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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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2
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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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3
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Witte F, Zeidler C, Ständer S. [Management of pruritus in the elderly]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:670-677. [PMID: 37599291 DOI: 10.1007/s00105-023-05207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Chronic pruritus (CP), a frequent (20.3%) symptom in the elderly, increases with age. It has a significant impact on the quality of life, ranking among the 50 most burdensome diseases worldwide (Global Burden of Disease Study). OBJECTIVES The aim is to provide an overview of the symptom CP in the elderly and to improve differentiation of underlying conditions and management of this entity. MATERIALS AND METHODS A literature search in PubMed was performed, using the terms 'pruritus', 'elderly' and 'gerontodermatology'. RESULTS The main causes of CP in the elderly are the physiologic aging process (xerosis cutis, immunosenescence, neuropathy), the increase in potentially pruritic diseases with increasing age (diabetes mellitus, chronic renal failure), and polypharmacy. Therapeutic options relate to causes, severity of pruritus, and individual patient factors (multimorbidity, impaired organ function). The recently updated S2k guideline 'Diagnosis and therapy of chronic pruritus' is helpful. CONCLUSION CP in the elderly is challenging for both patients and physicians. Not only the difficulty of identifying the underlying cause, but the complexity of treatment and its tolerability and practicability determines these patients' further burden.
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Affiliation(s)
- F Witte
- Klinik für Hautkrankheiten, Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - C Zeidler
- Klinik für Hautkrankheiten, Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - S Ständer
- Klinik für Hautkrankheiten, Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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4
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Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management. Am J Clin Dermatol 2023; 24:199-223. [PMID: 36539678 DOI: 10.1007/s40257-022-00746-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.
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A Rare Case of Transient Acantholytic Dermatosis (AKA. Grover's Disease) with Concomitant Pediculosis Pubis: An Atypical Presentation and First Documented Case Report. Dermatopathology (Basel) 2021; 8:502-508. [PMID: 34698112 PMCID: PMC8544346 DOI: 10.3390/dermatopathology8040052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
A 66-year-old male presented with a one-month history of persistent pruritic eruptions distributed mainly on the trunk. A punch biopsy from the left upper abdomen revealed focal acantholytic dyskeratosis with mixed inflammatory infiltrate in the dermis composed of numerous eosinophils. Grover's disease was diagnosed based on the clinical and histopathological findings. Appropriate treatment was initiated but failed to relieve symptoms of itchiness. A further investigation of the hair follicles under mineral oil preparation revealed an infestation of pediculosis pubis. Subsequent treatment with Ivermectin and permethrin cream led to the complete resolution of his symptoms. This case report highlights an unusual and first documented case of Grover's disease with a concomitant infestation of pediculosis pubis. To date, no reported cases in the literature have associated Grover's disease with pubic lice infestation. However, there are three reported cases of concurrent scabies and Grover's disease in the literature. This rare case underscores the clinical value in further investigating treatable underlying conditions in patients with suspected transient acantholytic dermatosis.
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6
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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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7
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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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8
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Abstract
ABSTRACT Grover disease is an acquired acantholytic dermatosis affecting middle-aged men, with pruritus being the most commonly associated symptom. Grover disease tends to wax and wane and can last between several months to several years. Although Grover disease is usually papular, we report here a patient who presented with mainly vesicular and bullous lesions on his back originally concerning for folliculitis, contact dermatitis, or disseminated herpes simplex viral infection. Skin biopsy demonstrated acantholysis, suprabasal blisters, and a predominantly lymphocytic dermal infiltrate. Tzanck preparation for giant cells, immunohistochemistry for viral markers, and direct immunofluorescence staining were all negative. A diagnosis of bullous Grover disease was made based on clinicopathological correlation. Minocycline was recommended based on report of its efficacy. However, patient declined treatment and his rash self-resolved within a couple of months. This case brings awareness to this atypical variant of Grover disease and encourages physician to include Grover disease in their differential of vesiculobullous disorders.
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9
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Zweegers J, Lubeek SFK. Comment on “Grover disease: review of subtypes with a focus on management options”. Int J Dermatol 2020; 59:e135-e136. [DOI: 10.1111/ijd.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jeffrey Zweegers
- Department of Dermatology Radboud University Medical Center Nijmegen The Netherlands
| | - Satish F. K. Lubeek
- Department of Dermatology Radboud University Medical Center Nijmegen The Netherlands
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10
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Affiliation(s)
- Jayden Galamgam
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, California
| | - Delphine J. Lee
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Correspondence to: Delphine J. Lee, MD, PhD, Division of Dermatology, Harbor-UCLA Medical Center and The Lundquist Institute, 1000 W Carson St, Box 458, Torrance, CA 90502.
