Q: My dermatologist diagnosed a skin rash a year and a half ago between my breasts and my navel as Grover’s disease. Because of the extreme itching accompanying the rash, we have tried numerous techniques for alleviating the itch so as to bring comfort. Nothing seems to work. We tried two ointments – Mupirocin that I’ve discontinued and Triamcinolone acetonide USP 0.15% that I continue to use. I also have ultraviolet light sessions in my doctor’s office. Still, nothing has lessened my symptoms and the rash appears to be spreading to my back.
The doctor says there is no known cure for this disease but it is not contagious. I am hoping you can supply me with more positive information for a treatment, cure, or alleviation of the symptoms. By the way and of further information, I did have X-ray radiation therapy for breast cancer prior to the onset, but not in the same area. Any advice or suggestions you might have would really be appreciated.
A: Grover’s disease a/k/a acantholytic dermatosis or transient acantholytic dermatosis is an annoying and rare skin condition characterized by red lesions that itch and commonly appear on the torso, back and legs. The condition is generally found in Caucasian men over the age of 40 or 50 although, and to a lesser degree, women may carry the diagnosis. The actual ratio is thought to be three to one for the male population over that for women. Generally benign, this self-limiting disorder is persistent and difficult to manage.
While the exact cause remains unclear, there may be a relation to blockages in the sweat glands in the upper layers of the skin. However, this theory is often questioned, since most cases present in the wintertime when the skin is dry, rather than in the summer when we are more likely to sweat. Another trigger for Grover’s other than heat exposure is being subjected to extreme changes in the temperature. Symptoms may last between six and twelve months and may come and go at will, without explanation. A hallmark is pruritis (itching) with variable degrees exhibited between patients. Diagnosis may be determined by a dermatologist because of the appearance of the rash; when any doubt remains, a skin biopsy may be necessary for confirmation.
Home remedies, while undocumented, includes such things as taking vitamin B supplements and eliminating foods and beverages that contain sulfides and gluten from the diet. Minor outbreaks may be controlled with prescription-strength topical cortisone creams, while more severe cases may require oral medications including tetracycline or Accutane for up to three months. When the drugs fail to bring relief, PUVA phototherapy, oral anti-fungals or cortisone injections may be appropriate, yet there have been incidents when phototherapy may exacerbate Grover’s rather than calm it. Oral retinoids including acitretin or isotretinoin (Accutane) have brought relief to some patients, yet both products have side effects that may cause a physician to refrain from writing such prescriptions.
I’m afraid I haven’t the words of encouragement you are seeking but you are not contagious, the disorder is self-limiting (usually lasting no more than 6 to 12 months), may clear with the therapy you are on, or your physician may choose to try something else such as systemic oral steroids. On the home front, you might consider diet modifications and lastly, you may have had some of the blanks filled in which will alert you as to what is occurring to you personally with this unpleasant condition. In the big scheme of things, this is a relatively new disorder, since it was only identified in 1970, so perhaps physicians can learn along with you as research continues.
