Synonyms

• TAD
• Transient Acantholytic Dermatosis

Disorder Subdivisions

• None

Related Disorders List

Information on the following diseases can be found in the Related Disorders section of this report:

• Darier disease
• Dermatitis herpetiformis
• Pemphigus

General Discussion

Grover's disease is a rare, transient skin disorder that consists of small, firm, raised red lesions, most often on the skin of the chest and back. Diagnosis of this disorder becomes apparent under microscopic examination when the loss of the "cement" that holds the skin cells together is observed. Over time, as the skin loses the "cement", the cells separate (lysis). Small blisters containing a watery liquid are present. These blisters tend to group and have a swollen red border around them. Grover's disease is mainly seen in males older than forty or fifty. Its cause is unknown but it is thought to be related to trauma to sun damaged skin.

Symptoms

Symptoms of Grover's disease are small, solid, raised bumps on the skin; separation of connective tissue in the skin's outer layers (acantholysis); and itching (pruritus). For some patients the itching may be severe. Patients with this disorder often have blisters containing a thin, watery liquid with hair follicles (recessed spots with a central hair) within the affected area. The skin eruptions are found in groups and have a swollen, red border around them. The formation of skin overgrowth (hyperkeratosis) occurs above the blisters. There is an abnormality of the horny layer of the skin resulting from a disturbance in the process by which skin cells, damaged by the environment, attach to each other.



The eruptions in Grover's disease are usually found on the back, chest and sometimes on the sides of the extremities (arms and legs) and can last from a few weeks to many months. The disease usually recedes at its own pace (self-limiting).

Causes

The exact cause of Grover's disease is not known. It may be related to fragility of old sun-damaged skin. Some doctors feel that this skin disorder may be related to heat and sweating. There have been multiple cases of this disorder associated with such things as hot tubs, hot water bottles, electric blankets, steam baths and prolonged confinement to a bed. This theory has not been proven. At least one case of this disorder has been associated with follicle mites which are parasites.

Affected Populations

Grover's disease is a rare skin disorder seen mainly in males over the age of forty or fifty. It has also been found in females.

Related Disorders

Symptoms of the following disorders can be similar to those of Grover's disease. Comparisons may be useful for a differential diagnosis:



Darier disease is a gradually progressive, hereditary skin disorder. It is characterized by elevated spots (papules) on the scalp, forehead, face, neck, area behind the ears and middle of the back. Gradual burning and itching occurs and the spots become larger, darker and may be covered with grey/brown scales or crusts. This disorder is gradually progressive, and tends to become more severe with exposure to sunshine and/or emotional stress. Darier disease is inherited as a dominant trait. (For more information on this disorder choose "Darier Disease" as your search term in the Rare Disease Database.)



Dermatitis herpetiformis is an uncommon skin disorder affecting 15 to 60 year olds. Clustered blisters and firm spots (papules) may occur on the skin of the extensor areas (elbows, knees, pelvis, buttocks, skull), face and neck. Itching and burning may be severe. IgA (antibodies found in sweat, tears and saliva) is found in almost all normal-looking and blistered skin. The exact cause of dermatitis herpetiformis is unknown. (For more information on this disorder choose "Dermatitis Herpetiformis" as your search term in the Rare Disease Database.)



Pemphigus is a group of rare skin disorders characterized by blisters in the outer layer of the skin (epidermis) and within mucous membranes (the thin moist lining of the body's internal surfaces). The location and type of blisters varies according to the type of pemphigus. Blisters are common to all types of pemphigus. They may be firm or soft. Blisters form due to separation of closely connected tissues in the epidermis (acantholysis). Most patients with this disorder have increased IgG (a particular antibody in the blood that fights foreign substances) in the blood and in the areas of the blisters. IgG attacks foreign substances (antigens) located on the surface of particular skin cells and also can attack normal skin cells. (For more information on this disorder choose "Pemphigus" as your search term in the Rare Disease Database.)

Standard Therapies

Grover's disease may be difficult to treat in some patients. Some patients will be affected once and the condition may respond readily to standard treatments. For others, the disorder may recur several times and require long-term therapy or the use of more potent drugs. Decreased bathing and topical lubrication is usually beneficial.



The milder topical steroids and antihistamines may provide temporary relief of the itching that occurs with Grover's disease. Reports of the effectiveness of tetracycline may be found in the medical literature. The use of oral retinoids (acetretin or isotretinoin) has been reported, but these pharmaceuticals must be used with extreme care.



Topical treatment with selenium sulfide has been effective in clearing up the lesions on some patients.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com.

References

TEXTBOOK

James WD, Berger T, Elston DM. Eds. Andrew's Diseases of the Skin: Clinical Dermatology. 10th ed. Saunders Elsevier. Philadelphia, PA. 2006:478.



JOURNAL ARTICLES

Hanson M, Hsu S. Pruritic papules on the chest and back. Grover's disease. Am Fam Physician. 2006;74:641-42.



Scheinfeld N, Mones J. Seasonal variation of transient acantholytic dyskeratosis (Grover's disease). J Am Acad Dermatol. 2006;55:263-68.



Tscharner GG, Buhler S, Borner M, Hunziker T. Grover's disease induced by cetuximab. Dermatology. 2006;213:37-39.



Quirk CJ, Heenan PJ. Grover's disease: 34 years on. Australas J Dermatol. 2004;45:83-86.



Happle R. Linear Darier's or Grover's disease? J Am Acad Dermatol. 2003;49:1200-01.



FROM THE INTERNET

Grover's disease. DermNet NZ. Last updated 08 Dec 2006. 3pp.

http://www.dermnetnz.org/scaly/grovers.html

Accessed 12/29/2006



Grover's disease. The Doctor's Doctor. Last Updated July 7, 2006. 14pp.

http://www.thedoctorsdoctor.com/diseases/grovers_disease.htm

Accessed 12/29/2006



Grover's Disease. DermIS. nd. 1p

http://www.dermis.net/dermisroot/en/41086.htm

Accesed 12/29/2006



Zabawski Jr EJ, Cockerell CJ. Transient Acantholytic Dermatosis. emedicine. Last Updated: June 8, 2005. 10pp.

http://www.emedicine.com/derm/topic426.htm

Resources

NIH/NationaI Institute of Arthritis and Musculoskeletal and Skin Diseases

Information Clearinghouse

One AMS Circle

Bethesda, MD 20892-3675

USA

Tel: (301)495-4484

Fax: (301)718-6366

Tel: (877)226-4267

TDD: (301)565-2966

Email: NIAMSinfo@mail.nih.gov

Internet: http://www.niams.nih.gov/



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Email: http://rarediseases.info.nih.gov/GARD/EmailForm.aspx

Internet: http://rarediseases.info.nih.gov/GARD