Grover's Disease/Transient Acantholytic Dermatosis
Saturday, January 01, 2011
Lesions of transient acantholytic dermatosis (TAD) often are not
"transient," and may persist for years. Heat and sweating appear to
be triggers, with patients presenting after trips to tropical or
semitropical climates, with fever, and after hospitalization or
bedrest. Immunosuppression may increase the risk of developing TAD,
as it is seen in patients with HIV infection, in leukemia, and in
patients recently receiving bone marrow transplants. Pruritus may
be severe. The strategy is to suppress the pruritus and if possible
clear the cutaneous lesions.
- If TAD is not pruritic, treatment may not be required.
- A high-potency or superpotent steroid cream, applied twice
daily can be effective in some patients, and may suffice for
patients with mild disease. Occlusion with a sauna suit may enhance
therapy, although care must be taken to avoid overheating and
- Topical tretinoin gel 0.025% or tazarotene gel 0.05% or 0.1%
applied once to twice daily may be effective. Often topical
application must be continued to the point of irritancy for the
lesions to resolve. Peeling should be anticipated.
For patients with extensive or severely pruritic disease, begin
low-dose isotretinoin 20-40 mg/day. Response may take more than a
month. The dose can be tapered gradually as the condition improves;
however, often 4-6 months of low-dose isotretinoin (10mg/day) may
be required to induce a remission.
- Photochemotherapy (PUVA) is effective in some cases; an initial
brief exacerbation may occur, however, before clearing.
- Systemic steroids can provide temporary relief, and can induce
remissions. Relapses may occur. Systemic steroids should be
reserved for the most severely pruritic patients, and an
alternative treatment, as noted above, that will allow transition
off the systemic steroids should be started if the systemic
steroids are required for longer than 1 month in a dose exceeding
- An emollient lotion containing menthol, phenol, and camphor may
provide temporary relief.
- Antihistamines (e.g., doxepin 10-25 mg., hydroxyzine 10-50 mg,
or diphenhydramine 25-50 mg as a single nightly dose) may help
control the pruritus.
- Avoidance of sweating may prevent exacerbations.
- TAD, despite its name, may not be transient, and may persist
- The potential side effects of topical and systemic retinoids
and topical steroids should be monitored.