Grover's disease

[Guest guest]

Hi all,

Not holding my breath here, but by any chance has anyone

on this list ever heard of Grover's disease? It is basically a

rash that typically appears on the chest and trunk. I have

only a mild case, but have had it for several years now, and

would love to find a way to take care of it (my doctor wants

to give me cortisone, which I have declined).

Any help or info much appreciated.

Dave

Here is a technical description:

Background: Transient acantholytic dermatosis (Grover's Disease) is a not

uncommon condition, but surprisingly it was not thoroughly characterized

until Grover did so in 1970. While generally accepted to be a benign,

self-limited disorder, it is often persistent and difficult to manage;

hence, the description of “transient” is misleading. The presentation can be

subtle or it may closely resemble other pruritic dermatoses. A high index of

suspicion for this disease is necessary if the diagnosis is to be made

correctly. Furthermore, the histology of Grover disease closely resembles

that of several other conditions that are clinically distinct, which may add

to potential diagnostic confusion.

Pathophysiology: The etiology of Grover disease is unknown. A number of

factors have been suggested as being potentially causal or exacerbating,

however. The most frequent association is with heat or sweating, and

obstruction of sweat ducts has been postulated to be responsible. Many

patients describe preceding exposure to sunlight, although exposure to

artificial ultraviolet radiation has not been shown to reproduce the

process. Grover disease seems to occur more frequently in patients with

atopic dermatitis and asteatotic dermatitis, although many individuals with

these conditions never develop it. Viral, bacterial and other pathogens have

also been proposed, but no causative role has been established. The exact

pathogenesis has not been elucidated.

Frequency: In the US: Exact numbers regarding the prevalence of the disease

are not available. Because of the clinical similarities with other entities

and variable findings histopathologically, the disease is underdiagnosed in

nondermatology settings and probably underdiagnosed overall.

Race: Grover disease most commonly affects middle-aged white men, although

it may be seen in other ethnic groups such as Hispanics and blacks.

Sex: Men are affected 3 times more often than women.

Age: Grover disease most commonly affects middle-aged men; however, it has

been in reported in children.

History: One of the hallmarks of Grover disease is pruritus, and all

affected individuals experience variable degrees of itching, sometimes

severe in nature. The clinical appearance does not always correlate to the

degree of pruritus; for example, some patients with limited cutaneous

disease complain of severe itching, while others with many lesions have few

or no symptoms.

Physical: The process usually begins as an eruption of the skin of the

anterior chest, upper back and lower rib cage. Severely affected patients

may have disseminated disease affecting the neck, shoulders, arms and legs.

The scalp is usually not affected, and the palms and soles are almost always

spared. Individual lesions are erythematous to red brown keratotic papules

that remain discrete and do not usually tend to coalesce. Occasionally,

lesions may be acneiform, vesicular, pustular and rarely, even bullous.

Although the most common presentation is that of widespread scattered

papules, there may be unusual distributions including zosteriform. No

systemic symptoms are associated with Grover disease, but oral lesions can

develop that resemble aphthae and may be slightly painful.

Causes: The etiology of Grover disease is unknow