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11
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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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12
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Hailey-Hailey-Like Pattern of Acantholysis on the Scalp Should Raise the Possibility of Incipient Pemphigus Vulgaris. Am J Dermatopathol 2019; 41:286-288. [PMID: 30640761 DOI: 10.1097/dad.0000000000001298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hailey-Hailey disease (familial benign chronic pemphigus) is a genodermatosis with a typical clinical presentation of macerated plaques involving intertriginous areas of the body and affects multiple family members. Epidermal acanthosis, incipient, and completed acantholysis of many of the spinous keratinocytes of the epidermis and foci of dyskeratosis are well-recognized histologic findings. We have observed solitary lesions on the "scalp" of patients having a Hailey-Hailey-like pattern, and not the suprabasilar clefting of pemphigus represents the first manifestation of pemphigus vulgaris, which was confirmed with direct immunofluorescence in all our patients.
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13
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See SHC, Peternel S, Adams D, North JP. Distinguishing histopathologic features of acantholytic dermatoses and the pattern of acantholytic hypergranulosis. J Cutan Pathol 2018; 46:6-15. [DOI: 10.1111/cup.13356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Sharlene Helene C. See
- Department of Dermatology; University of California San Francisco; San Francisco California
- Department of Pathology; University of California San Francisco; San Francisco California
| | - Sandra Peternel
- Department of Dermatology; University of California San Francisco; San Francisco California
- Department of Pathology; University of California San Francisco; San Francisco California
- Department of Dermatovenereology, University of Rijeka, Faculty of Medicine; Rijeka Croatia
| | - Derrick Adams
- Lassen Medical Clinic, Dermatology division; Red Bluff California
| | - Jeffrey P. North
- Department of Dermatology; University of California San Francisco; San Francisco California
- Department of Pathology; University of California San Francisco; San Francisco California
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14
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Donati M, Paolino G, Didona D, Panetta C, Vollono L, Mercuri SR, Donati P. Bullous pemphigoid as a further association in extensive cases of Grover disease. GIORN ITAL DERMAT V 2018; 155:515-516. [PMID: 30350558 DOI: 10.23736/s0392-0488.18.06066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michele Donati
- Department of Surgical Pathology, Campus Biomedico University, Rome, Italy
| | - Giovanni Paolino
- Department of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Dermatology, Sapienza University, Rome, Italy
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany -
| | - Chiara Panetta
- Laboratory of Dermatopathology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Laura Vollono
- Unit of Dermatology, Tor Vergata Polyclinic Foundation, Tor Vergata University, Rome, Italy
| | - Santo R Mercuri
- Department of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Pietro Donati
- Laboratory of Dermatopathology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
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15
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Ellenbogen E, Geller S, Azrielant S, Zeeli T, Goldberg I, Schmidt E, Zillikens D, Mrowietz U, Sherman S, Mercer S, Didkovsky E, Hodak E, Sprecher E. Grover disease and bullous pemphigoid: a clinicopathological study of six cases. Clin Exp Dermatol 2018; 44:524-527. [PMID: 30264538 DOI: 10.1111/ced.13789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/29/2022]
Abstract
Grover disease (GD) is an idiopathic dermatosis that typically manifests as itchy papules over the trunk in middle-aged men. Bullous pemphigoid (BP) is an autoimmune bullous disease that affects older people. Not only are the two diseases easily distinguishable on clinical grounds, they are also characterized by differences in histopathology, pathogenesis and response to treatment Thus, the co-occurrence of these two conditions in the same patient is usually considered coincidental. In this report, we present a multicentre retrospective analysis of six patients who developed both GD and BP over a short period of time, and in all cases but one, GD preceded BP. We discuss the clinical and histopathological features of these patients, and the suggested mechanisms of the diseases. We conclude that GD might predispose to the development of BP.
