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Simpson CL, Tiwaa A, Zaver SA, Johnson CJ, Chu EY, Harms PW, Gudjonsson JE. ERK hyperactivation in epidermal keratinocytes impairs intercellular adhesion and drives Grover disease pathology. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.30.591953. [PMID: 38746263 PMCID: PMC11092613 DOI: 10.1101/2024.04.30.591953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Grover disease is an acquired dermatologic disorder characterized by pruritic vesicular and eroded skin lesions. While its pathologic features are well-defined, including impaired cohesion of epidermal keratinocytes, the etiology of Grover disease remains unclear and it lacks any FDA-approved therapy. Interestingly, drug-induced Grover disease occurs in patients treated with B-RAF inhibitors that can paradoxically activate C-RAF and the downstream kinase MEK. We recently identified hyperactivation of MEK and ERK as key drivers of Darier disease, which is histologically identical to Grover disease, supporting our hypothesis that they share a pathogenic mechanism. To model drug-induced Grover disease, we treated human keratinocytes with clinically utilized B-RAF inhibitors dabrafenib or vemurafenib and leveraged a fluorescent biosensor to confirm they activated ERK, which disrupted intercellular junctions and compromised keratinocyte sheet integrity. Consistent with clinical data showing concomitant MEK blockade prevents Grover disease in patients receiving B-RAF inhibitors, we found that MEK inhibition suppressed excess ERK activity to rescue cohesion of B-RAF-inhibited keratinocytes. Validating these results, we demonstrated ERK hyperactivation in skin biopsies of vemurafenib-induced Grover disease, but also in spontaneous Grover disease. In sum, our data define a pathogenic role for ERK hyperactivation in Grover disease and support MEK inhibition as a therapeutic strategy. GRAPHICAL ABSTRACT
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Moodie D, Dunn C, Fernandez C, Nathoo R. Retinoids for the Treatment of Refractory Grover's Disease: A Case Series and Review of the Literature. Cureus 2024; 16:e53510. [PMID: 38440005 PMCID: PMC10911476 DOI: 10.7759/cureus.53510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/06/2024] Open
Abstract
Grover's disease, also known as transient acantholytic dermatosis (TAD), currently has no published randomized control trials regarding the treatment of the disease; thus, evidence for treatment is largely derived from case studies and case reports. In this case series, we summarize the current treatment options for Grover's disease and discuss two cases of refractory Grover's disease treated with low-dose oral isotretinoin in patients who previously failed to reach clearance with multiple treatment options. Our aim is to highlight the efficacy of low-dose systemic retinoid therapy in Grover's disease when other treatment options prove unsatisfactory.
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Affiliation(s)
- David Moodie
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Charles Dunn
- Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery, Oviedo, USA
| | - Chloe Fernandez
- Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery, Oviedo, USA
| | - Rajiv Nathoo
- Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery, Oviedo, USA
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Hrin ML, Patel PV, Jorizzo JL, Feldman SR, Huang WW. Methotrexate Versus Acitretin for Grover's Disease Refractory to Topical Therapies. J Cutan Med Surg 2024; 28:68-69. [PMID: 37991057 DOI: 10.1177/12034754231211567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Matthew L Hrin
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Palak V Patel
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph L Jorizzo
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
| | - William W Huang
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Sudy E, Urbina F. Acantholytic Dyskeratosis Post-COVID-19 Vaccination: Another Case With Rapid Response to Isotretinoin. Am J Dermatopathol 2023; 45:727-728. [PMID: 37335843 DOI: 10.1097/dad.0000000000002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- Emilio Sudy
- Dermatologists in Private Practice, Santiago de Chile
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Alhetheli G, Alhazmi S, Almutairi S, Alharbi S, Alharbi N, Alsweed M, Al-Dhubaibi MS, Alsaud J, Asiri L. The Effects of Isotretinoin on The Menstrual Cycle: A Cross-Sectional Study. Clin Pract 2022; 12:908-917. [PMID: 36412674 PMCID: PMC9680279 DOI: 10.3390/clinpract12060095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Menstrual irregularities during isotretinoin therapy, including amenorrhea, can cause a great deal of health-status uncertainty such as the possibility of pregnancy. This study aimed to evaluate the effects of isotretinoin treatment on the menstrual cycle. This cross-sectional study was conducted among females aged between 15−45 years taking isotretinoin for acne. Descriptive statistics were used in the form of frequencies and percentages to represent categorical variables. Pearson’s chi-squared test was performed to assess the relationship between some of the variables with menstrual irregularities. A logistic regression model was performed to assess the risk factors for developing menstrual irregularities during isotretinoin therapy. Of participants with a known regular menstrual cycle, 10.4% were found to have irregularity in their cycle after starting the drug (p < 0.001). Amenorrhea was the most commonly reported menstrual irregularity in isotretinoin-treated females. Our results showed that single females, those who took isotretinoin for 10−12 months and who were concurrently taking hormonal contraceptives all have a statistically significant higher risk of developing menstrual irregularities than others. In conclusion, we found that a statistically significant number of participants with a regular menstrual cycle pre-isotretinoin intake developed irregularity in their cycle after starting the drug. The mechanism of how isotretinoin influences female hormonal imbalances, thereby affecting menstrual irregularities is still poorly understood and needs to be clarified in further clinical studies.
