Initial Treatment for Grover's Disease
Topical corticosteroids are the first-line treatment for Grover's disease, with medium- to high-potency formulations like triamcinolone 0.1% cream applied 2-3 times daily to affected areas on the torso. 1, 2
Treatment Approach
First-Line Therapy: Topical Corticosteroids
Medium- to high-potency topical corticosteroids demonstrate a 70% response rate and represent the most frequently employed and effective initial treatment. 1
Triamcinolone acetonide 0.1% cream should be applied to affected areas 2-3 times daily and gently rubbed in. 2
Betamethasone cream applied twice daily for 4 weeks is an alternative medium-to-high potency option that has shown effectiveness in transplant patients with Grover's disease. 3
Treatment duration typically ranges from a few weeks to several months, as 42% of cases resolve spontaneously within one week to eight months. 1
Adjunctive Symptomatic Management
Antihistamines (such as cetirizine, loratadine, or fexofenadine) should be added for symptomatic relief of pruritus. 4
Moisturizing emollients applied at least once daily help address xerosis cutis, which is a recognized trigger for Grover's disease. 3, 4
Patients should avoid heat, excessive sweating, and UV light exposure, as these are established exacerbating factors. 3, 5
Second-Line Options for Refractory Cases
When Topical Steroids Fail After 2-4 Weeks
Systemic retinoids (such as isotretinoin or acitretin) demonstrate an 86% response rate and should be considered for persistent disease unresponsive to topical therapy. 1, 6
Oral corticosteroids show a 64% response rate but should be reserved for extensive or severely symptomatic cases due to systemic side effects. 1
PUVA phototherapy and methotrexate are reserved for resistant cases that fail both topical and initial systemic therapies. 3, 5
Clinical Pearls and Monitoring
Key Considerations for This Patient Population
White males in their 60s represent the highest-risk demographic, with a male-to-female ratio of 3.95:1 and mean age of 59 years. 1
The torso (particularly the chest) is the most common location, presenting as pruritic erythematous papules or vesicle-papules. 1, 3
Histological confirmation showing suprabasal acantholysis is definitive but not always necessary if clinical presentation is classic. 3, 7
Important Caveats
Screen for underlying conditions including immunosuppression, malignancies, and other dermatologic diseases (eczema, psoriasis, solar keratoses), as these frequently coexist with Grover's disease. 5, 7
Sun-damaged skin increases disease risk, so evaluate for actinic keratoses and skin cancers in this 68-year-old patient. 3, 5
The disease course is unpredictable—while often transient, some cases persist chronically for years, requiring ongoing management. 3, 5
Conservative management with trigger avoidance and emollients alone may be sufficient if lesions are asymptomatic and stable. 4, 3