Grover's disease: Clinicopathologic review of 72 cases

Objective: To report the clinicopathologic findings in patients with Grover 's disease. Material and Methods: We reviewed the medical records and biopsy specimens from 72 patients with transient acantholytic dermatosis (Grover's disease) examined at Mayo Clinic Rochester. Hematoxylin-eosin-stained biopsy specime ns (from all patients) were assessed. Immunohistochemistry stains BRST-2, C AM 5.2, and CD44 were used to stain eight specimens. Direct immunofluoresce nce reports were reviewed. Selected specimens were stained by indirect immu nofluorescence to detect major basic protein. Results: Of the 72 patients, 63 (88%) were men, and the mean age was 48 yea rs (range, 31 to 85), Lesions were distributed mainly on the trunk tin 71 p atients) and proximal extremities (in 25), Heat and sweating frequently wer e exacerbating factors. Fifteen patients (21%) were bed-bound. Concurrent n ondermatologic malignant disease was present in 18 patients (25%), Two pati ents (3%) had acquired immunodeficiency syndrome, Follow-up in 28 patients (mean, 38 months; range, 3 months to 7 years) revealed that the disease had recurred in 13, persisted in 3, and resolved in 12, Review of the biopsy s pecimens showed that acantholysis was pemphigus vulgaris-like in 40 patient s (56%), Darier's disease-like in 16 (22%), spongiotic in 12 (17%), pemphig us foliaceus like in 2 (3%), and Hailey-Hailey disease-like in 2 (3%), A pe rivascular lymphocytic infiltrate of varied intensity in 64 specimens (89%) was associated with eosinophils in 16 (22%). In nine biopsy specimens with dermal eosinophilia stained for major basic protein, varied dermal cellula r and extracellular deposition of major basic protein was present. Results of direct immunofluorescence studies, performed in 17 cases, were negative or nonspecific, CD44 stained acantholytic areas in addition to sweat glands in two of eight specimens (25%), Conclusion: Further studies of the pathogenesis of Grover's disease are nee ded. The predisposing conditions, site of involvement, and relapsing nature of this disorder may implicate acrosyringeal dysfunction as the cause.