Transient acantholytic dermatosis
Transient acantholytic dermatosis is a skin condition affecting the chest and back. It can be transient, as the name suggests, but may also relapse or become chronic/persistent. Transient acantholytic dermatosis is also known as Grover disease.
Who gets transient acantholytic dermatosis?
Transient acantholytic dermatosis most often affects men over 50. It is less common in women or younger people. It is common in those who are unwell in some way, but can arise in quite healthy people as well.
What causes transient acantholytic dermatosis?
The cause of transient acantholytic dermatosis is unknown. Sometimes, it follows sweating or some unexpected heat stress, so there has been suspicion that it may relate to sweat or sweat ducts. But it also may arise in quite dry skin. Many affected individuals are sun damaged.
Clinical features of transient acantholytic dermatosis
Transient acantholytic dermatosis often starts quite suddenly. It is more common in winter than in summer. It results in small red, bumpy spots (papules) on the central back, mid chest and occasionally elsewhere. Although frequently itchy, transient acantholytic dermatosis may cause no symptoms. The spots may be blistered, crusted or eroded. There may be slight bleeding.
Sometimes, transient acantholytic dermatosis can be complicated by the development of dermatitis, usually in a discoid pattern i.e with round or oval-shaped plaques. These tend to present as larger itchy patches with a dry surface, and the rash may spread to affect other areas of the body.
How is transient acantholytic dermatosis diagnosed?
Transient acantholytic dermatosis is usually diagnosed clinically, but a skin biopsy may be necessary. The pathology of transient acantholytic dermatosis is characteristic, with acantholysis (separated skin cells) with or without dyskeratosis (abnormal rounded skin cells).
How long does transient acantholytic dermatosis last?
The duration of transient acantholytic dermatosis is variable—from days to decades. Most cases last six to twelve months. It can come and go, often with a seasonal variation.
Treatment of transient acantholytic dermatosis
There is no curative treatment for transient acantholytic dermatosis, but the following suggestions may be helpful.
- Remain cool, as sweating may induce more itchy spots. Apply diphemanil methylsulfate powder (Prantal™).
- Apply a mild topical steroid such as hydrocortisone in a cool lotion. It can be applied frequently to the affected areas to relieve itching.
- Moisturising creams or antipruritic lotions containing menthol and camphor may also help.
- Calcipotriol cream has been reported to be of benefit.
- A course of tetracycline or an oral antifungal medication such as itraconazole helps some patients.
- Phototherapy can be helpful, but may also provoke the disease.
- Experimentally, oral retinoids such as acitretin or isotretinoin have been reported to be helpful. However, they have important side effects and are not necessary for mild cases.