Transient acantholytic dermatosis (Grover disease)

Management Strategy

The diagnosis can be made on clinical grounds, although histology can also be helpful. Focal acantholysis is the characteristic epidermal change. Hyperkeratosis, parakeratosis, and spongiosis are other common histologic changes, and may mimic Darier disease, pemphigus, and Hailey–Hailey disease. Immunofluorescence does not aid in diagnosis.

Treatment is difficult; nearly all evidence for therapies comes from case series, case reports, and clinical experience. Patients should be advised to avoid known triggers such as excessive sun exposure, strenuous exercise, heat, and occlusive fabrics. In mild cases, simple antipruritic measures such as avoidance of soap , simple emollients , and soothing baths with bath oils or colloidal oatmeal may be of benefit. Wet compresses with zinc oxide, calamine, or potent topical corticosteroids may help relieve the itching. Antihistamines may be helpful for symptomatic relief of itching.

Topical calcipotriol (ointment) twice daily 50 mcg/g may be helpful after 3–4 weeks of treatment.

Systemic therapy may be indicated in more extensive and persistent disease. Oral vitamin A has been recommended in the past. The aromatic retinoid acitretin has been used successfully in doses of 0.5 mg/kg daily. Isotretinoin 40 mg daily has been used for periods ranging from 2 to 12 weeks. It may be administered on a reducing regimen if the initial response is rapid, with a maintenance dose of 10 mg daily.

Systemic corticosteroids have been used to suppress inflammation and pruritus, but relapses frequently occur on drug withdrawal.

Psoralen with UVA (PUVA) may be useful, but an initial exacerbation may occur. There are reports of the success of narrowband UVB and of medium-dose UVA1 phototherapy.

Topical 5-fluorouracil, dapsone, antibiotics, and cryotherapy are ineffective. Off-label uses of biologics (e.g., rituximab and etanercept) have been reported to be useful.