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Grover Syndrome (Transient Acantholytic Dermatosis
🩺 Grover’s disease, or transient acantholytic dermatosis, is an intensely itchy eruption caused by focal loss of adhesion between epidermal keratinocytes. It mainly affects men over 50 and usually involves the chest and upper back.
🧾 Risk Factors
- Heat, sweating and occlusive clothing
- Dry or sun-damaged skin
- Older age and male sex
- Fever, hospitalisation or prolonged bed rest
- Renal failure or organ transplantation
- Chemotherapy and BRAF inhibitors
🤒 Clinical Features
- Small itchy red or red-brown papules
- May become vesicular, crusted or eroded
- Usually affects the central chest, upper back and upper arms
- Worse with heat and sweating
- Face, palms, soles and mucosa are usually spared
🔍 Diagnosis
Diagnosis is usually clinical. Consider skin biopsy if the eruption is atypical, persistent or uncertain. Histology shows focal acantholysis, sometimes with dyskeratosis or spongiosis.
⚖️ Differential Diagnosis
- Miliaria, Folliculitis, Eczema, Drug eruption
- Scabies, Darier disease, Hailey-Hailey disease or pemphigus
💊 Management
- Keep cool and avoid excessive sweating
- Use regular emollients and avoid irritant soaps
- Apply a moderate-to-potent topical corticosteroid for a short course
- Menthol preparations may reduce itching
- Sedating antihistamines may help nocturnal pruritus
- Refer persistent or severe disease to dermatology
🏥 Specialist Treatment
- Narrowband UVB phototherapy
- Acitretin or isotretinoin for resistant disease
- Systemic corticosteroids are rarely required
📈 Prognosis
Grover’s disease is benign and may resolve within weeks or months, although recurrent or chronic disease is common.
💡 Clinical Clue
Consider Grover’s disease in an older man with an intensely itchy papular eruption over the chest and back, particularly after heat, sweating or hospitalisation.
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