Introduction:
Grover's disease was described in 1970. Papulovesicular eruptions on the proximal extremities and trunk characterize it. It is a temporary skin condition that resolves over a week or a month but is more likely to be persistent. It is a benign, self-limiting condition.
What Is the Pathophysiology of Grover's Disease?
There are many reasons for Grover's disease. It is often associated with heat or sweating, and the obstruction of sweat ducts has been hypothesized to be responsible for Grover's disease. Grover's disease is higher in winter and summer. Xerosis may be a potential cause of Grover's disease and is aggravated by cold weather.
Many individuals describe before sunlight exposure. However, studies have shown that ultraviolet radiation does not reproduce the progress of the disease. Grover's disease is frequent in individuals with asteatotic dermatitis and atopic dermatitis. But most of them do not develop the disease. Bacterial, viral, and other pathogens play a role, but the cause is unclear. A few cases showed an association with lymphoma, and the exact pathology is unclear. Melanoma with CTLA-4 inhibition has been associated with Grover's disease. Some cases showed an association between autoimmune antibodies and Grover's disease.
Who Are the People Commonly Affected by Grover's Disease?
Frequency: The exact case prevalence is unknown as most cases remain undiagnosed or underdiagnosed as there are clinical similarities between other entities and their histopathological findings. Grover's disease is associated with immobilization occlusion.
Race: Grover's disease is commonly seen in middle-aged white men. Other ethnic groups which may be affected are Hispanics and blacks.
Sex: Grover's disease shows a male preference, and women are less frequently affected.
Age: Grover's disease is common in middle-aged men. However, it is seen in children as well.
What Are the Signs and Symptoms of Grover's Disease?
One of the trademark signs of Grover's disease is pruritus; for example, some individuals with limited cutaneous disease may have severe itching. In contrast, others may have no or few symptoms. Though the symptoms may resolve in weeks or months, they often recur. The lesions may occasionally bleed. Some systemic symptoms are seen in Grover's disease.
Physical Examination Findings:
Grover's disease usually presents at first as an eruption of skin on the chest, lower portion of the ribcage, and the upper part of the back. Individuals with a severe form of Grover's disease have disseminated manifestations such as the shoulders, the neck, the arms, and the legs. The scalp, palms, and soles are commonly not affected. Solitary lesions are erythematous and have red-brown keratotic papules, which are discrete and do not usually coalesce. The lesions appear to be vesicular, acneiform, pustular, and bulbous. The most common sign is scattered papules. Unusual signs and symptoms include zosteriform or unilateral.
What Are the Complications of Grover's Disease?
Dermatitis may lead to complications in diagnosis as it produces round, scattered, crusted plaques similar to Grover's disease. Scarring is rarely seen unless there is excoriation. Lesions tend to resolve with post-inflammatory pigmentation alteration or without any residual change.
What Is the Differential Diagnosis for Grover's Disease?
The differential diagnosis includes:
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Dermatitis Herpetiformis - Extensor distribution, vesicular and pruritus are more severe.
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Folliculitis - Pustules in long standing lesions, and follicular papules.
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Arthropod reaction- Cluster forming tendency, extremities, and exposed sites are usually involved.
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Papular Urticaria - Severe lesions tend to spread, primary excoriation.
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Miliaria Rubra- Medical history with an exaggeration of heat; the lesions are often nodular.
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Papular Drug Eruption - Papules may coalesce into plaques, and the extremities are affected.
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Herpes Simplex or Herpes Zoster - Immunosuppression, vesicular, and painful.
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Scabies- Intractable itching, which is worst at night; webs, fingers, and axillae are affected.
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Papular Pityriasis Rosea - Herald patches, less severe pruritus, and collarette of scales.
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Secondary Syphilis - Scaly with palmar lesions and mild pruritus.
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Galli-Galli Disease - lower extremities are affected, usually the groin and hands.
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Darier Disease - Follicular involvement.
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Pemphigus Foliaceus - Erosions.
What Are the Diagnostic Tests for Grover's Disease?
Grover's disease has similar symptoms to the herpes virus; hence the healthcare provider may suggest a test to rule out HSV-1 and HSV-2. Skin scraping test with oil preparation detects ova, mites, and scybala of scabies is commonly seen in individuals with pruritis and rash. However, the signs and symptoms of Grover's disease differ from scabies. Infections from parasites, cat mites, and bird mites may show similar signs and symptoms to Grover's disease. Grover's disease shows a negative result for immunofluorescence.
What Is the Treatment and Management of Grover's Disease?
Successful treatment depends on the accurate diagnosis of the disease at an early stage and treatment of the features of underlying atopy. Recurrence is present most of the time. The individual's high sweat antigen or metal concentrations should be evaluated.
Medical Approach:
Topical steroids reduce inflammation and control the itching in Grover's disease. Pramoxine and Menthol may also relieve itching. For refractory disease conditions, retinoids such as vitamin A 50000 units daily for two weeks and continued for 12 weeks. Adjunct therapy involves 40 mg per day of Isotretinoin for twelve weeks. In severely resistant cases, oral corticosteroids, psoralen plus ultraviolet A light (PUVA), UV-B exposure, Methotrexate, and Grenz radiation may be effective.
How to Prevent Grover's Disease?
Individuals are advised to avoid activities causing excessive heat, like vigorous exercise and prolonged sun exposure. Individuals should avoid the application of irritants.
How to Monitor Grover's Disease?
Initial care for Grover's disease involves mid-potency topical corticosteroids and oral antihistamines. Individuals are advised to apply Menthol and Camphor regularly. Atopic skin care measures are advised. Acitretin, psoralen plus ultraviolet A light (PUVA), UV-B exposure, Methotrexate, and Grenz radiation may be effective in severe cases.
Conclusion:
Grover's disease is a temporary skin condition that causes sudden red, blistery, raised, and itchy spots. Commonly seen in middle-aged white men and often seen in cold climates. Treatment is through medication.
