Transient acantholytic dermatosis
Alerts and Notices
SynopsisTransient acantholytic dermatosis, also known as Grover disease, is an acquired skin disorder of unknown etiology. The disease has been diagnosed in 0.1%-0.8% of the total population and is found primarily in White men aged 30 and older; the male-to-female ratio ranges from 1.8-7:1 in the literature. Although the cause has not been established, the condition has been linked to heat, sweating, excessive sun exposure, ionizing radiation, and some medications, including immunotherapies such as BRAF inhibitors, sulfadoxine-pyrimethamine, recombinant IL-4, ipilimumab, and other immune checkpoint inhibitors.
One large retrospective study of outpatients found the disease diagnosed 4 times more often in the winter than in the summer and attributed this difference to dry skin. Another study of inpatients found prolonged bed rest as a risk factor. Atopic dermatitis, renal failure (acute, chronic), transplantation, and malignancies have also been associated with this diagnosis.
Clinically, transient acantholytic dermatosis presents with red scaly papules and papulovesicles over the trunk. The condition is usually intensely pruritic; however, some individuals are asymptomatic. Flares of disease may be marked by an increase in both pruritus and surrounding erythema, vesicles, and erosions. This appearance is frequently encountered on the backs of hospitalized patients on prolonged bed rest.
This condition is histologically variable, and the key finding on pathology is focal acantholysis. The disease can be self-resolving or may wax and wane for several years, and cases of persistent disease have been reported. Since the condition is benign, the primary goal of treatment is control of symptoms.
L11.1 – Transient acantholytic dermatosis [Grover]
17796002 – Transient acantholytic dermatosis
Differential Diagnosis & Pitfalls
- Bacterial folliculitis or Pityrosporum folliculitis – Lesions are perifollicular and pustules may be more evident.
- Acne – Younger patients with more pustules, inflammatory papules, and comedones located on the face in addition to the trunk.
- Pemphigus foliaceus – Larger erosions that may have yellow, flaky, adherent scale.
- Pemphigus vulgaris – Presents with oral mucosal involvement.
- Impetigo – Impetiginization and honey-colored crusting.
- Miliaria rubra – Distributed in areas where there has been prolonged occlusion.
- Cutaneous candidiasis – May present with pustules in areas where there has been prolonged occlusion.
- Seborrheic dermatitis – Sebaceous distribution, scaly plaques.
- Pityriasis rosea – Herald patch with papules and plaques arranged along the skin fold lines.
- Scabies – Look for burrows in characteristic locations, such as the finger web spaces and wrists.
- Darier disease – Seborrheic distribution with associated nail changes; lifelong as well as family history.
- Hailey-Hailey disease – Affects intertriginous areas of the skin; lifelong as well as family history.
- Galli-Galli disease – Affects larger portions of the body and has characteristic downward protrusion of digitate rete ridges.
- Arthropod assault
- Papular eczema
- Multiple lichen planus-like keratoses
- Multiple actinic keratoses
- Irritant contact dermatitis
- Pityriasis lichenoides
- Secondary syphilis
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Transient acantholytic dermatosis