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Affiliation(s)
- Ghadah Alhetheli
- Division of Dermatology and Cutaneous Surgery, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
- Correspondence:
| | - Sadin Alhazmi
- College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | - Shumukh Almutairi
- College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | - Samar Alharbi
- College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | - Norah Alharbi
- College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | - Maha Alsweed
- College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | | | - Jolan Alsaud
- College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
| | - Lina Asiri
- College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
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Brihan I, Fekete G, Turda C, Tica O, Venter A, Ianosi S, Neagoe CD, Branisteanu D. Clinicopathological correlation of transient acantholytic dermatosis: A case report. Exp Ther Med 2021; 23:173. [PMID: 35069854 PMCID: PMC8764573 DOI: 10.3892/etm.2021.11096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ilarie Brihan
- Dermatology Department, Dermatology Clinic, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Gyula Fekete
- Dermatology Department, Dermatology Clinic, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology, 540530 Targu Mureș, Romania
| | - Constanta Turda
- Department of Psycho‑Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Ovidiu Tica
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alina Venter
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Simona Ianosi
- Department of Dermatology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Carmen-Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Daciana Branisteanu
- Department of Dermatology, University of Medicine and Pharmacy ‘Grigore T. Popa’, 700115 Iasi, Romania
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Das A, Sil A, Khullar G. Transient dermatoses: Leaving a lasting memory. Indian J Dermatol Venereol Leprol 2021; 88:265-267. [PMID: 34245536 DOI: 10.25259/ijdvl_1028_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Abheek Sil
- Department of Dermatology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Geeti Khullar
- Department of Dermatology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Bellinato F, Maurelli M, Gisondi P, Girolomoni G. Clinical features and treatments of transient acantholytic dermatosis (Grover's disease): a systematic review. J Dtsch Dermatol Ges 2020; 18:826-833. [PMID: 32767513 DOI: 10.1111/ddg.14202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/07/2020] [Indexed: 01/27/2023]
Abstract
Grover's disease (GD) is an itchy acantholytic disorder occurring on the trunk of middle-aged men. Based on the best evidence, this study aimed to provide a summary of the clinical characteristics, disease course and treatments of GD. A systematic review was performed according to PRISMA guidelines for original articles published between 01.01.1970-08.15.2019, assessing clinical features and/or any type of intervention for GD. A total of 263 articles were retrieved, and 116 original reports that were deemed relevant and satisfied the inclusion criteria were included in the analysis (88 case reports, 26 case series and two retrospective reviews). From these articles, 317 patients were identified, with a male-to-female ratio of 3.95. The mean age was 59 years (range 11-92). Typical lesions were itchy papules and vesicle-papules, generally located on the trunk. Spontaneous resolution within one week to eight months was described in 42 % of cases. Topical corticosteroids (TCSs) were the most frequent treatment (response rate of 70 %) followed by systemic retinoids and corticosteroids with response rates of 86 % and 64 %, respectively. According to the results of this review, TCS appears to be the most frequently employed treatment, and we suggest TCS as first-line therapy. Second-line treatments could include systemic retinoids or systemic corticosteroids.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Bellinato F, Maurelli M, Gisondi P, Girolomoni G. Klinische Merkmale und Behandlungen der transitorischen akantholytischen Dermatose (Morbus Grover): ein systematischer Review. J Dtsch Dermatol Ges 2020; 18:826-834. [DOI: 10.1111/ddg.14202_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
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Aldana PC, Khachemoune A. Grover disease: review of subtypes with a focus on management options. Int J Dermatol 2019; 59:543-550. [PMID: 31724740 DOI: 10.1111/ijd.14700] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/25/2023]
Abstract
Grover disease (GD) is a benign eruption that causes a papulovesicular rash on the trunk and proximal extremities. It often resolves spontaneously but can follow a more chronic and fluctuating course that may last several years. Although the etiology remains unknown, several associated triggers have been identified including heat and sweating, cool and dry air, renal failure, malignancy, and the initiation of several drugs. Since the disease tends to resolve on its own, management is aimed at disease prevention and symptomatic relief. First-line therapy includes topical steroids and vitamin D analogues with adjuvant antihistamines. In more severe cases that are refractory to less aggressive therapy, systemic corticosteroids, retinoids, and phototherapy may lead to successful resolution. Novel therapies are few and have little evidence but involve innovative use of light therapy and immune modulators. Herein, we review the literature and new trends of GD with a focus on established and novel treatments.
