An obese 52-year-old man with diabetes presented to his family physician (FP) with an itchy rash that he’d had on his back for the past 3 months. He said that it came on suddenly during cold weather, but it also got worse after sweating. The red papules on his back were not associated with hair follicles. Four months earlier, he’d started an angiotensin-converting enzyme (ACE) inhibitor for his hypertension.
What's your diagnosis?
The FP was concerned that this could be a drug eruption but didn’t want to stop the ACE inhibitor because the patient had hypertension that was finally under control. Therefore, she performed a punch biopsy around one of the red papules for a definitive diagnosis. She also prescribed 0.1% triamcinolone cream and oral hydroxyzine for the pruritus while awaiting the diagnosis. The punch biopsy revealed that the patient had transient acantholytic dermatosis, also known as Grover’s disease.
Grover’s disease mostly affects older men (>50 years), but occasionally occurs in women and younger people. Pruritus is a common complaint and some sufferers feel that sweating makes it worse. The cause is unknown and the prognosis is variable.
Grover’s disease is transient for some, but it can also be chronic or relapsing. As it is a relatively rare condition, there are few high-quality studies to guide treatment. Some of the treatments described in the literature include topical steroids, oral antihistamines, oral antifungals, oral antibiotics, oral retinoids, moisturizers, and phototherapy.
When this particular patient returned for follow-up, he noted about a 50% improvement in his symptoms and the red papules were less red. The patient was referred to Dermatology and told to continue the triamcinolone cream until he could see a dermatologist.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Hunter-Anderson K. Folliculitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:680-685.