Grover Disease With Features of Epidermolytic Hyperkeratosis

Management and Treatment of Grover’s Disease: A Case Report and Review of Literature

This case report details a rare case of Grover's disease in an 80-year-old Caucasian male complaining of a rash across his chest over the last three to four months. The patient has a past medical history of essential hypertension, hyperlipidemia, osteoarthritis of the knee, chronic gastroesophageal reflux disease (GERD), supraventricular tachycardia, status post prostate cancer, and restless legs syndrome. During his initial evaluation, he was found to have a pruritic, erythematous, papular rash most notably along his upper trunk and chest. The patient utilized multiple lotions, emollients, and anti-itch creams with minimal relief of his symptoms and presentation. Following a referral to Dermatology, a biopsy of the rash was conducted, which revealed intraepidermal acantholysis, the hallmark finding for a diagnosis of Grover's disease. Subsequently, he was treated with a topical triamcinolone acetonide 0.1% cream for 14 days. This study details a case of Grover's disease along with potential comorbidities and contributing factors in order to further understand the pathogenesis and etiology of this relatively rare condition. 

Epidermolytic Hyperkeratosis in an Epidermoid (Infundibular) Cyst

ABSTRACT

Epidermolytic hyperkeratosis (EHK) is an uncommon histopathologic reaction pattern that may represent a primary pathological process or a coincidental finding in a variety of neoplasms. We present a case of EHK in an epidermoid (infundibular) cyst. Histopathologically, EHK demonstrates vacuolar degeneration of keratinocytes in the spinous and granular cell layers, with disrupted cellular boundaries, enlarged basophilic keratohyalin-like granules and amorphous eosinophilic inclusions, along with massive hyperkeratosis. In addition to the morphologic description of EHK, we summarize the diagnoses in which EHK has been reported. Prior cases of EHK in an epidermoid (infundibular) cyst are summarized to compare findings. The significance of incidental EHK in skin lesions is unknown.

Clinical features and treatments of transient acantholytic dermatosis (Grover's disease): a systematic review

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.

Clinico-Pathological Study of 4 Cases of Pseudoherpetic Grover Disease: The Same as Vesicular Grover Disease

INTRODUCTION

Grover disease (GD) was described with 4 histopathological patterns, but later wide histopathological studies found additional ones including vesicular GD. From 2014, 2 new patterns, GD with epidermolytic hyperkeratosis and pseudoherpetic GD, have been proposed.

OBJECTIVES

The authors present 4 cases of pseudoherpetic GD and review the 6 previously published cases to better characterize this variant clinically and histopathologically.

RESULTS

Half of the patients were men. Mean age at diagnosis was 70, 25 years old. All the patients were immunosuppressed, and 75% of them were treated with chemotherapy. Lesions were asymptomatic or itchy papules sometimes crusted and intermingled with isolated vesicles or pustules mostly in the trunk. Skin biopsies showed intraepidermal vesicles filled with plasma (50%) with floating grouped acantholytic cells. No viral inclusions were found, and immunostaining for herpes virus and varicella zoster was negative.

DISCUSSION

Vesicular pattern in GD is described exclusively from a histopathological point of view, and it is defined as the presence of an intraepidermal vesicle filled with plasma and with dyskeratotic cells in the upper part of the vesicle. After reviewing all the described cases, pseudoherpetic GD presents the same histopathological features than vesicular GD, but authors paid attention to the presence of grouped acantholytic cells mimicking multinucleated cells of herpes infection. The authors consider that the so-called pseudoherpetic GD is a vesicular GD, where clinical suspicion of varicella raises this differential diagnosis and leads us to check viral nuclear cytopathic changes, and the authors favor the use of vesicular GD in the dermatopathologist report.

Grover Disease With Epidermal Dysmaturation Pattern: A Common Histopathologic Finding

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.