Grover’s disease is a rare transient acantholytic benign dermatosis, clinically characterized by a rash of dense bright red papules on unchanged or slightly edematous skin. The distinctive features of the disease are the itching that accompanies each “attack” of papules, and their ability to resolve spontaneously. The primary elements are localized in the neck, decollete and shoulder areas. Pathology is diagnosed on the basis of anamnesis, clinic, biopsy data and smear prints. Mild forms are treated with vitamins and antibiotics, external corticosteroid ointments. In severe cases, corticosteroids and retinoids are connected inside.
General information
Grover’s disease is a rather rare itchy persistent dermatosis of unclear genesis with the phenomena of acantholysis. It develops slowly, constantly recurs. The dermatologist R. Grover was the first to describe this disease in 1970. Since then, the pathological process has been known as transient acantholytic dermatosis or Grover’s disease. Pathology has a gender coloring, dermatosis is more often diagnosed in men aged 40-50 years. There are no racial differences, Grover’s disease is not endemic. Some seasonal features are noted: dermatosis occurs in patients with photosensitive skin types 1 and 2 (light-skinned), relapses occur in the summer, on hot days, especially after physical exertion.
Causes
There is no complete clarity in the etiology of the pathological process. Most modern specialists in the field of dermatology consider hyperinsolation to be the main provoking moment, which becomes the trigger of Grover’s disease against the background of a labile nervous system and an allergic mood of the body to ultraviolet.
There are several options for the development of the disease. The main one is a violation of the keratinization process. Dermal cells (keratinocytes) produce a protein that glues the layers of the epidermis and dermis together, thereby determining the elasticity and strength of the skin. Ultraviolet accelerates the process of keratinization, changing the structure of keratin and making it less sticky, which leads to a violation of skin density, loss of communication between cells and the appearance of acantholysis in the upper layers of the dermis. At the same time, due to hyperkeratotic processes, papules are formed. Some medications (for example, antibiotics) and mechanical friction of the skin can aggravate this condition. This is a transient process, when the action of sunlight is eliminated, keratinization is restored, acantholysis and papules self-resolve.
The second option is associated with an imbalance of the neuroendocrine regulation of the skin. Lack of coordination in complex cell division processes leads to partial loss of desmosomal connections and accelerated division of epidermal cells. Hyperinsolation, physical activity and hyperhidrosis are considered as triggers. As a result, the upper layers of the skin become loose, begin to peel off with the formation of acantholysis, the dermis cells divide intensively, forming elements of “plus tissue” in the form of papules. Since pathological failures in the work of regulatory systems are long–running processes, and changes in the skin are transient, Grover’s disease is called persistent dermatosis, that is, a pathological process that slowly develops and constantly involutes, while maintaining the previous state as the basis for a new “attack”.
The third variant of the development of Grover’s disease basically has an allergic mood of the body. As a result of the action of UVI and against the background of a rise in temperature, hypersensitive skin to the sun begins to produce antibodies, which are visually manifested by the formation of “sunny” papules. With the elimination of ultraviolet exposure, the pathological process is spontaneously resolved. There is another variant of the development of Grover’s disease, in which pathological changes in the skin are considered as part of the paraneoplastic process. In this case, the formation of papules is a response of the skin to damage to its cells by toxins latently or clearly existing focus of the oncological process. It is with this mechanism of pathology development that itching is the dominant symptom.
Classification and symptoms
The average duration of Grover’s disease is about 3 years. Depending on the duration of one “attack” of primary rashes, there are:
- Acute form of Grover’s disease – the duration of the disease is less than a month.
- The chronic (recurrent) form of Grover’s disease is the duration of the disease from several months to several years.
The main feature of the clinical picture is the transient nature of itchy dermatosis. Visually, Grover’s disease is characterized by the appearance of small (up to 5 mm in diameter) painless dense red itchy papules on the unchanged or slightly hyperemic skin of the chest, back, neck and extremities. Sometimes papules peel off, more often they are covered with crusts formed as a result of combing. They have no tendency to group. Since rashes constantly reappear, the process becomes widespread. Often rashes are preceded by prodromal syndrome. Mostly men over 40 suffer. The disease proceeds in waves, relapses occur in the summer, which is associated with the main trigger of the pathological process – insolation. Aggravating the severity of Grover’s disease is physical activity, excessive sweating, heat and subfebrility.
Diagnostics
The clinical diagnosis is made on the basis of anamnesis of the disease (hyperinsolation), symptoms (with mandatory examination of papules by a dermatologist in lateral illumination) and exclusion of somatic pathology with a mandatory biopsy result, where the presence of foci of acantholysis in the upper layers of the epidermis is a pathognomonic symptom. The cellular structure of the affected area is also determined by the analysis of smears-prints, in which acantholytic cells and impaired keratinization of the skin layers are found. Differential diagnosis is carried out with pemphigus, pruritus, Darye’s disease, benign Haley-Haley pemphigus, Dego’s disease, red sweating, papular urticaria, During dermatitis, scabies, insect bites, dermatomycosis, folliculitis and drug toxidermy.
Treatment
The disease is treated by a dermatologist, focusing on the severity of the pathological process. In mild forms, vitamin therapy courses are prescribed in combination with antibiotics to stop the secondary infection that has joined, external hormonal ointments. In severe cases, corticosteroids and retinoids are connected inside, antiseptics and ointments based on betamethasone with an occlusive 4-hour dressing are used. Sometimes aminoquinoline drugs are used to relieve inflammation. With resistance to therapy, hospitalization is possible to prevent complications and select the correct dosage. In some cases (taking into account the genesis of pathology), PUVA therapy is effective. The prognosis depends on the severity of the course, there is no complete cure.
