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. [12]
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). [13, 14] Acrosyringeal acantholysis may be present, [15] and multinucleated cells may suggest herpetic infection. [16]
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).
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:
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Darier disease - Virtually identical; greater tendency to involve follicles; clinical correlation essential
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Linear acantholytic epidermal nevus - Virtually identical; clinical correlation essential
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Hailey-Hailey disease - Epidermis usually more hyperplastic; more diffuse involvement
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Pemphigus vulgaris - Broad zones of suprabasilar acantholysis; mucosal involvement; involvement of adnexal structures; often abundant eosinophils
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Primary spongiotic dermatitis (allergic contact dermatitis, nummular dermatitis) - Involvement of entire epidermis; psoriasiform hyperplasia
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Acantholytic solar keratosis - Atypical keratinocytic proliferation in lower portion of epidermis with cytologic atypia and mitoses; alternating orthokeratosis and parakeratosis; solar elastosis
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Solitary acantholytic keratosis - Epidermal hyperplasia; slight papillomatosis or digitation of epidermis; clinical correlation required
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Pemphigus foliaceus/erythematosus - Broad zone of subcorneal and subgranular acantholysis; involvement of adnexal structures; often eosinophils
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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
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Familial dyskeratotic comedones - Small cylindrical invagination with epithelial lining demonstrating acantholytic dyskeratosis
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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).
