Original Article
Grover's Disease: Clinicopathologic Review of 72 Cases

https://doi.org/10.4065/74.3.229Get rights and content

Objective

To report the clinicopathologic findings in patients with Grover's disease.

Material and Methods

We reviewed the medical records and biopsy specimens from 72 patients with transient acantholytic dermatosis (Grover's disease) examined at Mayo Clinic Rochester. Hematoxylin-eosin-stained biopsy specimens (from all patients) were assessed. Immunohistochemistry stains BRST −2, CAM 5.2, and CD44 were used to stain eight specimens. Direct immunofluorescence reports were' reviewed. Selected specimens were stained by indirect immunofluorescence to detect major basic protein.

Results

Of the 72 patients, 63 (88%) were men, and the mean age was 48 years (range, 31 to 85). Lesions were distributed mainly on the trunk (in 71 patients) and proximal extremities (in 25). Heat and sweating frequently were exacerbating factors. Fifteen patients (21%) were bedbound. Concurrent nondermatologic malignant disease was present in 18 patients (25%). Two patients (3%) had acquired immunodeficiency syndrome. Follow-up in 28 patients (mean, 38 months; range, 3 months to 7 years) revealed that the disease had recurred in 13, persisted in 3, and resolved in 12. Review of the biopsy specimens showed that acantholysis was pemphigus vulgaris-like in 40 patients (56%), Darier's disease-like in 16 (22%), spongiotic in 12 (17%), pemphigus foliaceus-like in 2 (3%), and Hailey-Hailey disease-like in 2 (3%). A perivascular lymphocytic infiltrate of varied intensity in 64 specimens (89%) was associated with eosinophils in 16 (22%). In nine biopsy specimens with dermal eosinophilia stained for major basic protein, varied dermal cellular and extracellular deposition of major basic protein was present. Results of direct immunofluorescence studies, performed in 17 cases, were negative or nonspecific. CD44 stained acantholytic areas in addition to sweat glands in two of eight specimens (25%).

Conclusion

Further studies of the pathogenesis of Grover's disease are needed. The predisposing conditions, site of involvement, and relapsing nature of this disorder may implicate acrosyringeal dysfunction as the cause.

Section snippets

MATERIAL AND METHODS

The medical records and biopsy slides from patients with a diagnosis of Grover's disease or transient acantholytic dermatosis examined at our institution between 1972 and 1994 were reviewed. Patients were selected for this study on the basis of histologically proven focal acantholysis in association with a clinical history that ruled out other known causes of focal acantholysis.

RESULTS

The study group consisted of 72 patients—63 men (88%) and 9 women—all of whom were white. The mean age of the study cohort was 48 years (range, 31 to 85). The mean duration of disease at initial examination was 22 months (range, 10 days to 15 years). All but 1 of the 72 patients had pruritus, which was the indication for examination by a dermatologist in almost all instances.

Pruritic papules (in 70 patients), papulovesicles (in 13), plaques (in 3), and bullae (in 1) were the commonest primary

DISCUSSION

Transient acantholytic dermatosis has been reviewed previously.5, 6, 7 We describe the characteristics, associations, and outcome of Grover's disease in our patients.

The male-to-female ratio in the current study was 7:1. A 3:1 ratio has been reported.8 In our study, all patients were white, similar to the pattern of occurrence noted in most previous studies of this disorder. Twenty cases have been reported from Japan,9 and case reports have described Grover's disease occurring in the Korean

CONCLUSION

This large series of patients with Grover's disease and those previously described are similar in patient demographics, initial clinical manifestations, distribution of lesions, relationship to heat, exercise, and sweating, and occurrence of lesions in bedbound patients. Histologically, the previously described patterns of acantholysis were seen in biopsy specimens from our patients, and the results of the immunofluorescence studies were negative or inconsistent.

Findings in this study that

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    1

    Current address: St. Vincent's Hospital, Indianapolis, Indiana.

    2

    Current address: Hospital de Cruces, Bilbao, Spain.

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