Grover's disease (GD) is a polymorphic,
pruritic
Itch (also known as pruritus) is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasan ...
, papulovesicular
dermatosis characterized histologically by
acantholysis
Acantholysis is the loss of intercellular connections, such as desmosomes, resulting in loss of cohesion between keratinocytes,Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) ''Robbins & Cotran Pathologic Basis of Disease'' (7th ed.). Saunders. P ...
[Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. .] with or without dyskeratosis. Once confirmed, most cases of Grover's disease last six to twelve months, which is why it was originally called "transient". However it may last much longer. Nevertheless, it is not to be confused with
relapsing linear acantholytic dermatosis
Relapsing linear acantholytic dermatosis is a cutaneous condition characterized by relapsing linear erosions and crusting, histologically identical to Hailey–Hailey disease. It is not to be confused with transient acantholytic dermatosis.
See ...
.
Signs and symptoms
![Grover's disease, advanced case, fifth month](https://upload.wikimedia.org/wikipedia/commons/9/90/Grover%27s_disease%2C_advanced_case%2C_fifth_month.jpg)
Grover's disease often starts quite suddenly. There are intensely itchy spots on the central back, mid chest and occasionally elsewhere. Frequently, it follows sweating or some unexpected heat stress.
The itchy eruption lasts an average of 10–12 months. It is characterized by papules and papulovesicles with excoriations occurring on the chest, back, lower sternum, arms, and thighs.
The papules are most commonly found on the mid chest.
Sometimes the features of Grover's are found in people who do not itch or have a conspicuous rash. Most of the people with Grover's who visit a dermatologist, however, itch a lot.
Cause
The cause of Grover's disease is unknown. Suspected triggers of disease activity include heat and sweating, sunlight, and adverse reaction to medications
as well as
ionizing radiation
Ionizing radiation (or ionising radiation), including nuclear radiation, consists of subatomic particles or electromagnetic waves that have sufficient energy to ionize atoms or molecules by detaching electrons from them. Some particles can travel ...
, end-stage
renal disease
Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can b ...
/
hemodialysis
Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...
, and mechanical irritation or prolonged bed rest.
Some cases of Grover's disease have been associated with medications such as
sulfadoxine-pyrimethamine
Sulfadoxine/pyrimethamine, sold under the brand name Fansidar, is a combination medication used to treat malaria. It contains sulfadoxine (a sulfonamide) and pyrimethamine (an antiprotozoal). For the treatment of malaria it is typically used al ...
,
ribavirin
Ribavirin, also known as tribavirin, is an antiviral medication used to treat RSV infection, hepatitis C and some viral hemorrhagic fevers. For hepatitis C, it is used in combination with other medications such as simeprevir, sofosbuvir, pegin ...
,
cetuximab
Cetuximab, sold under the brand name Erbitux, is an epidermal growth factor receptor (EGFR) inhibitor medication used for the treatment of metastatic colorectal cancer and head and neck cancer. Cetuximab is a chimeric (mouse/human) monoclonal an ...
, and
interleukin-4
The interleukin 4 (IL4, IL-4) is a cytokine that induces differentiation of naive helper T cells ( Th0 cells) to Th2 cells. Upon activation by IL-4, Th2 cells subsequently produce additional IL-4 in a positive feedback loop. IL-4 ...
,8-15 One series of 300 patients with Grover's disease reported an association with other coexisting dermatoses including
atopic dermatitis
Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin (dermatitis). It results in puritis, itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thickens o ...
,
contact dermatitis
Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are ...
, and
xerosis cutis
Xeroderma, xerosis or xerosis cutis, or simply dry skin, is a skin condition characterized by excessively dry skin.
The medical term ''xeroderma'', meaning "dry skin", derives from modern Latin, ''xero-'' 'dry' + Greek ''derma'' 'skin'.
In most ...
. Finally, smaller series have detailed an association with
pyoderma gangrenosum
Pyoderma gangrenosum is a rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow. Pyoderma gangrenosum is not infectious.
Treatments may include corticosteroids, ciclosporin, infliximab, or cana ...
, bacterial and viral infections, and occasionally, malignancies.
Diagnosis
Grover's may be suspected by its appearance, but since it has such a characteristic appearance under the microscope a shave skin or punch biopsy is often performed.
Treatment
Sweating causes lesions to form, but lesions aggravated by sweat usually return to "normal" fairly quicklyavoiding sweat is not considered a reason to avoid exercise. Minor outbreaks can be controlled with prescription strength topical cortisone creams. More severe eruptions usually clear up after treatment for one to three months with
Accutane
Isotretinoin, also known as 13-''cis''-retinoic acid and sold under the brand name Accutane among others, is a medication primarily used to treat severe acne. It is also used to prevent certain skin cancers (squamous-cell carcinoma), and in th ...
or tetracycline. If these fail or the outbreak is severe, PUVA phototherapy treatments, antifungal medication and cortisone injections are alternatives.
Some research has suggested a correlation of Grover's disease with mercury toxicity in which case
Dimercaptosuccinic acid
Succimer, sold under the brand name Chemet among others, is a medication used to treat lead poisoning, lead, mercury poisoning, mercury, and arsenic poisoning. When radioactive tracer, radiolabeled with technetium-99m, it is used in a number of ...
might help.
Epidemiology
The prevalence and incidence of Grover's disease have not been firmly established. In a study from Switzerland, Grover's disease was diagnosed in just 24 of more than 30,000 skin biopsies.
Grover's disease is mainly seen in males over the age of forty.
Grover's disease affects chiefly white adults in the fifth decade or later, and appears to be around 1.6 to 2.1 times more common in men than in women. Grover's disease appears less commonly in darker-skinned individuals.
[http://www.uptodate.com/patients/content/topic.do?topicKey=~JmwJAF8q.xf7GjV ]
History
This condition was first reported in 1975 by the American dermatopathologist, Ralph Wier Grover (1920–2008) while working at Franklin Hospital in New York. He described and examined around 40 patients having the characteristic signs of the disease, which now bears his name.
References
External links
{{Vesiculobullous disease
Chronic blistering cutaneous conditions
Rare diseases