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Affiliation(s)
- E Ellenbogen
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Geller
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Azrielant
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Zeeli
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Goldberg
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Germany
| | - U Mrowietz
- Department of Dermatology, Venerology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S Sherman
- Department of Dermatology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Mercer
- Department of Dermatology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Didkovsky
- Institute of Pathology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Hodak
- Department of Dermatology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Grover Disease With Epidermal Dysmaturation Pattern: A Common Histopathologic Finding. Am J Dermatopathol 2018; 40:642-646. [PMID: 29443699 DOI: 10.1097/dad.0000000000001112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Grover disease is an entity whose diagnosis is based on clinicopathologic correlation. Histopathologically, focal acantholysis is the most common finding. In some cases, there is prominent squamous atypia which can prove to be very challenging and the lesion may be confused with an epidermal neoplasm. OBJECTIVE To report on atypical histopathological changes in Grover disease and to provide helpful clues to differentiate between the epidermal atypia seen in some cases of Grover disease and epithelial neoplasms. MATERIAL AND METHODS We analyzed 33 cases of Grover disease histologically diagnosed at Wake Forest Baptist Medical Center, NC, between 2011 and 2017. Atypical changes in keratinocytes were defined as epithelial buds, nuclear pleomorphism, and dyskeratosis in all layers of epidermis or altered granular layer. RESULTS Twenty cases (64%) showed foci with alteration of the normal keratinocytic maturation, whereas 18 cases demonstrated nuclear pleomorphism. Buds of epithelial cells emanating from the basal layer of the epidermis and granular cell alteration was present in 19 cases. CONCLUSIONS The findings especially the presence of an altered granular layer may represent a diagnostic clue in cases of Grover disease with atypical changes.
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17
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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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18
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Matsudate Y, Urano Y, Hashimoto T. Grover's disease in a patient with pemphigus vulgaris. Int J Dermatol 2017; 56:1052-1054. [PMID: 28766705 DOI: 10.1111/ijd.13718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Yoshio Urano
- Division of Dermatology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
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19
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Rodríguez-Pazos L, Vilas-Sueiro A, González-Vilas D, Durana C. Enfermedad de Grover en fracaso renal crónico. Nefrologia 2015; 35:331-4. [DOI: 10.1016/j.nefro.2015.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
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20
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Cohen PR, Paravar T, Lee RA. Epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection: multinucleated epithelial giant cells in the epidermis of lesional skin biopsies from patients with acantholytic dermatoses can histologically mimic a herpes virus infection. Dermatol Pract Concept 2014; 4:21-7. [PMID: 25396080 PMCID: PMC4230253 DOI: 10.5826/dpc.0404a03] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Multinucleated giant cells in the epidermis can either be epithelial or histiocytic. Epithelial multinucleated giant cells are most often associated with herpes virus infections. PURPOSE To review the histologic differential diagnosis of conditions with epithelial and histiocytic multinucleated giant cells-since multinucleated giant cells in the epidermis are not always pathognomonic of a cutaneous herpes virus infection-and to summarize dermatoses in which herpes virus infection has been observed to coexist. METHODS Two individuals with acantholytic dermatoses whose initial lesional skin biopsies showed multinucleated epithelial giant cells suggestive of a herpes virus infection are reported. Using the PubMed database, an extensive literature search was performed on multinucleated giant cell (and epidermis, epithelial, and histiocytic) and herpes virus infection. Relevant papers were reviewed to discover the skin conditions with either multinucleated giant cells in the epidermis or coincident cutaneous herpes virus infection. RESULTS Initial skin biopsies from patients with either pemphigus vulgaris or transient acantholytic dermatosis mimicked herpes virus infection; however, laboratory studies and repeat biopsies established the correct diagnosis of their acantholytic dermatosis. Hence, epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection. Indeed, epithelial multinucleated giant cells in the epidermis can be observed not only in the presence of infection (herpes virus), but also acantholytic dermatoses and tumors (trichoepithelioma and pleomorphic basal cell carcinoma). Histiocytic multinucleated giant cells in the epidermis can be observed in patients with either giant cell lichenoid dermatitis or lichen nitidus of the palms. CONCLUSIONS Epithelial and histiocytic multinucleated giant cell can occur in the epidermis. Keratinocyte-derived multinucleated giant cells are most commonly associated with herpes virus infection; yet, they can also be observed in patients with skin tumors or acantholytic dermatoses. Cutaneous herpes simplex virus infection can coexist in association with other conditions such as acantholytic dermatoses, benign skin tumors, bullous disorders, hematologic malignancies, inflammatory dermatoses, and physical therapies. However, when a herpes virus infection is suspected based upon the discovery of epithelial multinucleated giant cells in the epidermis, but either the clinic presentation or lack of response to viral therapy or absence of confirmatory laboratory studies does not support the diagnosis of a viral infection, the possibility of a primary acantholytic dermatosis should be considered and additional lesional skin biopsies performed. Also, because hematoxylin and eosin staining is not the golden standard for confirmation of autoimmune bullous dermatoses, skin biopsies for direct immunofluorescence should be performed when a primary bullous dermatosis is suspected since the histopathology observed on hematoxylin and eosin stained sections can be misleading.
