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Grover's Disease

 

Introduction

Grover's disease is an itchy skin condition on the chest and back. Grover's disease most often affects men over 50. It is also known as "transient acantholytic dermatosis", and is much less common in women or younger people. Grover's disease often starts quite suddenly. It results in very itchy spots on the central back, mid chest and occasionally elsewhere. Frequently, it follows sweating or some unexpected heat stress. Typical Grover's Disease shows itchy bumps. Dermatologists may make the diagnosis from the appearance of the rash, but a skin biopsy may be necessary to confirm it. Grover's disease has a characteristic appearance under the microscope. Most cases of Grover's disease last six to twelve months. Occasionally it may persist for longer. Treatment often seems unsatisfactory. The most important thing is to remain cool, as further sweating will induce more itchy spots. A mild topical steroid such as hydrocortisone or Des Owen in a cool lotion can be applied frequently to the affected areas and result in relief.

 

What are the symptoms?

Sometimes Grover's disease can cause a more severe skin reaction with more irritation. Itching occurs in about 80% of the patients with Grover's disease and can at times be quite severe, particularly when the patient becomes overheated. Occasionally, there may be other symptoms, including tiredness. The rash usually fades and disappears within one year after peak activity but can sometimes last much longer. Various environmental or physical factors can cause transient worsening or even reappearance of the rash. These include physical exertion, such as running or bathing in hot water. Although the disorder usually resolves in time, Dr. Jacobs should be consulted to rule out other conditions.

 

What is the cause of this skin disorder?

The cause of Grover's disease is not known. It definitely is not caused by a fungus or bacterial infection, and it is not caused by anything that a person has eaten. It also is not due to any known type of allergic reaction, either internal or external. Grover's disease is not a skin manifestation associated with any type of internal disease such as diabetes, cancer, or kidney disease. Grover's disease is felt to be due to faulty keratinization or the process of forming the protective texture for the surface of the skin. Porokeratosis is observed to be a result of abnormal growing clones of skin forming cells, which lead to keratinization, or the process of forming the protective texture for the surface of the skin, that is defective.

 

Who usually diagnoses it?

The diagnosis of Grover's disease is usually made by the dermatologist, a physician with special training in skin diseases. The appearance of the rash may not be typical, however, making the diagnosis more difficult. The numbers and sizes of the spots can vary greatly and occasionally the rash can be concentrated in an unusual location, such as the lower body or on the face. Several other skin conditions are similar in appearance to Grover's disease. Certain skin fungus infections may resemble this rash. Also, reactions to various internal medications, such as antibiotics, fluid pills, and heart medications, may mimic Grover's disease. Various tests may be necessary to confirm diagnosis. The dermatologist may order blood tests, or even a biopsy of one of the spots to ascertain a definite diagnosis.

 

What is the treatment?

Treatment may include external and internal medication for itching. Only gentle, soothing measures should be used, as aggressive treatment has been known to cause the lesions to spread. If symptoms are mild, no treatment may be needed. Various types of soothing medicated lotions and lubricants may be prescribed to combat the rash. Individuals with Grover's disease should take lukewarm, rather than hot, baths. Soap: Soap is bad for Grover's disease involved skin. Dial, Zest, Lever, Safeguard, Ivory, gels, and Irish Spring are among the worst. Soap removes skin oils needed to hold in moisture. If oils are removed, the skin develops cracks, fissures, and dry inflammation. Soap should not be used on dry or sensitive skin. Most of us use far too much soap. Actually, plain water is often just enough to cleanse the skin. If you can't live without soap, it's OK to use Dove soap for your face, feet, armpits, and groin.

 

Avoid Allergic Items: Grover's disease involved skin can become itchy when exposed to allergic type substances such as perfumes, dyes, conditioners, powders, anti-perspirants, hair sprays, grasses, plants, fragranced products, shampoos, unrinsed laundry detergents, fabric softener sheets, dog or cat hairs, carpets, chemicals, Aloe Vera, PABA, detergents, acrylic nails, polishes, nickel, elastic, latex, etc. Hair conditioners can induce itch! Please avoid perfumes.

ABC Bathing: It is important to avoid soap on areas of Grover’s. Persons with Grover’s involved skin may bathe or shower twice daily: 1. Use no soap on dry or sensitive skin areas. You may use mild Gentle Face and Body Cleanser, instead of soap. 2. After bathing, thoroughly lubricate your skin using a Replenishing Cream available OTC. 3. After your bath, you should not towel dry. Wipe off the water with your hands, then, apply a thin film of Cream to your entire body. This film will seal in your new moisture. 4. For shampoo, use OTC fragrance free Gentle Shampoo. Mild lubricants, or anti- pruritic creams, or mild hydrocortisone creams may be used all over the body to soothe the inflammation. Oral antihistamines may be used to reduce itching. Soap tends to dry the areas and increases roughness. Picking or extracting of lesions are not recommended as picking may result in secondary infection with staph, strep, or other bacteria.

 

Other Measures: Mild lubricants, or anti- pruritic creams, or mild hydrocortisone creams may be used all over the body to soothe the inflammation. Oral antihistamines may be used to reduce itching. Oral corticosteroids may be needed in cases of severe inflammation. Dr. Jacobs usually prescribes topical steroid lotions and may add tetracycline type antibiotics for Grover's. Mild sun exposure may help speed resolution of lesions; however, care must be taken to avoid sunburn. Expectations (prognosis): Grover's disease usually goes away within one year, but symptoms may recur. Strenuous activity may aggravate the rash.  Another important feature of treatment includes reassurance to the patient by the physician that Grover's disease is not a dangerous skin condition.

 

 

 
Ken Alpern, M.D. Charity Morris, PAC Eleni Litras,
PAC

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Hello, and welcome to our dermatology office. My name is Randy Jacobs, MD, FAAD. Some people are blessed with the most beautiful skin, and it’s all natural. Others have to work at it. Healthy skin is lovely to behold, comfortable to live in, and a pleasure to touch.
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