CORRESPONDENCE

Year : 2014 | Volume : 59 | Issue : 6 | Page : 621--623

Grover's disease with acrosyringeal acantholysis: A rare histological presentation of an

uncommon disease
Rajiv Joshi1, Atul Taneja2,
1
Department of Dermatology P. D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
2
Department of Dermatology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India

Correspondence Address:
Rajiv Joshi
Department of Dermatology P. D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra
India

How to cite this article:

Joshi R, Taneja A. Grover's disease with acrosyringeal acantholysis: A rare histological presentation of an uncommon
disease.Indian J Dermatol 2014;59:621-623

How to cite this URL:

Joshi R, Taneja A. Grover's disease with acrosyringeal acantholysis: A rare histological presentation of an uncommon disease.
Indian J Dermatol [serial online] 2014 [cited 2023 Aug 19 ];59:621-623
Available from: https://www.e-ijd.org/text.asp?2014/59/6/621/143548

Full Text
Sir,

Transient acantholytic dermatosis (Grover's disease) was first described as a distinct entity in 1970 by Grover. [1] It usually
occurs in middle-aged and elderly people as a discrete pruritic, papular or papulo-vesicular eruption favoring the trunk. The
eruption may persist in some patients and the term "papular acantholytic dermatosis" is a preferred term to describe this
entity. Heat and sweating are known predisposing factors and leakage of sweat from blocked acrosyringeal ducts may be
a contributory factor. [2] However, a contrary viewpoint has been expressed based on finding of more cases during the
winters and it has been suggested that Grover's disease is not caused by sweating and heat, but occurs in individuals with
a xerotic epidermis with decreased sweat production and is likely to be related to impaired epidermal integrity. [3]

Histologically, it shows focal acantholysis with or without dyskeratosis, which may resemble Darier's disease, pemphigus
or Hailey-Hailey disease. [4] A spongiotic variant with some acantholysis within spongiotic foci in the epidermis is another
presentation of Grover's disease. [5] Rare cases where the acantholysis was restricted to the acrosyringium have been
described. [6],[7] The acantholysis in Grover's disease is often focal and may be missed unless several sections are
examined. [8]

Although Grover's disease has been commonly reported in the western literature, it seems to be distinctly uncommon in
the Indian subcontinent and we could find no reports of Grover's disease in Indian journals devoted to dermatology. A
single case report describing Grover's disease in a 22-year-old Nepali man has been published. [9] The only Indian case
report of transient acantholytic dermatosis that we could find was of a 55-year-old man with pemphigus foliaceous who
developed transient keratotic papules with Darier's disease like histology and which cleared spontaneously in 15 days
without treatment. [10]
A 48-year-old male shopkeeper presented with sudden onset of innumerable small (2-3 mm) pruritic erythematous papules
with an eroded surface restricted to the abdomen and flanks. At places the lesions had a linear configuration, but mostly
were discrete and equally spaced from one another. While few lesions appeared to be related to hair follicles most papules
were non-follicular in location [Figure 1] and [Figure 2]. There was no history of prolonged exposure to heat or excessive
sweating. There was no history of similar eruption in the past nor was there any family history of similar complaints. The
eruption had been present for about 1 week before he sought medical treatment as the pruritus and burning sensation
were distressing; although, no new lesions were developing.{Figure 1}{Figure 2}

A punch biopsy taken from one of the erythematous eroded papules showed acrosyringeal acantholysis and dyskeratosis,
which was seen in a concentric fashion involving acrosyringeal keratinocytes at the mid spinous level. There was partial
separation of the acrosyringeal keratinocytes with few dyskeratotic cells with pyknotic nuclei and pink cytoplasm [Figure 3],
[Figure 4] and [Figure 5]. The adjacent epidermis was mildly hyperplastic and showed mild spongiosis with a thickened
basket weave horny layer containing occasional parakeratosis [Figure 6]. The upper dermis was mildly edematous and had
a moderately dense perivascular infiltrate of lymphocytes and few extravasated erythrocytes.{Figure 3}{Figure 4}{Figure 5}
{Figure 6}

Based on the clinical presentation of discrete severely pruritic erythematous eroded papules on the trunk and focal
acrosyringeal acantholysis on histology a diagnosis of Sudoriferous acrosyringeal acantholytic variant of Grover's disease
was made and the patient was started on capsule doxycycline 100 mg twice daily, topical beclomethasone cream and oral
levocetirizine 5 mg twice daily for the pruritus.

On follow-up at 2 weeks, there was satisfactory improvement in the pruritus and the rash had subsided by 25%.
Continuation of the medication was advised for another 2 weeks, but the patient was lost to further follow-up.

Grover's disease appears to be distinctly uncommon in India as we could not find any case reports published in Indian
journals. It may be an under-recognized entity, especially because the histological picture can be very variable and biopsy
may not reveal the pathological findings unless several sections are examined. Our case fits in very well with the clinical
description of Grover's disease with innumerable discrete erythematous pruritic eroded papules on the trunk in a middle-
aged man. The histological picture of acrosyringeal acantholysis is very rare with only six cases described in world
literature. [5],[6]

We report this case to draw attention to this uncommon condition, which has received very little attention in Indian
dermatological literature. Given our hot and humid climate, it may not be unreasonable to expect that cases of Grover's
disease are missed due to lack of awareness of this entity or inability to demonstrate the typical histological findings
associated with Grover's disease.

References
1 Grover RW. Transient acantholytic dermatosis. Arch Dermatol 1970;101:426-34.
2 Hu CH, Michel B, Farber EM. Transient acantholytic dermatosis (Grover's disease). A skin disorder related to heat and
sweating. Arch Dermatol 1985;121:1439-41.
3 Scheinfeld N, Mones J. Seasonal variation of transient acantholytic dyskeratosis (Grover's disease). J Am Acad
Dermatol 2006;55:263-8.
4 Chalet M, Grover R, Ackerman AB. Transient acantholytic dermatosis: A reevaluation. Arch Dermatol 1977;113:431-5.
5 Davis MD, Dinneen AM, Landa N, Gibson LE. Grover's disease: Clinicopathologic review of 72 cases. Mayo Clin Proc
1999;74:229-34.
6 Hashimoto K, Moiin A, Chang MW, Tada J. Sudoriferous acrosyringeal acantholytic disease. A subset of Grover's
disease. J Cutan Pathol 1996;23:151-64.
7 Antley CM, Carrington PR, Mrak RE, Smoller BR. Grover's disease (transient acantholytic dermatosis): Relationship of
acantholysis to acrosyringia. J Cutan Pathol 1998;25:545-9.
8 Fernández-Figueras MT, Puig L, Cannata P, Cuatrecases M, Quer A, Ferrándiz C, et al. Grover disease: A reappraisal of
histopathological diagnostic criteria in 120 cases. Am J Dermatopathol 2010;32:541-9.
9 Dwari BC, Ghosh A, Bajracharya S, Gupta S, Chaudhary N. Transient acantholytic dermatosis (Grover's disease): A
case report. J Pak Assoc Dermatologists 2007;17:112-5.
10 Manjare AK, Ghate SS, Jerajani HR. Transient acantholytic dermatos is associated with pemphigus foliaceus. Int J
Dermatol 2012;51:1389-91.
 Saturday, August 19, 2023
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