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Affiliation(s)
- Philip R Cohen
- Division of Dermatology, University of California San Diego, San Diego, California
| | - Taraneh Paravar
- Division of Dermatology, University of California San Diego, San Diego, California
| | - Robert A Lee
- Division of Dermatology, University of California San Diego, San Diego, California
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Munoz J, Guillot B, Girard C, Dereure O, Du-Thanh A. First report of ipilimumab-induced Grover disease. Br J Dermatol 2014; 171:1236-7. [PMID: 24749658 DOI: 10.1111/bjd.13058] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- J Munoz
- Department of Dermatology, University Hospital of Montpellier, University Montpellier 1, 80 rue Augustin Fliche, F-34295, Montpellier Cedex 5, France
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Phillips C, Kalantari-Dehaghi M, Marchenko S, Chernyavsky AI, Galitovskiy V, Gindi V, Chun S, Paslin D, Grando SA. Is Grover's disease an autoimmune dermatosis? Exp Dermatol 2014; 22:781-4. [PMID: 24131368 DOI: 10.1111/exd.12266] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 12/14/2022]
Abstract
Grover's disease (GD) is a transient or persistent, monomorphous, papulovesicular, asymptomatic or pruritic eruption classified as non-familial acantholytic disorder. Contribution of autoimmune mechanisms to GD pathogenesis remains controversial. The purpose of this study was to investigate antibody-mediated autoimmunity in 11 patients with GD, 4 of which were positive for IgA and/or IgG antikeratinocyte antibodies by indirect immunofluorescence. We used the most sensitive proteomic technique for an unbiased analysis of IgA- and IgG-autoantibody reactivities. Multiplex analysis of autoantibody responses revealed autoreactivity of all 11 GD patients with cellular proteins involved in the signal transduction events regulating cell development, activation, growth, death, adhesion and motility. Semiquantitative fluorescence analysis of cultured keratinocytes pretreated with sera from each patient demonstrated decreased intensity of staining for desmoglein 1 and/or 3 and PCNA, whereas 4 of 10 GD sera induced BAD expression, indicating that binding of autoantibodies to keratinocytes alters expression/function of their adhesion molecules and activates apoptosis. We also tested the ability of GD sera to induce visible alterations of keratinocyte shape and motility in vitro but found no specific changes. Thus, our results demonstrated that humoral autoimmunity in GD can be mediated by both IgA and IgG autoantibodies. At this point, however, it is impossible to conclude whether these autoantibodies cause or are caused by the disease. Antidesmoglein antibodies may be triggered by exposure to immune system of sequestered antigens due to disintegration of desmosomes during primary acantholysis. Clarifying aetiology of GD will help improve treatment, which currently is symptomatic and of marginal effectiveness.
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Affiliation(s)
- Courtney Phillips
- Department of Dermatology, University of California, Irvine, CA, USA
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Moon HR, Lee JH, Rhee DY, Won CH, Chang SE, Lee MW, Choi JH, Moon KC. Grover's Disease in a Liver Transplant Patient. Ann Dermatol 2014; 26:117-8. [PMID: 24648700 PMCID: PMC3956779 DOI: 10.5021/ad.2014.26.1.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/01/2013] [Accepted: 03/04/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye-Rim Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Young Rhee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Chan Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Garibyan L, Chiou AS, Elmariah SB. Advanced aging skin and itch: addressing an unmet need. Dermatol Ther 2013; 26:92-103. [PMID: 23551366 DOI: 10.1111/dth.12029] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Itch is the most common skin disorder in the elderly and frequently diminishes quality of life in this population. The high prevalence of pruritus in elderly patients is attributed in part to the decline in the normal physiology of the advanced aging skin, and reflects poor hydration, impaired skin barrier, and altered neural function, all ultimately contributing to inflammation and pruritus. As the elderly population continues to grow, practitioners need to be aware of how to evaluate and manage pruritus, recognizing the common conditions contributing to itch in elderly patients as well as the challenges of treatment in this group. Ultimately, management of pruritus will require an individually tailored approach that is guided by a patient's general health, severity of symptoms, and the potential adverse effects of itch therapies.
