Grover's disease (transient acantholytic dermatosis)
Definition & Pathogenesis
- Grover disease (Transient Acantholytic Dermatosis, TAD) = acquired, usually transient acantholytic dermatosis; Grover 1970 first description.
- Pathogenesis: Trigger is focal acantholysis of suprabasal keratinocytes without autoantibodies.
- Middle age / geriatrics: Manifestation typically > 40–50 years, m:f approx. 2–3:1.
- Triggers: Frequent triggers are heat + sweating + UV exposure + bedriddenness (hospital stay) + xerosis + oncologics (BRAF / IL-2 / anti-PD-1 therapy).
Clinical Presentation
- Location: Predilection sites are upper trunk (presternal, back) + proximal extremities.
- Morphology: Classic efflorescence is small (1–3 mm) erythematous papulovesicles with crust, densely set, polymorphic.
- Cardinal symptom: Characteristic is pronounced pruritus, often therapy-resistant.
- Course: classically transient (weeks–months), in 20–30 % chronic-relapsing over years.
Diagnostics
- Clinical + histology for diagnostic confirmation.
- Histology: Pathognomonic are focal suprabasal acantholysis with 4 histological patterns: Darier-like, Hailey-Hailey-like, pemphigus-like, spongiotic variant.
- DIF: In Grover, direct immunofluorescence is negative (DD to pemphigus / IgA pemphigus / Duhring).
- Serology: Anti-Dsg1/3 negative — important pemphigus exclusion.
- Trigger history: medications (BRAF inhibitors, IL-4 receptor blockers [dupilumab trigger described], anti-PD-1), sun exposure, sweating.
Differential diagnoses
- Seborrhoeic dermatitis
- Psoriasis vulgaris (plaque psoriasis)
- Urticaria
- Dyshidrotic hand eczema (pompholyx)
- Pityriasis rosea
- Atopic dermatitis (atopic eczema)
- Prurigo nodularis
- Hailey-Hailey disease
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Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.