Q: On itchy skin, the dermatologist I go to said I have Grover disease. No cure! Will you send me information? Every day twice to three times I have to rub a calming cream and triamcinolone acetonide cream on. I am not diabetic and have no known kidney or blood disease.
A: Grover disease, also known as transient acantholytic dermatosis, commonly causes itchy red spots to appear on the trunk but there are times when the disorder lacks the telltale rash, making it more difficult to diagnose. Once confirmed, the condition lasts six to 12 months but may last substantially longer. It commonly affects men over the age of 50 and is less common in women and younger individuals. Essentially, the disorder is not curable and the exact cause remains unknown but in many instances, symptoms can be brought under control. The most logical association involves heat, sweating, or sweat duct obstruction, as the condition has been known to begin or worsen following temperature extremes. At other times it will appear for no apparent reason at all. The condition usually begins as a skin eruption on the anterior chest, upper back, and lower rib cage. Those severely affected may also have areas of the arms, legs, neck and shoulders affected, yet oddly enough, the scalp, soles of the feet and palms of the hands remain clear.
There are five patterns of Grover described as one that simulates Darier disease, one for Hailey-Hailey disease, pemphigus vulgaris, pemphigus foliaceus, and spongiotic dermatitis. One pattern often is predominate but each may be found in different lesions on the same patient.
Minor outbreaks can be controlled with prescription topical cortisone creams. More advanced eruptions are commonly treated with tetracycline pills or Accutane for up to three months. Beyond that, anti-fungal pills, cortisone injections and even PUVA phototherapy might be necessary for control. PUVA is a combination of psoralen and long-wave ultraviolet radiation. Psoralen is an oral medication that is taken one hour prior to ultraviolet light treatment. Individuals who have undergone PUVA will have an increased risk of developing squamous cell skin cancer and photo aging of the skin. The skin aging cannot be reversed; however, the skin cancer can be easily treated with minor surgery. Light treatment is given up to three times a week for up to 15 weeks. Following that time, maintenance therapy may be required on a weekly basis. In all cases, the skin of the individual undergoing this treatment will darken. In 20% of all cases a stinging sensation will be noted. Beyond that, and to a much smaller degree, headache, nausea and dizziness may occur. Oral cortisone may clear the condition on a temporary basis; however, the telltale rash will reappear as soon as the individual discontinues the medication. Grover disease is unaffected by diet; however dietary supplements to include vitamin A may be administered at 50,000 U three times a day for 14 days and daily for up to 12 weeks. Activity that induces sweating and increasing bodily heat should obviously be avoided. One study found more cases occur during the winter, suggesting a possible link between dry skin and exposure to dry cold weather. Benadryl might help control the itch; however, drowsiness can result, so that consideration must be a part of the equation.
Ask your physician or a dermatologist about a trial of vitamin A, avoid over-heating whenever possible, and continue to use soothing creams that reduce your symptoms. I’m reluctant to endorse light therapy because of the potential for the development of skin cancer but if it appeals to you, get your doctor’s advice on the matter before making any decisions.