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Affiliation(s)
- Lilit Garibyan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02129, USA
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Grover's Disease after Heart Transplantation: A Case Report. Case Rep Transplant 2013; 2012:126592. [PMID: 23320241 PMCID: PMC3539346 DOI: 10.1155/2012/126592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/05/2012] [Indexed: 12/04/2022] Open
Abstract
Grover's disease is a transient acantholytic dermatosis of unknown cause, manifesting clinically as a papular skin eruption that is usually located on the anterior chest and abdomen. Histologically characterized by an acantholytic pattern, it has been associated with numerous disorders, including hematologic malignancies, chronic renal failure, and HIV infection, as well as with chemotherapy and bone marrow and/or kidney transplant. Evaluation of followup and treatment is often complicated by spontaneous remission and the occasionally fluctuant course of the disease. Here we report the case of a patient with sudden onset of Grover's disease after heart transplantation. To the best of our knowledge, this is the first observation of Grover's disease as diagnosed after heart transplantation.
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Asahina A, Ishiko A, Saito I, Hasegawa K, Sawamura D, Nakano H. Grover's disease following multiple bilateral Blaschko lines: a rare clinical presentation with genetic and electron microscopic analyses. Dermatology 2012; 225:183-7. [PMID: 23075809 DOI: 10.1159/000343172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/30/2012] [Indexed: 11/19/2022] Open
Abstract
Grover's disease is an acquired dermatosis of unknown cause histopathologically characterized by the presence of acantholysis. We report an 83-year-old Japanese man who showed multiple pruritic papular lesions distributed bilaterally along Blaschko lines, necessitating the exclusion of segmental Darier's disease. No mutations in ATP2A2, ATP2C1 or keratin 5 genes were found both in the lesional skin and in peripheral leukocytes, suggesting that putative pathogenesis of Grover's disease is distinct from those of other acantholytic dermatoses. Electron microscopy revealed poorly developed tonofibrils in the basal cells, and the structure of desmosomes appeared normal, with an increase in the number of desmosomes in the spinous layer, indicating compensation of defective desmosomal function. Impairment of desmosomal plaque proteins linking tonofilaments to desmosomal cadherins may thus account for acantholysis. The unusual bilateral mosaic arrangement in our patient may offer valuable clues to the genetic basis of Grover's disease.
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Affiliation(s)
- Akihiko Asahina
- Department of Dermatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan.
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Abstract
Grover disease (GD) is a rather common papular pruritic dermatosis that can be transient, persistent, or asymptomatic. The microscopic diagnosis of clinically suspected lesions can be challenging because GD can adopt different patterns, and involved areas are generally admitted to be mostly focal. The histopathologic hallmark of the disease is acantholysis, frequently combined with dyskeratosis, which confers the lesions an appearance similar to Darier disease, Hailey-Hailey disease, or pemphigus. Eczematous features can be observed as well. In this study of 120 consecutive cases of GD, we have found a sex and age incidence similar to what has been previously described, with no obvious seasonal influence, but careful evaluation of their microscopic features suggests that the histopathological diagnostic criteria of GD should be expanded. Specifically, in addition to the commonly described GD findings, we have detected cases with porokeratosis-like oblique columns of parakeratosis, lesions showing a nevoid or lentiginous silhouette, intraepidermal vesicular lesions, lichenoid changes with basal vacuolization and dyskeratosis, and dysmaturative foci with keratinocyte atypia. Moreover, quite often the dermal infiltrate was composed not only of lymphocytes intermingled with eosinophils, but also of neutrophils. In many cases, the capillary vessels showed hints of vascular damage including endothelial tumefaction due to cytoplasmatic edema and erythrocyte extravasation. Finally, because involved areas were larger than 2 mm in more than 50% of our cases, we should assume that GD lesions are not always as small as commonly claimed. Awareness of the patterns newly described herein may be important to avoid underdiagnosis of GD and may contribute to understand the pathogenesis of this acantholytic disease.
