Grover's disease: Symptoms, causes, pictures, treatment

Grover's disease is an uncommon but potentially debilitating skin condition. Doctors are not yet sure what causes the disease or how to cure it, but treatments are available to manage the symptoms.

Also called transient acantholytic dermatosis, Grover's disease typically presents as a rash on the chest and back. Intense itching often accompanies the rash.

Possible treatments include oral medications and topical creams for direct application to the skin. The most effective treatment will vary from person to person, so people with Grover's disease will need to consult with a doctor to find what works best for them.
What is Grover's disease?
A person with Grover's disease will experience red bumps on the back and chest.
Image credit: Tvbanfield, (2009, March 5).


Grover's disease usually begins as small itchy red bumps on the back and chest, which may then spread to the upper limbs. The bumps are usually slightly raised but can feel soft or hard to the touch.

According to Dr. Adam Friedman, an associate professor of dermatology at the George Washington School of Medicine and Health Sciences, water-filled blisters may appear alongside or inside these bumps.

Most cases of Grover's disease last for 6–12 months, but some may last longer or come and go over time.

According to some sources, Grover's disease primarily affects white men aged 50 and above and is less common in women and younger people. It is very rare, with a Swiss study finding only 24 (0.08 percent) examples of Grover's disease among 30,000 skin biopsies.
Symptoms

For most people with Grover's disease, the most disruptive symptom is intense itching at the rash location.

Not everyone experiences itching, but for those that do, the itching can become so severe that it interferes with daily activities and sleep quality.

"Both the itch and the clinical appearance can have a tremendous impact on quality of life and be quite disabling," says Dr. Friedman.

Scratching the itch also worsens the problem by damaging the skin and making it prone to bleeding and infection.
Causes and risk factors
Grover's disease can cause sweating and fever-like symptoms.

Grover's disease occurs as a result of changes to the proteins that help to hold the skin cells together.

These changes occur at a microscopic level and cause partial breakdown of the skin. For some people, this breakdown results in Grover's disease.

While the exact cause remains unclear, there are many possible triggers, including:
increased sweating
prolonged bed rest, for example during hospital stays
extended periods of sun exposure
dry skin, especially during the winter months
organ transplants
end-stage renal (kidney) disease and hemodialysis
exposure to radiation, such as X-rays

Cancer, chemotherapy, and recent organ transplants can increase the risk of developing abnormal forms of Grover's disease. In these cases, the rash may appear in an unusual location on the body after beginning on the back or chest.

Doctors tend to keep all risk factors in mind, rather than focusing on any one trigger. Dr. Friedman states that "it is probably a mix of factors including sun exposure, age, and skin care habits."
Is it contagious?

Grover's disease is not contagious, even when another person comes into contact with the rash.
Diagnosis

The only way to confidently diagnose Grover's disease is to do a skin biopsy. A biopsy is a tissue sample that a doctor sends to a laboratory for testing.

Dermatologists typically use a shave skin biopsy. They will numb the area of skin, so the individual does not feel any pain, then use a razor-like tool to cut a sample from one of the rash bumps.

There is a small chance that a biopsy will leave a scar. To minimize that chance, a person should follow the doctor's post-procedure instructions.

Sometimes people may confuse Grover's disease with other conditions, including:
Darier disease: Unlike Grover's disease, Darier disease usually appears during or just after puberty (before age 30) and is hereditary.
Hailey-Hailey disease: This disease involves blisters and crusted skin bumps, but is genetic.
Pemphigus foliaceus: This is an autoimmune condition. Doctors can use immunofluorescence, a staining technique that can identify pemphigus foliaceus under a microscope, to distinguish it from Grover's disease.
Galli-Galli disease: This condition involves a rash that looks similar to Grover's disease, but it is hereditary.

In addition to the biopsy, a doctor is likely to ask about any family history of skin conditions to help them make the correct diagnosis.
Treatment
A doctor will often prescribe a moisturizer as one of the first lines of treatment.

There is no standard treatment plan for Grover's disease, but dermatologists and other experts have developed several lines of treatment that can help reduce symptoms.

Doctors will begin treating Grover's disease using the first line of treatment and move onto the second or third line if symptoms do not improve.

First line:
moisturizers, including lotions, balms, and gels
over-the-counter (OTC) or prescription anti-itch corticosteroid cream
oral antihistamines, which are available OTC in many forms

Second line:
topical vitamin D analogs in a liquid or cream for topical application
antifungal or antibiotic therapy

Third line:
oral or injectable systemic corticosteroids, which require a prescription (oral prednisone is very common)
oral or topical systemic retinoids, which also need a prescription
PUVA phototherapy, which uses ultraviolet light to provide relief but can sometimes make the disease worse initially

Dr. Friedman suggests combining different treatments to get symptoms under control.

"Aggressive treatment, especially in severe cases, is needed to provide relief," he states. "I frequently use oral retinoids, a form of vitamin A, to treat moderate to severe cases, along with potent topical steroids and antibacterial washes."
Prevention

Since heat and sweating may trigger Grover's disease, doctors recommend that people who may be at risk avoid places or activities that could cause the body to heat up excessively or produce sweat.

This could include wearing moisture-wicking clothing or avoiding intense sun exposure.

Grover's disease is not always preventable, so it is best to see a doctor as soon as any symptoms appear. Prompt diagnosis can help prevent symptoms from impacting on a person's quality of life.


A Grover's disease rash and the itching that accompanies it can lower a person's quality of life. The good news is that the disease is not life-threatening and usually goes away in 6–12 months.

Dermatologists can help people to manage the condition and control their symptoms.