Clinical features and treatments of transient acantholytic dermatosis (Grover’s disease): a systematic review

Abstract

Summary Grover's disease (GD) is an itchy acantholytic disorder occurring on the trunk of middle‐aged men. Based on the best evidence, this study aimed to provide a summary of the clinical characteristics, disease course and treatments of GD. A systematic review was performed according to PRISMA guidelines for original articles published between 01.01.1970–08.15.2019, assessing clinical features and/or any type of intervention for GD. A total of 263 articles were retrieved, and 116 original reports that were deemed relevant and satisfied the inclusion criteria were included in the analysis (88 case reports, 26 case series and two retrospective reviews). From these articles, 317 patients were identified, with a male‐to‐female ratio of 3.95. The mean age was 59 years (range 11–92). Typical lesions were itchy papules and vesicle‐papules, generally located on the trunk. Spontaneous resolution within one week to eight months was described in 42 % of cases. Topical corticosteroids (TCSs) were the most frequent treatment (response rate of 70 %) followed by systemic retinoids and corticosteroids with response rates of 86 % and 64 %, respectively. According to the results of this review, TCS appears to be the most frequently employed treatment, and we suggest TCS as first‐line therapy. Second‐line treatments could include systemic retinoids or systemic corticosteroids.

A Case of Extensive Grover’s Disease in a Patient with a History of Multiple Non-Melanoma Skin Cancers

“…GD was first described in 1970 as transient acantholytic dermatosis [ 1 ] typically occurring in white men around the sixth decade of life [ 2 ]. It clinically presents with benign, polymorphic, papulovesicular eruptions on the trunk that can form crusts and keratotic erosions [ 3 ].…”

“…In case of involvement of at least 1 additional body area, GD is classified as extensive or atypical if it involves a non-truncal area [ 4 ] as the case in our patient. The predominant symptom in 75% of GD patients is pruritus, whereas 25% are asymptomatic [ 2 ], the latter frequently being reported in extensive cases with associated malignancy [ 4 ]. The etiology of GD is unknown; however, several factors promoting the onset or extent of the disease have been reported.…”

“…The course of the disease can vary from a spontaneous resolution without treatment (in up to 42% of cases) [ 2 ] to a recurrent or chronic course in which skin lesions and pruritus last for several years with little response to therapy [ 5 ].…”

“…Additionally, it seems essential to strictly avoid exposure to the abovementioned promoting factors. Spontaneous regression of signs and symptoms may also occur by treatment of underlying diseases [ 2 , 5 ]. The latter not only supports the pathophysiological hypothesis of GD as a secondary disease requiring predisposing conditions to occur [ 5 ] but also highlights an important treatment target: the restoration and stabilization of skin integrity through elimination of the primary source of irritation.…”

Skin changes in hairy cell leukemia

“…Vemurafenib was also associated with other hyperkeratotic cutaneous adverse reactions including squamous cell carcinoma, plantar hyperkeratosis, verrucal keratosis, and keratosis pilaris–like reactions [ 119 , 120 ]. Grover’s disease is an acquired skin disorder characterized by pruritic papulovesicular eruptions, edematous papules, and/or papulovesicles of the trunk with acantholysis of the epidermis in histopathological examination [ 121 ]. Grover’s disease was observed in 42.9% of metastatic melanoma patients treated with a single BRAF inhibitor [ 119 ].…”