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

Abstract

Grover disease (GD) is a benign eruption that causes a papulovesicular rash on the trunk and proximal extremities. It often resolves spontaneously but can follow a more chronic and fluctuating course that may last several years. Although the etiology remains unknown, several associated triggers have been identified including heat and sweating, cool and dry air, renal failure, malignancy, and the initiation of several drugs. Since the disease tends to resolve on its own, management is aimed at disease prevention and symptomatic relief. First-line therapy includes topical steroids and vitamin D analogues with adjuvant antihistamines. In more severe cases that are refractory to less aggressive therapy, systemic corticosteroids, retinoids, and phototherapy may lead to successful resolution. Novel therapies are few and have little evidence but involve innovative use of light therapy and immune modulators. Herein, we review the literature and new trends of GD with a focus on established and novel treatments. Historical evolution of our understanding of Grover disease Grover disease was first described in 1970 as a self-limited eruption of pruritic, discrete, and edematous papules and vesicles which appeared on the trunk and extremities following nonspecific irritation. These lesions occurred in six patients without family history of skin disease and had a duration of a few weeks up to several months. Cytology of the lesions revealed focal acantholysis within the epidermis and varying levels of dyskeratosis that resembled changes seen in Darier and Hailey-Hailey ª

Grover's disease successfully treated with calcipotriene/betamethasone dipropionate ointment

“…There is no established treatment for GD as it is difficult to evaluate the efficacy of medicines due to its characteristics of spontaneous remission and fluctuation. Several case series and case reports show the effectiveness of emollients, topical corticosteroids, topical vitamin D analogs, oral antihistamines, oral retinoids and oral corticosteroids 1‐4 . Although it may spontaneously remit, the effectiveness of Cal/BD was suggested in our case by prompt improvement after the switching from topical corticosteroid and the superior effectiveness to the calcipotriol ointment in a half‐side test.…”

“…Grover's disease (GD) is a self‐limiting skin disorder characterized by multiple pruritic papules or vesicles on the trunk and extremities 1 . Histologically, it shows focal acanthosis and dyskeratosis in the epidermis 1 . Topical corticosteroids are useful in a limited number of patients 2 .…”

Epidermolytic hyperkeratosis: one more pattern of Grover disease

“…Grover disease (GD) is an acquired dermatosis that is classically described as an itching papulovesicular rash which forms crusts and keratotic erosions after a few weeks 1 . It is characterized by four different acantholytic histologic patterns, spongiotic, pemphigus‐like, Darier‐like, and Hailey‐Hailey‐like.…”

“…Exacerbating factors typically include heat, exercise, sweating, and UV light 3 . Chronic renal failure, malignancy, and transplants have also been associated with GD eruptions 1 . Moreover the microscopic hallmark of GD is the presence of focal acantholysis and dyskeratosis 2 .…”

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

“…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.…”