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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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Abstract
BACKGROUND Grover disease is a clinicopathologic entity characterized by acantholysis. The histologic changes typically occupy circumscribed foci, therefore early stages could go unnoticed and be misdiagnosed. OBJECTIVE To report on early histopathologic changes in Grover disease. MATERIAL AND METHODS We analyzed 22 cases of Grover disease histologically diagnosed at Wake Forest University School of Medicine, NC, between 2000 and 2009. Early changes were defined as elongation of rete ridges and mild focal acantholysis. RESULTS Six cases (27%) showed elongation of the rete ridges with focal acantholysis. Mild spongiosis was seen in 4 cases. Superficial perivascular inflammatory infiltrate was found in all cases, 5 of which showed eosinophils. CONCLUSIONS These findings may represent a diagnostic clue in cases of early Grover disease, if clinical correlation is made.
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NAKAJIMA K, HASHIMOTO T, NAKAJIMA H, YOKOGAWA M, IKEDA M, KODAMA H. IgG/IgA pemphigus with dyskeratotic acantholysis and intraepidermal neutrophilic microabscesses. J Dermatol 2007; 34:757-60. [DOI: 10.1111/j.1346-8138.2007.00378.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- S Orpin
- Department of Dermatology, Solihull Hospital, Solihull, UK.
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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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36
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Scheinfeld N, Mones J. Seasonal variation of transient acantholytic dyskeratosis (Grover's disease). J Am Acad Dermatol 2006; 55:263-8. [PMID: 16844509 DOI: 10.1016/j.jaad.2006.01.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 01/04/2006] [Accepted: 01/14/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Grover's disease (GD), or transient acantholytic dermatosis, is a pruritic, papulovesicular eruption characterized histopathologically by acantholysis with or without dyskeratosis. The origin of GD is unknown. Suggested causes include sweating, heat, immobilization occlusion, external beam and ultraviolet radiation, and xerosis. GD has also been found to occur in association with other diseases. OBJECTIVE Our aim was to assess whether GD exhibits seasonal variation and, if so, to determine whether any inferences can be drawn from its seasonal variation regarding its cause. METHODS We identified 385 patients who fulfilled both clinical and histopathologic criteria for GD among 423,106 patients diagnosed at the Ackerman Academy of Dermatopathology in New York City during the period from July 1, 1999 through June 30, 2004. By design, no hospitalized patients were studied. RESULTS A diagnosis of GD was given to 0.09% of biopsy specimens at the Ackerman Academy of Dermatopathology. GD was diagnosed approximately 4 times more commonly in winter than in summer, although the number of biopsies was constant. The average age of GD patients was 64 years with a male/female ratio of 1.95:1. The most common histopathologic type of GD was pemphigus vulgaris. GD was suspected clinically in 54% of patients. LIMITATIONS This study did not assess hospitalized patients with GD or GD patients who lived outside the northeastern United States. Because the data assessed resided in a commercial dermatopathology laboratory, patients assessed in almost all cases had insurance coverage. Patients without insurance likely were not included in the study. CONCLUSIONS The diagnosis of GD constitutes a higher proportion of biopsies in the winter than in the summer and therefore, by inference, occurs more frequently in the winter. In the winter, elderly men whose skin is naturally xerotic sweat less and are exposed to low ambient humidity. Rather than being caused by sweating and heat, GD arises against a backdrop of an intact but xerotic epidermis with decreased sweat production and is likely related to impaired epidermal integrity.
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Affiliation(s)
- Noah Scheinfeld
- Department of Dermatology, St Luke's Roosevelt Hospital Center, New York, NY 10025, USA.
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Boutli F, Voyatzi M, Lefaki I, Chaidemenos G, Kanitakis J. Transient acantholytic dermatosis (Grover's disease) in a renal transplant patient. J Dermatol 2006; 33:178-81. [PMID: 16620222 DOI: 10.1111/j.1346-8138.2006.00041.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Grover's disease ("transient acantholytic dermatosis") is a transient dermatosis of unknown cause manifesting clinically as a papular skin eruption located usually on the anterior chest and abdomen and histologically with dyskeratosis and acantholysis. Grover's disease has occasionally been reported in patients with chronic renal failure, HIV infection, hematological malignancies and bone-marrow allotransplantation. We report herein a new case of Grover's disease that developed in a renal transplant patient. To the best of our knowledge, this is the first observation of Grover's disease developing in the setting of solid organ transplantation.
