A Case of Extensive Grover’s Disease in a Patient with a History of Multiple Non-Melanoma Skin Cancers

Abstract

We report on a 69-year-old man who presented with itching and erythematous papules on his torso and extremities, which were resistant to topical therapy with antibiotics and steroids. Physical examination revealed multiple erythematous papules on his back, neckline, and lower extremities. The lesions had appeared 4 years earlier and usually worsened with heat or extensive sweating. Histopathology of previous skin biopsies had shown multiple cutaneous squamous cell carcinomas or was non-conclusive. Thus, a re-biopsy was performed, revealing acanthosis and focal acantholytic dyskeratosis. These clinical and anamnestic findings lead to the diagnosis of extensive Grover’s disease (GD). Oral therapy with isotretinoin 30-mg QD led to the regression of the skin lesions. Topical adapalene, as well as topical corticosteroids, were later prescribed for maintenance therapy.

Acantholytic Dyskeratosis Post–COVID-19 Vaccination: Another Case With Rapid Response to Isotretinoin

“…3 In another publication, 30 mg was the initial dose for 2 months and 40 mg for another 4 months in 1 patient, being then discontinued due to extensive myalgia and replaced by topical adapalene. 4 In our case, the dose of isotretinoin was significantly lower (10 mg/d) and a good response was noticed from the beginning (Fig. 1).…”

“…

appearance in the oral mucosa and acral regions, although extremely rare, has been reported. 3,4 The histological findings are usually like the primary tumor, although occasionally it acquires a more indistinct histology. In cases of doubt, there is typically immunohistochemical positivity for CK7, CK20, CK19, and CDX2.Identification of these metastases is often associated with a poor prognosis, with median survival rates of 4.5 months.

…”

“…2 Oral isotretinoin has been scarcely used previously in Grover disease, with few published cases. 3,4 In a series of 4 patients, the dose used was 40 mg daily, with improvement of the eruption and pruritus between the second and fourth weeks. The patients were treated for 2-4 months and had no recurrences after a 10-month follow-up period.…”

An Unusual Trigger of Grover’s Disease (GD)

“…First-line treatment includes topical steroids, vitamin D analogs, and oral antihistamines. In prolonged or extensive GD cases, systemic corticosteroids, retinoids, and phototherapy may be used [ 11 ]. Our patient successfully responded to systemic steroids, high-potency topical steroids, emollients, and antihistamines after a prolonged and extensive course.…”