Treatment of Grover's Disease
For Grover's disease, first-line treatment consists of topical corticosteroids (such as betamethasone or mometasone furoate 0.1% cream) applied twice daily for 3-4 weeks, with topical vitamin D analogues as an alternative or adjunctive option. 1, 2
Initial Management Strategy
- Apply mid-to-high potency topical corticosteroids (betamethasone or mometasone furoate 0.1% cream) twice daily for 3-4 weeks as the primary treatment approach 1, 3, 2
- Add oral antihistamines for symptomatic relief of pruritus as adjuvant therapy 2
- Topical vitamin D analogues can be used as first-line alternatives or in combination with corticosteroids 2, 4
Conservative Measures and Trigger Avoidance
- Avoid excessive heat, sweating, and occlusive environments (such as tight bandages or prolonged bedrest) which can precipitate or exacerbate the condition 3, 2, 4
- Minimize ultraviolet radiation exposure, as UV light has been identified as an exacerbating factor 1
- Apply moisturizing emollients regularly, particularly in cool, dry conditions which may trigger disease onset 2
- Note that the disease is four times more likely to be diagnosed in winter months, suggesting xerosis cutis as a contributing factor 1
Escalation for Refractory or Severe Cases
When first-line topical therapy fails after 3-4 weeks or in cases of extensive disease:
- Oral retinoids (isotretinoin or acitretin) are effective for refractory cases, with three of four patients in one series achieving remissions lasting up to 10 months 5, 4
- Systemic corticosteroids can be considered for severe, widespread eruptions 2
- PUVA phototherapy has demonstrated efficacy in suppressing symptoms 2, 4
- Methotrexate is reserved for resistant cases that fail other systemic therapies 2
Clinical Course and Prognosis
- The disease typically follows a transient course lasting only a few weeks with appropriate treatment 1, 3
- However, chronic cases can persist for months to years, particularly in patients on hemodialysis or with immunosuppression 1, 2
- Spontaneous resolution may occur even without treatment, especially when precipitating factors are removed 1, 2
Important Caveats
- In immunosuppressed patients (kidney transplant recipients, HIV, bone marrow transplant), the disease may have a more prolonged course despite treatment 1
- Renal transplantation has been associated with remission in some hemodialysis patients with Grover's disease, though the mechanism remains unclear 1
- The condition can recur after initial successful treatment, particularly if triggering factors persist 5
- Histological confirmation is essential for diagnosis, showing characteristic suprabasal acantholysis with dyskeratosis 1, 3