Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, with variable clinical features, most commonly including café-au-lait macules and neurofibromas. The incidence of NF1 is approximately one in 3,000 individuals. Diffuse neurofibroma is the rarest subtype of neurofibromas. We present a case of a 39-year-old Micronesian male presenting with a substantially large and heavy overgrowth on his back, found to be consistent with diffuse neurofibroma on histopathologic examination. The patient also met the diagnostic criteria for NF1 based on clinical examination. Imaging showed the dermal and subcutaneous thickening without deep extension into the underlying fascial layer or muscles. A patient-centered, multidisciplinary approach was taken in the workup and management of this case. Our patient expressed disinterest in surgical interventions.

Introduction: Grover’s disease, or transient acantholytic dermatosis, is a common benign papulovesicular disorder that often affects elderly men. It is typically managed with topical therapeutics in this population. We present here an uncommon case of Grover’s disease, occurring in a relatively younger patient, that was recalcitrant to typical therapeutics modalities. Case Report: A 45-year-old woman presented to our clinic with a several month history of discrete, pink, ill-defined pruritic papules on her torso with sparing of her extremities. Grover’s disease was diagnosed based on her clinical presentation and subsequently biopsy-confirmed. She failed multiple topical medications, oral acitretin, and only experience minimal relief when transitioned to Naltrexone. Dupilumab was added to her regimen, with rapid improvement. She was eventually transitioned down to dupilumab monotherapy, and has remained clear since.  Conclusion: Grover’s disease is not common among middle-aged women. Novel therapies, such as biologics, have been efficacious in elderly (especially male) populations with this condition. Our case demonstrates the importance of attempting new treatment modalities such as dupilumab for patients with recalcitrant disease. Novel application of these biologic treatments may be needed in particular for atypical cases, such as when patients do not fit the known epidemiologic profile.