Grover's Disease
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.
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.
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.
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