Pseudoherpetic transient acantholytic dermatosis (Grover disease): case series and review of the literature

Abstract

A total of 3 cases of pseudoherpetic transient acantholytic dermatosis (Grover disease) are presented, followed by a brief review of prior reports. All 3 patients were above the age of 60 and presented with a pruritic eruption composed of papules with or without vesicles distributed on the trunk. For all 3 patients, the clinical differential diagnosis included drug eruption but did not include Grover disease; in 1 patient, the clinical impression included herpesvirus infection. Similar histologic and immunohistochemical findings were demonstrated in all 3 cases. Intraepidermal vesicles with acantholysis, multinucleation and hypereosinophilic keratinocytes mimicking necrosis raised the possibility of herpesvirus infection. However, the focality of the process at scanning magnification, absence of true cytopathic effect despite multinucleation, and identification of dyskeratosis rather than true necrosis all permitted for morphologic distinction as pseudoherpetic change. Immunohistochemistry, negative for herpes simplex virus and varicella zoster virus antigens, also distinguished pseudoherpetic change in these patients from a true herpesvirus infection. This series highlights an uncommon histologic variant of a common disorder and describes morphologic and immunohistochemical findings to facilitate its distinction from true herpesvirus infection.

Grover’s disease

“…A 78-year-old man with a history of hypertension, after anti-tuberculosis treatment for bone tuberculosis (15 years before), resection and radiotherapy for prostate cancer (3 years before), and myocardial infarction (2 years before), reported to the Department of Dermatology and Venereology to undergo a diagnostic work-up for skin lesions manifested as multiple papules and vesicles located on the skin of the torso and limbs, persisting for approximately 1.5 years (figs. [1][2][3]. The skin eruptions were accompanied by pruritus which intensified after sweating and hot baths.…”

“…Zmiany lokalizują się głównie na tułowiu. Najwięcej zachorowań obserwuje się u mężczyzn, zwłaszcza w wieku średnim i starszym [2]. W wycinku skóry zwykle stwierdza się ogniska akantolizy oraz dyskeratozy [3].…”

“…Wyróżniono trzy postacie kliniczne choroby: przejściową wypryskową, przetrwałą świądową oraz przewlekłą asymptomatyczną [4]. Dotychczas stwierdzono związek choroby Grovera głównie z nadmiernym poceniem się, przegrzaniem, ekspozycją na promieniowanie ultrafioletowe, zmianą pór roku, a także z nowotworami i stosowaniem leczenia przeciwnowotworowego lub innymi dermatozami [2,3,5,6].…”

“…The lesions appear primarily on the torso. Grover's disease is a condition seen predominantly in middle-aged and elderly men [2]. Skin biopsy typically reveals foci of acantholysis and dyskeratosis [3].…”

“…The disorder has three clinical forms: transient eruptive, persistently pruritic and chronic asymptomatic [4]. So far, Grover's disease has been found to be mainly linked to excessive sweating, overheating, exposure to UV radiation, change of seasons, but also several types of cancer and cancer therapy, or other dermatoses [2,3,5,6].…”