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Skin-nontumor / Clinical Dermatology

Blistering disorders

Transient acantholytic dermatosis

Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC (see Reviewers page)
Revised: 26 August 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● 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)


● Also called Grover's or Grover disease
● Proposed term is persistent and recurrent acantholytic dermatosis, since often is not transient (Hautarzt 2000;51:244)


● Incidence of 0.1%; 70% male, mean age 61 years


● Usually begins on anterior chest, upper back or lower chest
● May become disseminated, but scalp, palms and soles are spared


● Unknown
● Often associated with heat, sweating or sunlight exposure (Mayo Clin Proc 1999;74:229, Dermatology 1999;198:410), although many patients present in winter (J Am Acad Dermatol 2006;55:263)
● Associated with atopic dermatitis or asteatotic eczema

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

● 14 year old girl with bullous variant (Eur J Dermatol 2005;15:288)
● 60 year old man with pruritic eruption on his back and chest (Am Fam Physician 2006;74:641)
● 71 year old man with disease induced by cetuximab (anti-EGFR) for colon cancer (Dermatology 2006;213:37)


● 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

Various images

Bullous variant

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)

● 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

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

Differential diagnosis (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

End of Skin-nontumor / Clinical Dermatology > Blistering disorders > Transient acantholytic dermatosis

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