Anesthetic Considerations for Grover's Disease
Grover's disease (transient acantholytic dermatosis) does not require specific anesthetic modifications, and standard local anesthesia protocols for dermatologic procedures can be safely employed. 1
Key Clinical Context
Grover's disease is a pruritic papulovesicular eruption primarily affecting the trunk in older males, characterized by acantholytic histologic patterns without systemic implications that would alter anesthetic management. 2 The condition itself poses no contraindications to local or general anesthesia.
Standard Anesthetic Approach
Local Anesthesia for Dermatologic Procedures
Use standard local infiltration anesthesia with lidocaine with or without epinephrine according to anatomic location. 1
Epinephrine addition is safe and recommended for procedures on the trunk (the typical location of Grover's disease lesions), as it provides hemostasis and prolongs anesthetic duration without risk of tissue necrosis. 1
Concentrations of 1:100,000 or 1:200,000 epinephrine are appropriate for most dermatologic procedures. 1
Buffering with sodium bicarbonate reduces injection pain and is recommended, particularly when using lidocaine with epinephrine. 1
Maximal Barrier Precautions
If performing procedures requiring central venous access or neuraxial anesthesia, employ full aseptic technique including sterile gloves, gown, cap, mask, and large sterile drape with alcoholic chlorhexidine or povidone-iodine skin preparation. 1
Dermatologic Considerations
Skin Integrity Assessment
Patients with severe dermatitis or active skin lesions warrant careful evaluation for latex allergy risk. 1
Grover's disease patients may have concurrent dermatologic conditions or severe pruritus leading to excoriated skin. 2
Those with severe hand dermatitis are at increased risk for latex sensitization (approximately 8% of the population is sensitized, though only 1.4% exhibit true allergy). 1
Conduct thorough pre-operative assessment asking specifically about reactions to balloons, condoms, or latex gloves causing itching, rash, or angioedema. 1
Latex Precautions if Indicated
If latex allergy is suspected or confirmed, implement strict latex-free protocols: 1
- Use only synthetic gloves for all patient contact
- Schedule as first case to minimize airborne latex particle exposure
- Post "Latex allergy" notices on procedure room doors
- Ensure all equipment, dressings, and tapes are latex-free
- Document allergy prominently in medical records and on patient identification
Post-Procedure Wound Care
Use bland, fragrance-free emollients or petrolatum-based products for wound care. 3
Avoid fragranced products, alcohol-based lotions, and excessive antiseptic creams that can irritate healing skin. 3
Keep treated areas clean and gently pat dry between applications. 3
Do not use prophylactic topical antibiotics for clean procedural wounds; reserve antibiotics for clinical signs of infection, and avoid neomycin-containing preparations. 3
Critical Pitfalls to Avoid
Do not assume Grover's disease requires modified anesthetic dosing or special drug selection—the condition is purely dermatologic without systemic effects on drug metabolism or cardiovascular function. 2
Do not confuse pruritic trunk lesions with systemic disease—while Grover's disease has been associated with hematologic malignancies in some reports, the skin condition itself does not alter anesthetic risk. 2
Do not overlook concurrent conditions—patients with Grover's disease may have other dermatologic conditions (including severe dermatitis) that increase latex allergy risk, requiring specific precautionary measures. 1
Monitoring and Safety
Standard local anesthetic toxicity monitoring applies: 1
- Watch for circumoral numbness, facial tingling, metallic taste, or auditory changes indicating early toxicity
- Calculate maximum safe doses to prevent errors (though dermatologic procedures typically use well below toxic doses)
- Have resuscitation equipment immediately available
For patients with stable cardiac disease requiring epinephrine-containing anesthetics, consultation with cardiology is reasonable if uncertainty exists, though small amounts used in dermatologic surgery are generally well-tolerated. 1