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Galli-Galli disease
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Galli-Galli disease

Contributors: Carolyn Ziemer MD, Donna A. Culton MD, PhD, Whitney A. High MD, JD, MEng
Other Resources UpToDate PubMed


Galli-Galli disease (GGD) is a rare autosomal dominant genodermatosis that falls under the broader category of reticulate pigmented disorders of the skin. GGD is thought to be an allelic variant of Dowling-Degos disease (DDD), the latter a pigmentary disorder characterized by progressive hyperpigmentation of flexural skin. The distinguishing feature of GGD is the presence of suprabasal acantholysis histologically, and as such it has also been described as "acantholytic Dowling-Degos disease" in the literature.

In 1982, Bardach et al described the first cases of disease occurring in two brothers named Galli. The brothers presented with a reticulated hyperpigmented eruption affecting the skin folds. Biopsy demonstrated proliferation of rete ridges and basal layer hyperpigmentation as seen in DDD, but also focal suprabasal acantholysis.

Initially, GGD was favored to be a distinct clinical entity from DDD due to the unique and consistent feature of acantholysis; however, subsequent research supports a common etiology for DDD and GGD, as both have been found to share the same genetic defect.

Frameshift or nonsense KRT5 gene mutations lead to haploinsufficiency of keratin 5, a protein that plays an important role in cell-cell adhesion, epidermal differentiation, and melanosome uptake. The mechanism by which specific KRT5 mutations seen in DDD and GGD cause skin disease or correlate with variable histological subtypes is not yet elucidated.


L81.9 – Disorder of pigmentation, unspecified

370172004 – Skin pigmentation

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Differential Diagnosis & Pitfalls

Other reticulate pigmented disorders of the skin may be difficult to distinguish clinically, but the finding of suprabasal acantholysis on biopsy is exclusive to GGD.
  • Dowling-Degos disease – GGD is an acantholytic variant of DDD. Clinically, DDD may show comedo-like lesions and pitted perioral acneiform scars not typically seen in GGD.
  • Reticulate acropigmentation of Kitamura – Presents with acral hyperpigmented atrophic macules / pits or palmar fissures.
  • Reticulate acropigmentation of Dohi (dyschromatosis symmetrica hereditaria) – Presents with acral hyper- and hypopigmented macules on the dorsal hands and feet.
  • Haber syndrome – Verruciform papular lesions of trunk and roseate facial erythema, often presenting in childhood.
Other considerations in the differential diagnosis include:
  • Darier disease – Earlier onset, seborrheic distribution, characterized by crusted yellow-brown papules rather than lentigo-like macules; nail changes and mucous membrane involvement. On biopsy, dyskeratosis seen in Darier disease and not GGD.
  • Hailey-Hailey disease – Erosions in skin folds, dilapidated brick wall histology.
  • Grover disease – Very pruritic keratotic papules on trunk; acantholysis and dyskeratosis seen on biopsy, no elongation of rete ridges as in GGD.
  • Epidermolysis bullosa with mottled pigmentation – Also caused by keratin 5 mutation; has additional features of palmoplantar hyperkeratosis, bullous lesions.
  • Pemphigus vulgaris – Cutaneous and mucosal involvement, plus Nikolsky, plus immunofluorescence.
  • Confluent and reticulated papillomatosis (Gougerot-Carteaud syndrome)
  • Granular parakeratosis
  • Acanthosis nigricans

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Last Updated:03/20/2018
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Galli-Galli disease
A medical illustration showing key findings of Galli-Galli disease : Axilla, Brown color, Flexural distribution, Intertriginous distribution, Reticular - netlike, Hyperpigmented macules, Hyperpigmented papules
Clinical image of Galli-Galli disease - imageId=6846206. Click to open in gallery.  caption: 'Discrete and reticulated, brown macules and plaques on the breast and upper abdomen.'
Discrete and reticulated, brown macules and plaques on the breast and upper abdomen.
Copyright © 2023 VisualDx®. All rights reserved.