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Grover’s Disease / Transient Acantholytic Dermatosis

Clinical Case

Case 1

  • 49-year-old Caucasian male
  • No significant past medical history except for childhood eczema and allergic rhinitis
  • Recently returned from a one-month hiking trip to Australia
  • Presents for management of severe pruritic eruption that started on his trip
  • Denies any new cosmetic, plant, or insect exposures
  • Currently using diphenhydramine cream for relief of pruritus
  • Reports development of new lesions since returning from his trip.

Initial evaluation

  • Very healthy-appearing male
  • Monomorphous erythematous crusted papules scattered across the chest and back
  • Diagnosis: Grover’s disease (transient acantholytic dermatosis)
  • Fluocinonide 0.05% ointment once daily and frequent emollient use is recommended.
  • A prescription for hydroxyzine 25-50 mg at bedtime is also given to suppress nocturnal pruritus.
  • Patient is counseled to avoid sweating and occlusion, when possible.
  • Follow-up in four weeks

Follow-up evaluation

  • There are fewer lesions but the patient reports ongoing pruritic lesions. He admits to not using emollients
  • Ongoing fluocinonide ointment applied once daily and frequent emollient use is again recommended; education on use of emollients is discussed and a handout on gentle skin care is given (See handout Skin Care in Atopic Dermatitis)
  • Follow-up in four weeks
  • The patient is improved; the natural history of TAD is discussed, as recurrences are common, and the need for ongoing emollient use is reinforced.