What is the pathophysiology of transient acantholytic dermatosis (Grover disease)?

Updated: Mar 17, 2020
  • Author: Clay J Cockerell, MD; Chief Editor: Dirk M Elston, MD  more...
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The etiology of transient acantholytic dermatosis (Grover disease) is unknown. However, a number of factors have been suggested as being potentially causal or exacerbating. The most frequent association is with heat or sweating, and the obstruction of sweat ducts has been postulated to be responsible, although this association has been challenged, citing research that demonstrates that most patients with transient acantholytic dermatosis (Grover disease) present in winter, not summer. [3]

Many patients describe preceding exposure to sunlight, although exposure to artificial ultraviolet radiation has not been shown to reproduce the process. Transient acantholytic dermatosis (Grover disease) seems to occur more frequently in patients with atopic dermatitis and asteatotic dermatitis, although many individuals with these conditions never develop it. Viral, bacterial, and other pathogens have also been proposed, but no causative role has been established. A number of transient acantholytic dermatosis (Grover disease) case reports have described an association with lymphoma, but these seem to be in the extreme minority. [4, 5] The exact pathogenesis has not been elucidated. Melanoma therapy with CTLA-4 inhibition has been associated with the disease. [6, 7]  Similarly, a number of case reports have focused on describing a direct relationship between autoimmune antibodies and transient acantholytic dermatosis, and while there is a positive correlation between autoimmune antibodies and transient acantholytic dermatosis, it is unclear whether the autoimmune antibodies cause transient acantholytic dermatosis or if they increase as a result of transient acantholytic dermatosis. [8, 9]

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