Transient Acantholytic Dermatosis Workup

  • Author: Edward J Zabawski Jr, DO; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

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.
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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).[10]

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

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.

Specialty Editor Board

Donald Belsito, MD  Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

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: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

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. 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. Aug 2010;32(6):541-9. [Medline].

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

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

  13. 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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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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