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.
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. [22]
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.
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.
Prevention
Patients should avoid activities that cause excessive heat, such as exercise and prolonged sun exposure. Patients should also avoid applying topical irritants.
Long-Term Monitoring
Initial care for transient acantholytic dermatosis (Grover disease) may be limited to midpotency topical corticosteroids and oral antihistamines. Atopic skin care measures should be recommended. Regular use of moisturizers containing camphor and menthol should be advised.
Acitretin, calcipotriol, and UVA-1 have been described as useful in patients with disease that is difficult to manage. [23] Additionally, oral retinoids, methotrexate, etanercept, and phototherapy have also been reported to help.
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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.
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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.
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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).
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Higher magnification reveals the acantholytic dyskeratosis to better advantage. Note the corps ronds and grains (hematoxylin and eosin, original magnification X400).
