What is the treatment for Grover's disease?

Treatment of Grover's Disease

Topical corticosteroids should be the first-line therapy for Grover's disease, with medium- to high-potency formulations applied to the trunk and low-potency hydrocortisone reserved for facial lesions. 1

First-Line Treatment Approach

• Apply topical corticosteroids as primary therapy, which demonstrates a 70% response rate and represents the most frequently employed treatment in clinical practice 1
• Use medium- to high-potency topical steroid formulations (such as betamethasone or mometasone) for trunk and body lesions 2, 3
• Switch to low-potency hydrocortisone for facial application to minimize risk of skin atrophy 2
• Add topical vitamin D analogues as an alternative or adjunctive first-line option 4
• Prescribe antihistamines for symptomatic relief of pruritus, though these serve only as adjuvant therapy and do not treat the underlying disease 4, 1

Second-Line Treatment for Refractory Cases

When first-line topical therapy fails after 3-4 weeks, escalate to systemic treatments:

• Systemic retinoids (such as isotretinoin) demonstrate an 86% response rate and should be considered the preferred second-line option 1, 5
• Isotretinoin has shown particular efficacy in achieving remissions lasting up to 10 months in patients with relatively acute disease 5
• Systemic corticosteroids represent an alternative second-line choice with a 64% response rate, though lower than retinoids 1
• Typical treatment duration with topical betamethasone is 3-4 weeks, with lesions often persisting only a few weeks after initiation 2

Third-Line Options for Severe Refractory Disease

• Phototherapy (PUVA) can be considered for cases resistant to both topical and systemic therapies 2
• Methotrexate represents another option for resistant cases 2
• Novel therapies involving innovative light therapy and immune modulators have limited evidence but may be considered in exceptional circumstances 4

Disease Prevention and Trigger Avoidance

• Counsel patients to avoid identified triggers: heat and excessive sweating, cool dry air, UV radiation exposure 4, 2
• Apply moisturizing emollients regularly to combat xerosis cutis, which may trigger disease onset 2
• Recognize that spontaneous resolution occurs in 42% of cases within one week to eight months, so conservative management with trigger avoidance alone may be appropriate for mild cases 1

Special Populations and Clinical Pearls

• In immunosuppressed patients (including transplant recipients), the disease may follow a more chronic course but typically responds to standard topical corticosteroid therapy 2
• The disease predominantly affects middle-aged Caucasian men (male-to-female ratio 3.95:1, mean age 59 years) with typical presentation of itchy papules and vesicle-papules on the trunk 1
• Confirm diagnosis with skin biopsy showing characteristic suprabasal acantholysis with dyskeratosis before initiating systemic therapy 2
• Four histological subtypes exist (Darier-like being most common, plus pemphigus vulgaris-like, Hailey-Hailey-like, and spongiotic), but this does not alter treatment approach 2