A 60-year-old man presented with a pruritic rash on the chest and abdomen that had developed over a week in the summer, after a spate of yard work. The patient had multiple excoriated erythematous papules, some of which were hyperkeratotic. Biopsy of one of the lesions revealed epidermal hyperkeratosis and acantholysis, which confirmed the clinical diagnosis of Grover disease, or transient acantholytic dermatosis.
The cause of this disease is unknown, although it is often precipitated by sweating, fever, and bed confinement. The condition is fairly common, particularly in older men, and often lingers in varying degrees for months and sometimes years. The rash is usually distributed on the central anterior or posterior trunk.
The differential diagnosis includes acne, Pityrosporum folliculitis, psoriasis guttata, and Darier disease. In this patient, the biopsy results showed no yeast organisms, parakeratosis, or folliculocentric findings that would have supported other conditions in the differential diagnosis.
Therapeutic options include topical corticosteroids, phototherapy, topical calcipotriene, and systemic retinoids. These treatments can be used alone or in combination. Pruritus can persist even with treatment.
This patient was treated with triamcinolone (0.1%) cream. Within 5 months, the rash had resolved. ■