Grover Disease · What Is It, Causes, Signs, Symptoms, and More

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.

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.

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.

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.