Treatment of Grover's Disease
Topical corticosteroids are the first-line treatment for Grover's disease, with medium- to high-potency formulations (such as triamcinolone or clobetasol) applied to the trunk and low-potency hydrocortisone reserved for facial lesions. 1, 2
First-Line Therapy
- Apply medium- to high-potency topical corticosteroids (triamcinolone 0.1% or clobetasol 0.05%) to affected areas on the trunk twice daily for 3-4 weeks 1, 2, 3
- Use low-potency hydrocortisone on facial lesions to avoid skin atrophy 4
- Add topical vitamin D analogues as an alternative or adjunct to corticosteroids, which show good efficacy 1
- Prescribe oral antihistamines for symptomatic relief of pruritus as needed 4, 1
- Apply moisturizing emollients regularly to address xerosis, which can trigger disease 3, 5
Important caveat: If the rash is asymptomatic and stable, observation without treatment is acceptable since Grover's disease spontaneously resolves in 42% of cases within weeks to months 4, 2
Second-Line Therapy for Refractory Cases
When topical therapy fails after 4 weeks or disease is severe and widespread:
- Systemic retinoids show an 86% response rate and are the preferred second-line option 2
- Oral corticosteroids (prednisone 0.5-1 mg/kg/day) achieve a 64% response rate but carry more side effects 2
- Phototherapy (PUVA or narrowband UVB) can be considered for resistant cases 1, 3
Disease Prevention Strategies
- Avoid heat, sweating, and occlusive environments (bandages, tight clothing) which trigger acantholysis 3, 6
- Minimize UV exposure as ultraviolet radiation exacerbates disease 3
- Address xerosis with regular emollient use, particularly in winter months when disease is 4 times more common 3
Special Populations
In immunosuppressed patients (transplant recipients, chemotherapy patients):
- The same topical corticosteroid approach applies as first-line 3, 5
- Disease may resolve spontaneously within 2 weeks even without treatment modification 3
- Consider reducing immunosuppression if clinically feasible, though this is rarely necessary 3
Common pitfall: Do not confuse Grover's disease with graft-versus-host disease in transplant patients—the evidence provided about GVHD management 4, 7, 8 is not applicable to Grover's disease, which is a distinct acantholytic dermatosis requiring different treatment.