What is transient acantholytic dermatosis?

Transient acantholytic dermatosis, also known as Grover disease, is a frequent, acquired, itchy, truncal rash that histopathologically shows acantholysis. It is more common in Caucasian men over 50 with sun damaged skin. It is less prevalent in women and young adults.
Sun exposure, sweating, fever, cancer, and being in the hospital or bedridden are all risk factors for transient acantholytic dermatosis.

It is becoming more common with the use of BRAF inhibitors such as vemurafenib and dabrafenib monotherapy, as well as cytotoxic chemotherapeutic agents.

Causes :

The cause of transitory acantholytic dermatosis remains unknown. Because transitory acantholytic dermatosis is frequently associated with skin occlusion, heat, and sweating, one theory suggests that it is caused by sweat duct injury and occlusion. Drug-induced transitory acantholytic dermatosis may be due to medication or its metabolites being secreted in sweat, which has toxic effects on the epidermis, resulting in acantholysis and dyskeratosis. BRAF-induced transitory acantholytic dermatosis may be caused by keratinocyte proliferation triggered by MAP-kinase activation. SARS-CoV-2 was detected on immunohistochemistry in the sweat gland epithelium and cutaneous vasculature of a COVID-19 patient.

Clinical features :

Transitory acantholytic dermatosis frequently begins abruptly. Some (but not all) research indicates that it is more common in the winter than in the summer . The most frequently affected areas are the central back, mid-chest, and upper arms. Lesions consist of tiny red, crusty, or eroded papules and vesicles. The rash is extremely pruritic.

Diagnosis :

Transient acantholytic dermatosis is typically diagnosed clinically; however, a skin biopsy may be required. Transient acantholytic dermatosis has a distinct pathology that includes acantholysis (separated skin cells) and/or dyskeratosis (abnormally rounded skin cells). Spongiotic dermatitis might also be noticed.

Treatment :

Transient acantholytic dermatosis has no cure; however, the following tips may help relieve the itch and speed up the healing process:

Keep cool, as sweating may cause more itchy areas.
Menthol- and camphor-based moisturizing creams or antipruritic lotions can help lessen the desire to scratch.
Cryotherapy
Topical trichloroacetic acid
Topical steroid
Topical steroid/vitamin D analogue combination ointment
Oral retinoids
Phototherapy and photochemotherapy

Complications :

Dermatitis can complicate transient acantholytic dermatosis, which commonly appears in a discoid pattern with round or oval, dry, or crusted plaques. The plaques begin on the chest and back and may migrate to the limbs.

Prognosis :

Transient acantholytic dermatosis has a variable duration, but it usually resolves spontaneously within 2-4 weeks. It can come and go, with seasonal variations. Transient acantholytic dermatosis, despite being named transient, is frequently recurring and can be chronic, lasting for years.

Written by:

Atheer Alhuthaili , medical student.

Revised by:

Maee barakeh , medical student.

References:

DermNet.

Medscape.