INTRODUCTION
History of Transient Acantholytic Dermatosis (Grover Disease)
Transient acantholytic dermatosis, or Grover disease, is a rare acantholytic skin disorder that was first described by Dr. Ralph Weir Grover.1 Over the course of five years he observed six patients who presented with unusual transient truncal rashes. In 1970, he published a case series of these six patients and observed that the histology indicated an acantholytic process that seemed consistent with Hailey-Hailey disease or Darier disease. However, the clinical presentations, including the age of onset, temporal transience, and distribution of lesions, were not consistent with either entity. As such, he termed the disease “transient acantholytic dermatosis†in order to note the transient nature of this acantholytic eruption. Over time, more patients were described as having a similar condition.2-7 In many cases, their eruptions were not transient, prompting a shift toward the name “Grover’s disease†initially, and with a shift in medical literature away from possessive, eponymous disease names, it is more commonly known as “Grover disease†or “transient acantholytic dermatosisâ€.8 The disease was later categorized by subtypes based on histological patterns, with four main subtypes: Hailey-Hailey-like , Darier-like, Pemphigus vulgaris-like, and Spongiotic.9 Chalet et al. described histopathological diagnosis principles that remain relevant in the diagnosis of Grover disease, despite changing clinical criteria (Table 1).9 They note a clinical picture that consists of discrete lesions that do not demonstrate confluence and that can range from papulovesicular to keratotic. The lesions are frequently pruritic, and the primary locations include the upper chest, lumbar area, or the back. Although previously disputed, the consensus from the available literature is that Grover disease is more commonly diagnosed in the winter than in the summer.8,10-12 Scheinfeld et al. found a 4-fold increase of Grover disease diagnosis in winter months (January–March) than in summer months (June–August).10 Grover disease is typically diagnosed in older, male patients with a mean age of 61 years when diagnosed and a male to female ratio of 2.4:1.4,13,14
Discussion of Pathophysiology and Immunology
The exact pathogenesis of Grover disease is not entirely known. One theory suggests occlusion of the eccrine ducts leads to leakage, or “internal sweating.â€13 This process in which sweat molecules leak from the ducts to the epidermis is proposed to lead
Transient acantholytic dermatosis, or Grover disease, is a rare acantholytic skin disorder that was first described by Dr. Ralph Weir Grover.1 Over the course of five years he observed six patients who presented with unusual transient truncal rashes. In 1970, he published a case series of these six patients and observed that the histology indicated an acantholytic process that seemed consistent with Hailey-Hailey disease or Darier disease. However, the clinical presentations, including the age of onset, temporal transience, and distribution of lesions, were not consistent with either entity. As such, he termed the disease “transient acantholytic dermatosis†in order to note the transient nature of this acantholytic eruption. Over time, more patients were described as having a similar condition.2-7 In many cases, their eruptions were not transient, prompting a shift toward the name “Grover’s disease†initially, and with a shift in medical literature away from possessive, eponymous disease names, it is more commonly known as “Grover disease†or “transient acantholytic dermatosisâ€.8 The disease was later categorized by subtypes based on histological patterns, with four main subtypes: Hailey-Hailey-like , Darier-like, Pemphigus vulgaris-like, and Spongiotic.9 Chalet et al. described histopathological diagnosis principles that remain relevant in the diagnosis of Grover disease, despite changing clinical criteria (Table 1).9 They note a clinical picture that consists of discrete lesions that do not demonstrate confluence and that can range from papulovesicular to keratotic. The lesions are frequently pruritic, and the primary locations include the upper chest, lumbar area, or the back. Although previously disputed, the consensus from the available literature is that Grover disease is more commonly diagnosed in the winter than in the summer.8,10-12 Scheinfeld et al. found a 4-fold increase of Grover disease diagnosis in winter months (January–March) than in summer months (June–August).10 Grover disease is typically diagnosed in older, male patients with a mean age of 61 years when diagnosed and a male to female ratio of 2.4:1.4,13,14
Discussion of Pathophysiology and Immunology
The exact pathogenesis of Grover disease is not entirely known. One theory suggests occlusion of the eccrine ducts leads to leakage, or “internal sweating.â€13 This process in which sweat molecules leak from the ducts to the epidermis is proposed to lead
