January 1, 2010
Dear Mayo Clinic:
Can you tell me about Grover's disease, and what are the most effective treatments? I experience a rash and itching that sometimes keep me up at night, despite trying numerous medications.
Grover's disease — also known as transient acantholytic dermatosis — is a condition where itchy red spots appear without warning, usually on a person's back or upper chest. The condition has no cure. In some cases, Grover's disease may last a few months and then disappear. In others, it may continue on and off for years. Treatment is geared toward relieving the intense itching and rash that accompany this disorder.
The underlying cause of Grover's disease isn't clear, though it may be related to sweat gland obstruction (occlusion) with sweat dispersion in the upper layers of the skin. The disorder is most common in older white men. A history of significant sun exposure, heat, sweating and, occasionally, dry skin increase the risk of Grover's disease. Some people develop this condition in the hospital while lying on their backs for an extended time.
In patients who develop Grover's disease in the hospital, symptoms may disappear when the patient becomes mobile again. For people who have more persistent cases associated with sun-damaged or dry skin, symptoms of Grover's disease tend to come and go. In these individuals, the disease may flare when they are exposed to exacerbating factors such as high temperatures, sweating, or very dry skin.
To decrease the effects of Grover's disease, the first line of treatment is to avoid factors that can cause and aggravate the condition, such as high environmental temperatures, significant sweating, and dry skin. While no one treatment reliably relieves Grover's disease in all cases, effective therapies are available.
The rash from Grover's disease can be extraordinarily itchy. Treatments to decrease itching usually start with high-potency steroid creams, such as triamcinolone or clobetasol, along with antihistamines, such as diphenhydramine (Benadryl) or hydroxyzine (Vistaril, Atarax). If those medications don't provide enough relief, oral retinoid medications — isotretinoin (Accutane) or acitretin (Soriatane), for example — may occasionally be used to help decrease the inflammation and reduce itching.
If the rash and itching continue, light therapy (phototherapy) may be effective in some cases. Phototherapy involves exposing the skin to controlled amounts of natural sunlight or can include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light. Because exposure to light can sometimes intensify Grover's disease, light therapy should be directed by a dermatologist who has experience treating patients with Grover's disease.
Talk to your doctor or see a dermatologist to review your symptoms and develop an ongoing treatment plan that's right for you.
— Marcus Frohm, M.D., Dermatology, Mayo Clinic, Rochester, Minn.