Grover Disease: A Reappraisal of Histopathological Diagnostic Criteria in 120 Cases

Abstract

Grover disease (GD) is a rather common papular pruritic dermatosis that can be transient, persistent, or asymptomatic. The microscopic diagnosis of clinically suspected lesions can be challenging because GD can adopt different patterns, and involved areas are generally admitted to be mostly focal. The histopathologic hallmark of the disease is acantholysis, frequently combined with dyskeratosis, which confers the lesions an appearance similar to Darier disease, Hailey-Hailey disease, or pemphigus. Eczematous features can be observed as well. In this study of 120 consecutive cases of GD, we have found a sex and age incidence similar to what has been previously described, with no obvious seasonal influence, but careful evaluation of their microscopic features suggests that the histopathological diagnostic criteria of GD should be expanded. Specifically, in addition to the commonly described GD findings, we have detected cases with porokeratosis-like oblique columns of parakeratosis, lesions showing a nevoid or lentiginous silhouette, intraepidermal vesicular lesions, lichenoid changes with basal vacuolization and dyskeratosis, and dysmaturative foci with keratinocyte atypia. Moreover, quite often the dermal infiltrate was composed not only of lymphocytes intermingled with eosinophils, but also of neutrophils. In many cases, the capillary vessels showed hints of vascular damage including endothelial tumefaction due to cytoplasmatic edema and erythrocyte extravasation. Finally, because involved areas were larger than 2 mm in more than 50% of our cases, we should assume that GD lesions are not always as small as commonly claimed. Awareness of the patterns newly described herein may be important to avoid underdiagnosis of GD and may contribute to understand the pathogenesis of this acantholytic disease.

Grover's Disease after Heart Transplantation: A Case Report

“…Recently the histologic spectrum of GD has been widened from its classic 4-pattern basis (Darier disease-like, Hailey-Hailey disease-like, pemphigus-like, and spongiotic) to include some newly identified patterns [4]. Unawareness of these unusual features may impede diagnosis as GD or lead to outright-misdiagnosis as actinic keratosis, solar keratosis, insect bites reactions or drug eruptions.…”

“…The histological diagnosis of clinically suspected lesions may be compromised by GD's capacity to adopt differing patterns, and by the fact that involved areas are generally diagnosed as focal. The histopathologic hallmark of the disease is acantholysis, frequently in combination with dyskeratosis, with the result that the lesions resemble those of Darier disease, Hailey-Hailey disease, or pemphigus [4]. …”

Grover’s Disease Following Multiple Bilateral Blaschko Lines: A Rare Clinical Presentation with Genetic and Electron Microscopic Analyses

“…Environmental factors such as heat, sweating and ultraviolet light exposure are known to serve as triggering factors in Grover’s disease [1,2]. Indeed, our patient was forced to bed rest because of deteriorated general condition.…”

“…The hallmark of the histopathological feature is the presence of acantholysis, and Darier’s disease-like pattern is frequently observed among a wide range of variations [1,2,3]. We herein report an exceptional case of Grover’s disease with multiple bilateral lesions along Blaschko lines, necessitating the exclusion of segmental Darier’s disease.…”

Grover Disease With Features of Epidermolytic Hyperkeratosis

“…3 Recent literature also suggests that there may histopathologic changes distinct to early GD that may aid in early diagnosis, including elongation of rete ridges with acantholysis and eosinophils. A variation in features has led to 4 classically recognized patterns of acantholysis in GD: Darier like, Hailey-Hailey like, pemphigus like, and spongiotic.…”