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Affiliation(s)
- Fotini Boutli
- Skin and Venereal Diseases Hospital State Department, Thessaloniki, Greece
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Tscharner GG, Bühler S, Borner M, Hunziker T. Grover’s Disease Induced by Cetuximab. Dermatology 2006; 213:37-9. [PMID: 16778425 DOI: 10.1159/000092836] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Accepted: 01/20/2006] [Indexed: 11/19/2022] Open
Abstract
A 71-year-old man exhibited an acute acneiform rash affecting the face and the upper trunk about 2 weeks after starting cetuximab, an epidermal growth factor (EGF) receptor antagonist treatment for metastatic colon cancer. The skin eruption faded after stopping cetuximab and applying topical corticosteroids. The reexposure to cetuximab 3 weeks later provoked a more extended relapse of the skin rash, which then clinically and histologically corresponded to transient acantholytic dermatosis . While the acneiform cutaneous side effects of the EGF receptor antagonists are interpreted as a result of the direct interference with pilosebaceous follicle homeostasis, in this case an acrosyringium-related pathogenesis might be postulated. Applying topical corticosteroids and emollients, the cetuximab therapy could be pursued.
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Affiliation(s)
- G G Tscharner
- Department of Dermatology, University of Berne, Berne, Switzerland
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García-Río I, Delgado-Jimenez Y, Aragüés M, Fernández-Herrera J, Fraga J, García-Díez A. A case of Grover's disease with syringoma-like features and leukemia cutis. J Cutan Pathol 2006; 33:443-6. [PMID: 16776721 DOI: 10.1111/j.0303-6987.2006.00468.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Leukemia cutis used to be a late manifestation of leukemia. On the other hand, Grover's disease has been described in the setting of cancer. CASE REPORT A patient diagnosed as having a chronic myelomonocytic leukemia presented with lichenoid, slightly infiltrated plaques on the anterior aspect of his thorax and abdomen and papulovesicles on his back. A skin biopsy showed the co-existence of leukemia cutis, Grover's disease, and syringoma-like features. DISCUSSION We discuss and comment upon this unusual association.
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Affiliation(s)
- Irene García-Río
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain.
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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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Girard C, Durand L, Guillot B, Gildhou JJ, Bessis D. Persistent acantholytic dermatosis and extensive lentiginous 'freckling': a new entity? Br J Dermatol 2005; 153:217-8; author reply 218. [PMID: 16029360 DOI: 10.1111/j.1365-2133.2005.06666.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Certain dermatologic lesions may initially present or be more commonly ascribed to the elderly. These disorders encompass a diverse array of etiologically unrelated degenerative, autoimmune, idiopathic, and neoplastic conditions that may dramatically impact the quality of life and produce significant morbidity and mortality. As the population ages, a more complete understanding of the clinical and histopathologic features unique to the geriatric dermatologic patient is essential.
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Affiliation(s)
- Connie A Keehn
- Department of Pathology, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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Reply. J Am Acad Dermatol 2003. [DOI: 10.1016/s0190-9622(03)00867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pastor MA, Izquierdo MJ, Vargas-Machuca I, Carrasco L, Carmen Fariña MD, Martín L, Requena L. Enfermedad de Grover en un paciente con insuficiencia renal crónica en hemodiálisis. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76665-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fantini F, Kovacs E, Scarabello A. Unilateral transient acantholytic dermatosis (Grover's disease) along Blaschko lines. J Am Acad Dermatol 2002; 47:319-20. [PMID: 12140485 DOI: 10.1067/mjd.2002.120596] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sakalosky PE, Fenske N, Morgan MB. A case of acantholytic dermatosis and leukemia cutis: cause or effect? Am J Dermatopathol 2002; 24:257-9. [PMID: 12140444 DOI: 10.1097/00000372-200206000-00012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Leukemia cutis is capable of presenting in a variety of clinical and histologic guises. We describe a 75-year-old man with a recent diagnosis of M0 acute myelogenous leukemia, who presented with multiple pruritic erythematous papules on his chest and back. Microscopically, the epidermis showed acrosyringeal-based acantholysis consistent with transient acantholytic dermatosis (TAD), associated with exocytosis of atypical hematolymphoid cells. In addition, the dermis showed a contiguous atypical hematolymphoid proliferation consistent with conventional leukemia cutis. To our knowledge, this is the first such case combining features of TAD with leukemia cutis. It remains to be determined whether the acantholysis occurred secondary to the leukemia cutis, was initiated by the migration of leukemic cells, or if the association is merely serendipitous.
