Skin-nontumor / Clinical dermatology
Blistering disorders
Transient acantholytic dermatosis

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 17 June 2016, last major update July 2011

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Transient acantholytic dermatosis [title]

Cite this page: Transient acantholytic dermatosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skinnontumorGrover.html. Accessed December 4th, 2016.
Definition / General
  • Transient edematous papules and vesicles on chest and back, possibly due to heat and sweating
  • Initially characterized by Grover in 1970 (Arch Dermatol 1970;101:426)
Terminology
  • Also called Grover's or Grover disease
  • Proposed term is persistent and recurrent acantholytic dermatosis, since often is not transient (Hautarzt 2000;51:244)
Epidemiology
  • Incidence of 0.1%; 70% male, mean age 61 years
Sites
  • Usually begins on anterior chest, upper back or lower chest
  • May become disseminated, but scalp, palms and soles are spared
Etiology
Clinical Features
  • Benign, but often persistent and difficult to manage
  • High index of suspicion needed to make the diagnosis
  • All patients have some pruritis, may be severe; amount of itching does not correlate with amount of lesions
  • Lesions are red-brown, discrete papules that usually do not coalesce
  • 8% have coexisting hematologic malignancies (J Clin Oncol 1994;12:1703)
  • No systemic symptoms
Prognostic Factors
  • Most cases resolve within months, but often persists for years
Case Reports
Treatment
  • Topical corticosteroids for inflammation and itching
  • Menthol or pramoxine lotions for itching
  • Retinoids (Vitamin A, 50,000 Units 3 / day x 2 weeks, then daily x 12 weeks, OR isotretinoid 40 mg/day x 2 - 12 weeks)
  • For severely resistant cases, oral corticosteroids, UV-B, PUVA, methotrexate or grenz radiation may be effective (eMedicine)
  • Possibly triple antibiotics (Cutis 2007;80:72)
  • Avoid excess heat or sweating
Clinical Images

Images hosted on PathOut servers:

Breast skin, courtesy of Mark R. Wick, M.D.



Images hosted on other servers:

Various images

Micro Description
  • Spongiosis and focal acantholysis
  • Usually superficial dermal, perivascular infiltrate of lymphocytes and histiocytes; eosinophils in 25%
  • May have other coexisting dermatologic disorders (Arch Pathol Lab Med 2009;133:1490)

  • Patterns:
    • Pemphigus vulgaris–like (47%): predominantly limited to suprabasal acantholysis, with basal keratinocytes attached to basement membrane forming a characteristic tombstone appearance
    • Darier-like (18%): suprabasal acantholysis of keratinocytes with scattered apoptotic or dyskeratotic cells within various levels of the epidermis
    • Spongiotic (9%): edema within epidermis, causing separation of keratinocytes and prominent intracellular bridges
    • Pemphigus foliaceous–like (9%)
    • Mixed (9%)
    • Hailey-Hailey–like (8%): suprabasal acantholysis of all levels of the epidermis without significant dyskeratosis ("dilapidated brick wall" appearance)
Micro Images

Images hosted on PathOut servers:

Breast skin, courtesy of Mark R. Wick, M.D.



Images hosted on other servers:

Acantholytic dyskeratosis in epidermis

With corps ronds and grains

Pemphigus vulgaris–like pattern of suprabasal acantholysis

Various images

Spongiotic-like pattern

Negative Stains
  • No specific pattern for direct immunofluorescence
Differential Diagnosis
  • Pathology:
    • Darier's disease: virtually identical; greater tendency to involve follicles; no eosinophilic infiltrate; clinical correlation essential
    • Pemphigus vulgaris: broad zones of suprabasilar acantholysis; mucosal involvement; involvement of adnexal structures; often abundant eosinophils; fishnet pattern of IgG and C3 on direct immunofluoresence
    • Pemphigus foliaceus: broad zone of subcorneal and subgranular acantholysis; involvement of adnexal structures; often eosinophils; fishnet pattern of IgG and C3 on direct immunofluoresence
    • Primary spongiotic dermatitis: involvement of entire epidermis; psoriasiform hyperplasia

  • Clinical:
    • Dermatitis herpetiformis: severe pruritis, vesicles on extensor surface
    • Drug eruption: morbilliform papules on face, trunk, and extremities
    • Folliculitis: erythematous papules on trunk, head, and neck
    • Galli-Galli disease: acantholytic variant of Dowling-Degos disease; presents in similar manner, but has a focal reticulated pattern, affects hands, groin and lower extremities; histology shows elongation of rete ridges but no acantholysis (J Am Acad Dermatol 2008;58:299)
    • Parasites: examine scraping under microscope for organisms