success in treatment relies heavily on correct identification of the disease early in its course and treatment of any features of underlying atopy. Recurrence is the rule, not the exception; the term "transient" should be dropped as it is inaccurate and confusing and replaced with "recurrent pruritic". The role of sweat antigen or high sweat metal concentrations in patients with refractory and/or severe disease has not be evaluated but should be considered in those patients.

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Medical Care

Potent topical corticosteroids may be effective in diminishing inflammation and in controlling itching associated with transient acantholytic dermatosis (Grover disease). Menthol or pramoxine-containing lotions may also be helpful for itching.

For refractory disease, retinoids, such as vitamin A 50,000 U 3 times a day for 2 weeks then daily for up to 12 weeks or isotretinoin 40 mg/d for 2-12 weeks, may be effective.[14]

Oral corticosteroids, UV-B exposure, psoralen plus ultraviolet A light (PUVA), grenz radiation, and methotrexate (MTX) have all been reported to be effective in severely resistant cases. However, some cases are refractory to virtually all forms of therapy.

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Activity

Excess heat and sweating are frequently associated with an increase in the symptoms of transient acantholytic dermatosis (Grover disease). Activities that cause these symptoms should be avoided.

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Contributor Information and Disclosures
Author

Edward J Zabawski, Jr, DO Medical and Surgical Dermatology

Edward J Zabawski, Jr, DO is a member of the following medical societies: American Osteopathic Association, New England Dermatological Society

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 AIDS Society, International Academy of Pathology, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, Society for Investigative Dermatology, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

References
  1. Grover RW. Transient acantholytic dermatosis. Arch Dermatol. 1970 Apr. 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. 2000 Apr. 51(4):244-9. [Medline].

  3. Scheinfeld N, Mones J. Seasonal variation of transient acantholytic dyskeratosis (Grover's disease). J Am Acad Dermatol. 2006 Aug. 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. 2007 Nov. 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. 2008 Mar. 33(2):206-7. [Medline].

  6. Kanzaki T, Hashimoto K. Transient acantholytic dermatosis with involvement of oral mucosa. J Cutan Pathol. 1978 Feb. 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. 2002 Aug. 47(2):319-20. [Medline].

  8. Liss WA, Norins AL. Zosteriform transient acantholytic dermatosis. J Am Acad Dermatol. 1993 Nov. 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. 2008 Feb. 58(2):299-302. [Medline].

  10. Zabawski EJ, Costner M, Franklin G, Witheiler DD, Eichorn PJ, Cockerell CJ. A potpourri of parasitic infestations. Cutis. 1999 Feb. 63 (2):81-5. [Medline].

  11. Fernández-Figueras MT, Puig L, Cannata P, Cuatrecases M, Quer A, Ferrándiz C, et al. Grover disease: a reappraisal of histopathological diagnostic criteria in 120 cases. Am J Dermatopathol. 2010 Aug. 32(6):541-9. [Medline].

  12. Joshi R, Taneja A. Grover's Disease with Acrosyringeal Acantholysis: A Rare Histological Presentation of an Uncommon Disease. Indian J Dermatol. 2014 Nov. 59 (6):621-3. [Medline].

  13. Cohen PR, Paravar T, Lee RA. Epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection: multinucleated epithelial giant cells in the epidermis of lesional skin biopsies from patients with acantholytic dermatoses can histologically mimic a herpes virus infection. Dermatol Pract Concept. 2014 Oct. 4 (4):21-7. [Medline].

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

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

 
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A 54-year-old man with a pruritic eruption on the trunk. Notice the slight lichenification and significant erythema from rubbing that is localized to the central part of the torso. Also note the red-brown papules in the abdominal region.
Close-up view of the abdominal area of a patient with a pruritic eruption on the trunk. Multiple, small, discrete, red-brown papules characteristic of Grover disease are present.
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 dyskeratosis to better advantage. Note the corps ronds and grains (hematoxylin and eosin, original magnification X400).
 
 
 
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