Treatment of Grover Disease
Medium to high-potency topical corticosteroids are the first-line treatment for Grover disease, applied to affected areas 1-2 times daily for 1-4 weeks with gradual tapering. 1
Clinical Overview
Grover disease (transient acantholytic dermatosis) is a benign papulovesicular eruption that typically affects the trunk and proximal extremities. It commonly presents in middle-aged men with a male-to-female ratio of approximately 4:1, with a mean age of 59 years 2. The condition is characterized by pruritic papules and vesicle-papules that can cause significant discomfort.
Treatment Algorithm
First-Line Therapy:
- Topical corticosteroids: Medium to high-potency formulations (e.g., triamcinolone acetonide 0.1%, clobetasol propionate) 1, 3
- Apply 1-2 times daily to affected areas
- Treatment duration: 1-4 weeks with gradual tapering
- Response rate: approximately 70% 2
- Topical vitamin D analogues can be used alongside corticosteroids 3
- Topical menthol preparations provide counter-irritant effect for symptomatic relief 1
- Antihistamines for adjunctive relief of pruritus 1, 3
- Non-sedating options: fexofenadine 180mg, loratadine 10mg
- Mildly sedating: cetirizine 10mg
Second-Line Therapy (for refractory cases):
- Systemic retinoids (response rate: 86%) 2
- Acitretin at 0.8mg/kg/day has shown complete remission in persistent cases 4
- Systemic corticosteroids (response rate: 64%) 2
- Gabapentin or pregabalin when topical treatments are insufficient 1
- Pregabalin has shown success in treatment-resistant cases
Third-Line Therapy:
Important Clinical Considerations
Disease Course
- Spontaneous resolution within one week to eight months occurs in approximately 42% of cases 2
- Some cases may follow a chronic and fluctuating course lasting several years 3
Triggering Factors to Address
- Heat and sweating
- Cool and dry air
- Occlusive environments (e.g., bandages, prolonged bed rest) 5
- Renal failure
- Malignancy (including hematologic malignancies) 6
- Certain medications
Common Pitfalls to Avoid
- Inadequate treatment duration
- Using monotherapy when combination therapy may be more effective 1
- Failing to address underlying triggers
- Overlooking potential associations with malignancy or other systemic conditions 6
Special Considerations
- For localized or unilateral presentations, consider the possibility of other acantholytic dermatoses in the differential diagnosis 5
- Combination therapy (topical treatments plus systemic medications) is often more effective than monotherapy alone 1
- Inspect for other pathologic processes to rule out concomitant disorders 6
By following this treatment algorithm and addressing potential triggers, most patients with Grover disease can achieve symptomatic relief and disease resolution.