Comment on “Grover disease: review of subtypes with a focus on management options”

Abstract

Dear Editor,With great interest, we read the review article by Aldana and Khachemoune, entitled "Grover disease: review of subtypes with a focus on management options", published in the International Journal of Dermatology. 1 The authors reviewed the literature on Grover disease (GD) and described the treatment options as presented in case reports, case series, and from anecdotal evidence.Recently, a patient consulted us with therapy-resistant GD.Over the last 3 years, therapies included topical emollients (i.e., Grenz irradiation, and methotrexate in a dose of 25-50 mg/week are summarized as possible useful treatment modalities (in our own experience, a lower dose of methotrexate can be sufficient as well). The author also gives an overview of treatments that were unsuccessful in GD. Therapies used without improvement in GD include cryotherapy, 5-fluorouracil cream, clindamycin lotion, erythromycin 2% lotion, and oral therapies including penicillin G, cephalosporins, erythromycin, tetracycline, dapsone, and sulfapyridine. 6In summary, treatment options for GD include topical emollients (e.g., 10% glycerin in sorbolene cream), mercurochrome solution, salicylic acid or urea-containing ointments, zinc oxide cream, mentholated lotions, topical steroids, topical retinoids, topical vitamin D analogues (calcitriol, calcipotriol, or tacalcitol ointment), triple antibiotic ointment, 40% TCA, oral antihistamines (hydroxyzine, cetirizine, and fexofenadine), nbUVB, bath PUVA, oral PUVA with methoxsalen, ultraviolet A1, oral prednisone, oral retinoids (acitretin and isotretinoin), photodynamic therapy with topical 5-aminolevulinic acid (5-ALA), total skin electron beam radiotherapy, Grenz irradiation, methotrexate, and etanercept. [1][2][3][4][5][6] We would like to thank Aldana and Khachemoune for their extensive review on GD and would like to encourage physicians to perform prospective studies on GD. The development of a patient registry for GD would also be helpful in order to elucidate the most effective treatment options in patients with GD.