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Affiliation(s)
- Paola C Aldana
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA.,Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
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Gantz M, Butler D, Goldberg M, Ryu J, McCalmont T, Shinkai K. Atypical features and systemic associations in extensive cases of Grover disease: A systematic review. J Am Acad Dermatol 2017; 77:952-957.e1. [PMID: 28918973 DOI: 10.1016/j.jaad.2017.06.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/13/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Grover disease is an acantholytic disorder that typically occurs on the trunk of older individuals, primarily white men, in association with heat and xerosis. Cases with extensive and/or atypical distributions have been reported. OBJECTIVE To review the literature characterizing the population, morphology, associations, and disease course of extensive or atypical eruptions of Grover disease. METHODS A systematic literature review identified 50 articles with 69 cases. RESULTS Patient age ranged from 14 to 83 years (mean age, 56 ± 15), with 71% of patients being male and 29% female. Areas of involvement included the trunk (90%), upper and lower extremities (63% and 61%, respectively), face/scalp (28%), neck (21%), groin (11%), buttocks (8%), and axillae (6%). The most common associations included a history of malignancy (61%), recent chemotherapy (38%), and recent transplant (20%). LIMITATIONS Extensive cases with typical clinical morphology may not have been examined by biopsy or reported; thus, this review may have publication bias toward more severe or atypical presentations. CONCLUSIONS Greater variability exists among patients affected by extensive or atypical Grover disease than among those with typical disease. Malignancy is a common association, and there may be a role for immunosuppression in the pathogenesis of extensive or atypical Grover disease.
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Affiliation(s)
- Madeleine Gantz
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Daniel Butler
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Matthew Goldberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jubin Ryu
- Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, California
| | - Timothy McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Kanade Shinkai
- Department of Pathology, University of California, San Francisco, California.
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Norman R, Chau V. Use of etanercept in treating pruritus and preventing new lesions in Grover disease. J Am Acad Dermatol 2011; 64:796-8. [PMID: 21414507 DOI: 10.1016/j.jaad.2009.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 01/23/2009] [Accepted: 02/05/2009] [Indexed: 11/16/2022]
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Kouba DJ, Dasgeb B, Deng AC, Gaspari AA. Effective treatment of persistent Grover's disease with trichloroacetic acid peeling. Dermatol Surg 2006; 32:1083-8; discussion 1088. [PMID: 16918573 DOI: 10.1111/j.1524-4725.2006.32233.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David J Kouba
- Department of Dermatology, University of Maryand School of Medicine, Baltimore, Maryland 21201, USA
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Effective Treatment of Persistent Groverʼs Disease with Trichloroacetic Acid Peeling. Dermatol Surg 2006. [DOI: 10.1097/00042728-200608000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Breuckmann F, Appelhans C, Altmeyer P, Kreuter A. Medium-dose ultraviolet A1 phototherapy in transient acantholytic dermatosis (Grover's disease). J Am Acad Dermatol 2005; 52:169-70. [PMID: 15627107 DOI: 10.1016/j.jaad.2004.06.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- A Arechalde
- Department of Dermatology, University Hospital Geneva, Switzerland
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Erös N, Kovács A, Károlyi Z. Successful treatment of transient acantholytic dermatosis with systemic steroids. J Dermatol 1998; 25:469-75. [PMID: 9714982 DOI: 10.1111/j.1346-8138.1998.tb02437.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A sixty-year-old man, developed 2-5 mm sized, hyperemic, itchy papules, vesicles, erosions and crusts on hyperemic base on his chest, abdomen, back, gluteal region, and proximal sites of his upper and lower extremities. The direct and indirect immunoflurescence tests were negative. Histology revealed extensive acantholysis in the epidermis in the following forms: pemphigus vulgaris-like suprabasal acantholysis, Darier-like acantholytic dyskeratosis with corps ronds, Hailey-Hailey-like suprabasal clefts, and pemphigus foliaceus-like superficial acantholysis with spongiosis. Using systemic steroids, topical drying, and reepithelising therapy, the patient was cured. He was symptom-free the first, fourth, and thirteenth months after finishing steroid therapy. We review the literature and the new subdivision of the disease according to the histological and clinical features.
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Affiliation(s)
- N Erös
- Department of Dermatology, Semmelweis Hospital, Miskolc, Hungary
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Parsons JM. Transient acantholytic dermatosis (Grover's disease): a global perspective. J Am Acad Dermatol 1996; 35:653-66; quiz 667-70. [PMID: 8912557 DOI: 10.1016/s0190-9622(96)90715-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Twenty-six years have passed since Grover first described transient acantholytic dermatosis. Since then, the concept of Grover's disease has been expanded to include persistent acantholytic dermatoses as well. Although its origin remains unknown, it may result from an isomorphic response to excessive heat, sweating, or xerosis. It is currently classified as a nonfamilial, non-immune-mediated, acantholytic disorder.
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Abstract
We report a case of a bullous variant of transient acantholytic dermatosis in a 59-year-old female. Each bullous lesion lasted several weeks and healed without scarring. The lesions were migratory and recurrent without a cleared period. Histopathologic examination revealed an intraepidermal vesicle low in the epidermis. The lesions cleared after 2 months of isotretinoin therapy.
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Affiliation(s)
- J H Yoo
- Department of Dermatology, Seoul National University College of Medicine, Korea
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