Grover Disease

What Is It, Causes, Signs, Symptoms, and More

Author:Georgina Tiarks

Editors:Alyssa Haag,Józia McGowan, DO,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW

What is Grover disease?

Grover disease, or persistent or transient acantholytic dermatosis, is a skin condition characterized by an itchy papular rash, typically on sun-damaged areas like the trunk, neck, and extremities. It more commonly occurs amongst those assigned male at birth; those 40 years or older; or those with fair, light skin. Due to its highly itchy nature, cases of Grover disease may be confused with scabies, atopic dermatitis (i.e., eczema), or insect bites.

Red-brown maculopapular lesions on an adult male.

What causes Grover disease?

Although the exact cause of Grover disease is largely unknown, there have been several risk factors identified that increase the likelihood of developing the disease. It frequently occurs in populations of individuals who are assigned male at birth, with increased age, fair skin coloring, and prolonged sun exposure. Grover disease has also been associated with extreme climates that irritate the skin. Some individuals experience episodes triggered by the cold, dry air in the winter. Some individuals can have recurrent outbreaks in both the winter and summer. Researchers hypothesize the reduced sweat production may trigger the rash. Conversely, others have developed the rash after exposure to heat and sweating. In this case, researchers believe that eccrine ducts become blocked, causing sweat to accumulate within the epidermis, resulting in acantholysis (i.e., separation) of the epidermal layers.

In addition, Grover disease is associated with immunocompromised states, which can include renal failure, HIV, malignancy, organ transplant, and specific drug use (e.g., varenicline, sulfadoxine-pyrimethamine, BRAF inhibitors, and ipilimumab). Individuals may also have concurrent skin infections, such as tinea versicolor.

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What are the signs and symptoms of Grover disease?

The signs and symptoms of Grover disease include an extremely pruritic rash with reddish-brown papulovesicular lesions that resemble hyperkeratosis or eczematous plaques. These lesions may be widespread on the trunk, neck, and proximal extremities. They may become crusted from excessive scratching or progression of the vesicles.

Grover disease is also called transient or persistent acantholytic dermatosis. Transient means that the rash is self-limiting and can resolve spontaneously. On average, these episodes last two to four weeks. However, Grover disease may persist for years.

These itchy spots may be mistaken for scabies, eczema, or even extensive insect bites due to the presentation. 

How is Grover disease diagnosed?

Grover disease is diagnosed through a thorough medical history and physical examination by a healthcare provider. The characteristic pruritic maculopapular rash over the trunk, neck, or proximal extremities can indicate to a provider that Grover disease is present. A shaved skin biopsy may also be necessary to examine the specimen. Skin cell histology analysis may show acantholysis or dyskeratosis (i.e., abnormal keratinocytes). The sample can also be analyzed under electron microscopy, which may indicate a loss of desmosomes (i.e., a junction between adjacent cells).  

When Grover disease is suspected, looking for concurrent systemic conditions can be essential. In some cases, immune system compromise can co-occur with Grover disease. Healthcare providers may also order blood tests and imaging studies.

How is Grover disease treated?

Grover disease may be treated using a variety of different medications. For pruritus, emollients; topical corticosteroids (e.g., fluticasone propionate, triamcinolone acetonide, cortisone cream); and oral antihistamines (e.g., fexofenadine, hydroxyzine hydrochloride) may be recommended. Topical vitamin D (e.g., tacalcitrol) can also reduce pruritus and inflammation in those who fail to respond to corticosteroids or antihistamines.

If symptoms are severe, oral medications such as methotrexate, retinoids (e.g., acitretin), and corticosteroids may be prescribed. A more novel approach using anti-tumor necrosis factor (e.g., etanercept) may also be indicated. Psoralen and ultraviolet A light therapy (PUVA) and ultraviolet B light have also been reported as treatment options. One case report used 5-ALA (i.e., aminolevulinic acid) in conjunction with phototherapy; however, it has yet to be tested in a formal clinical trial. Treatment lengths can fluctuate depending on severity.

What are the most important facts to know about Grover disease?

Grover disease is a skin condition prevalent among individuals assigned male at birth with increased age and fair skin. While the cause of Grover disease is unknown, it is associated with dry and cold climates. People with Grover disease may experience extreme pruritus and red-brown maculopapular lesions dispersed on the trunk, neck, and proximal extremities. The rash may be transient, with spontaneous resolution; however, in some cases, it can persist for years. It can be diagnosed after a physical examination by a health care provider, though a shaved skin biopsy may also be required for histological analysis. Grover disease can be treated using a variety of topical and oral medications as well as light therapy. 

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Related links

Hair, skin, and nails
Skin anatomy and physiology
Skin histology

Resources for research and reference

Aldana, P. C., & Khachemoune, A. (2020). Grover disease: Review of subtypes with a focus on management options. International Journal of Dermatology, 59(5), 543–550.

Hovnanian, A. (2019). Acantholytic Disorders of the Skin. In S. Kang, M. Amagai, A. L. Bruckner, A. H. Enk, D. J. Margolis, A. J. McMichael, & J. S. Orringer (Eds.), Fitzpatrick’s Dermatology (9th ed.). McGraw-Hill Education.

Saavedra, A. P., Roh, E. K., & Mikailov, A. (2023). Miscellaneous Epidermal Disorders. In Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology (9th ed.). McGraw-Hill Education.