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Affiliation(s)
- Pamela E Sakalosky
- Departments of Pathology and Dermatology, University of South Florida College of Medicine and Department of Veterans Affairs Medical Center, Tampa, Florida 33556, USA
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Jaffee EM, Hruban RH, Biedrzycki B, Laheru D, Schepers K, Sauter PR, Goemann M, Coleman J, Grochow L, Donehower RC, Lillemoe KD, O'Reilly S, Abrams RA, Pardoll DM, Cameron JL, Yeo CJ. Novel allogeneic granulocyte-macrophage colony-stimulating factor-secreting tumor vaccine for pancreatic cancer: a phase I trial of safety and immune activation. J Clin Oncol 2001; 19:145-56. [PMID: 11134207 DOI: 10.1200/jco.2001.19.1.145] [Citation(s) in RCA: 407] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Allogeneic granulocyte-macrophage colony-stimulating factor (GM-CSF)-secreting tumor vaccines can cure established tumors in the mouse, but their efficacy against human tumors is uncertain. We have developed a novel GM-CSF-secreting pancreatic tumor vaccine. To determine its safety and ability to induce antitumor immune responses, we conducted a phase I trial in patients with surgically resected adenocarcinoma of the pancreas. PATIENTS AND METHODS Fourteen patients with stage 1, 2, or 3 pancreatic adenocarcinoma were enrolled. Eight weeks after pancreaticoduodenectomy, three patients received 1 x 10(7) vaccine cells, three patients received 5 x 10(7) vaccine cells, three patients received 10 x 10(7) vaccine cells, and five patients received 50 x 10(7) vaccine cells. Twelve of 14 patients then went on to receive a 6-month course of adjuvant radiation and chemotherapy. One month after completing adjuvant treatment, six patients still in remission received up to three additional monthly vaccinations with the same vaccine dose that they had received originally. RESULTS No dose-limiting toxicities were encountered. Vaccination induced increased delayed-type hypersensitivity (DTH) responses to autologous tumor cells in three patients who had received >or= 10 x 10(7) vaccine cells. These three patients also seemed to have had an increased disease-free survival time, remaining disease-free at least 25 months after diagnosis. CONCLUSION Allogeneic GM-CSF-secreting tumor vaccines are safe in patients with pancreatic adenocarcinoma. This vaccine approach seems to induce dose-dependent systemic antitumor immunity as measured by increased postvaccination DTH responses against autologous tumors. Further clinical evaluation of this approach in patients with pancreatic cancer is warranted.
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Affiliation(s)
- E M Jaffee
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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48
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Holst VA, Fair KP, Wilson BB, Patterson JW. Squamous cell carcinoma arising in Hailey-Hailey disease. J Am Acad Dermatol 2000; 43:368-71. [PMID: 10901726 DOI: 10.1067/mjd.2000.100542] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hailey-Hailey disease is a recurrent, autosomal dominant vesiculobullous dermatotis with a predilection for intertrigenous areas. We report what we believe to be the first case of squamous cell carcinoma arising de novo in a skin lesion of Hailey-Hailey disease. The occurrence of malignant neoplasms arising in the skin lesions of Hailey-Hailey disease and other acantholytic dermatoses is reviewed.
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Affiliation(s)
- V A Holst
- Departments of Pathology and Dermatology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908-0214, USA
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49
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50
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Casanova JM, Pujol RM, Taberner R, Egido R, Fernández E, Alomar A. Grover's disease in patients with chronic renal failure receiving hemodialysis: clinicopathologic review of 4 cases. J Am Acad Dermatol 1999; 41:1029-33. [PMID: 10570394 DOI: 10.1016/s0190-9622(99)70269-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 4 patients undergoing hemodialysis for chronic renal failure, a transient or persistent, papular and keratotic eruption developed on the trunk and arms. Histologic examination disclosed focal acantholysis with dyskeratosis. The lesions were clinically and histologically indistinguishable from those of Grover's disease. A possible association with Grover's disease and chronic renal failure and/or hemodialysis is postulated. Possible implicated pathogenic mechanisms are discussed. We suggest that Grover's disease should be included in the differential diagnosis of cutaneous eruptions in patients with chronic renal failure.
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Affiliation(s)
- J M Casanova
- Departments of Dermatology, Pathology, and Nephrology, Hospital Universitari Arnau de Vilanova, Facultat de Medicina de Lleida, Spain
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