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Transient Acantholytic Dermatosis Workup

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

Laboratory Studies

A skin scraping with oil preparation to search for mites, ova, and scybala of scabies is commonly warranted in any patient with pruritus and a rash. However, the clinical features of transient acantholytic dermatosis (Grover disease) is substantially different from scabies. More uncommon parasite infections, such as bird mite or cat mite, could mimic transient acantholytic dermatosis clinically.[10]

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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 the images below). 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).[11]  Acrosyringeal acantholysis may be present,[12] and multinucleated cells may suggest herpetic infection.[13]

Histopathology of Darier-type Grover disease. A foHistopathology 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 dyskHigher 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
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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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