Transitory acantholytic dermatosis L11.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

benign papular acantholytic dermatosis; Dermatosis acantholytic transient; Dermatosis benign papular acantholytic; Dermatosis transitory acantholytic; Grover M.; Grover`s disease; Grover's disease; M. Grover; persistent acantholytic dermatosis; transient acantholytic dermatosis

History
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Grover, 1970

Definition
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Probably not an entity but a collection of different benign, self-limiting dermatoses of unknown etiology which are histologically characterized by acantholysis. Possibly abortive form of M. Darier or M. Hailey-Hailey.

Etiopathogenesis
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Unknown, no family history. Provocations by local irritation, sunlight, xerosis, increased sweating and heat are possible.

Manifestation
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Occurs after the age of 40, especially in fair-skinned men.

Localization
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Preferably chest, neck, upper back.

Clinical features
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The clinical picture is extremely variable. There is always severe pruritus. The clinical picture originally described by Grover includes disseminated, urticarial, non-confluent papules and papulovesicles; Nikolski's phenomenon I and Nikolski's phenomenon II are negative (papulovesicular type). Also possible are bullous forms resembling pemphigus vulgaris, papular forms without the formation of vesicles, and papulokeratotic forms (similar to dyskeratosis follicularis).

Histology
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Acantholysis with subcorneal or suprabasal cleft formation, spongiosis and dyskeratosis. A distinction is made between Darier type, spongiotic type, Hailey-Hailey type and pemphigus type. Often several types coexist in one histological section. Monomorphic, lymphohistiocytic infiltrate in the papillary dermis.

Direct Immunofluorescence
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Pemphigus antibodies are negative.

Indirect immunofluorescence
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Pemphigus antibodies are negative.

Differential diagnosis
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External therapy
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Glucocorticoid creams such as 0.25% prednicarbate (e.g. Dermatop cream), 0.1% mometasone (e.g. Ecural fat cream) or 0.1% methylprednisolone (e.g. Advantan cream), above it lotio alba. Therapy attempt, especially in cases of agonizing pruritus with PUVA therapy or UVB/UVA radiation.

Internal therapy
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Glucocorticoids: 10-20 mg prednisolone equivalent/day(e.g. Urbason 8-10 mg or Decortin Tbl. 15-20 mg) Additional therapy with antihistamines such as desloratadine (e.g. Aerius) 5-10 mg/day or levocetirizine (e.g. Xusal) 5-10 mg/day. In extremely therapy-resistant cases, therapy with isotretinoin (e.g. isotretinoin-ratiopharm; acne normin) 30-40 mg/day. Cave! Safe anti-conception for women of childbearing age is absolutely necessary! Alternatively Acitretin (Neotigason Kps.) 20-30 mg/day.

Progression/forecast
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Mostly spontaneous healing within weeks to months, but also courses of treatment over many years are possible.

Literature
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  1. Bergua P et al (2003) Congenital acantholytic dyskeratotic dermatosis: localized Darier disease or disseminated benign papular acantholytic dermatosis? Pediatric dermatol 20: 262-265
  2. Fantini F et al (2002) Unilateral transient acantholytic dermatosis (Grover's disease) along Blaschko lines. J Am Acad Dermatol 47: 319-320
  3. Grover RW (1970) Transient acantholytic dermatosis. Arch Dermatol 101: 426-434
  4. Kiwan RA et al (2002) Grover disease (transient acantholytic dermatosis) and piebaldism. Cutis. 69: 451-453
  5. Lang I et al (1986) The spectrum of transient acantholytic dermatoses. Dermatologist 37: 485-493
  6. Sakalosky PE et al (2002) A case of acantholytic dermatosis and leukemia cutis: cause or effect? At J Dermatopathol 24: 257-259
  7. Scheinfeld N et al (2007) Seasonal variation of transient acantholytic dyskeratosis (Grover's disease). J Am Acad Dermatol 55: 263-268
  8. Streit M et al (2000) Transitory acantholytic dermatosis (Grover disease). An analysis of the clinical spectrum based on 21 histologically assessed cases. dermatologist 51: 244-249

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020