What are key histologic patterns and features 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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Several distinct histologic patterns of transient acantholytic dermatosis (Grover disease) have been described: (1) a pattern that simulates Hailey-Hailey disease; (2) a pattern that simulates Darier disease; (3) a pattern characterized mainly by spongiotic dermatitis; (4) a pattern that simulates pemphigus vulgaris; and (5) a pattern that simulates pemphigus foliaceus. Although one pattern may predominate, each pattern may be seen in different lesions from the same patient or, in some cases, within a single specimen. Other newly described patterns include (6) a pattern characterized by parakeratosis; (7) a pattern resembling a solar lentigo/Dowling-Degos disease, characterized by intraepidermal vesicles; (8) a pattern with lymphocytic infiltrate; and (9) a pattern characterized by disordered keratinocyte maturation. [21] The key discriminating features are described below:

  • Darier disease - Virtually identical; greater tendency to involve follicles; clinical correlation essential

  • Linear acantholytic epidermal nevus - Virtually identical; clinical correlation essential

  • Hailey-Hailey disease - Epidermis usually more hyperplastic; more diffuse involvement

  • Pemphigus vulgaris - Broad zones of suprabasilar acantholysis; mucosal involvement; involvement of adnexal structures; often abundant eosinophils

  • Primary spongiotic dermatitis (allergic contact dermatitis, nummular dermatitis) - Involvement of entire epidermis; psoriasiform hyperplasia

  • Acantholytic solar keratosis - Atypical keratinocytic proliferation in lower portion of epidermis with cytologic atypia and mitoses; alternating orthokeratosis and parakeratosis; solar elastosis

  • Solitary acantholytic keratosis - Epidermal hyperplasia; slight papillomatosis or digitation of epidermis; clinical correlation required

  • Pemphigus foliaceus/erythematosus - Broad zone of subcorneal and subgranular acantholysis; involvement of adnexal structures; often eosinophils

  • Warty dyskeratoma - Cup-shaped exoendophytic cystlike lesion; acantholytic and dyskeratotic cells lining cyst wall; pseudopapillae with acantholytic dyskeratosis lined by a single layer of basal cells

  • Familial dyskeratotic comedones - Small cylindrical invagination with epithelial lining demonstrating acantholytic dyskeratosis

  • Porokeratotic - Parakeratosis over parts of epidermis lacking a granular layer; upper epidermal layers have occasional dyskeratosis

  • Lentiginous - Rete ridge elongation; basal hyperpigmentation

  • Vesicular - Intraepidermal vesicles with little acantholysis and spongiosis surrounding it

  • Lichenoid - Occasional dyskeratosis; damage of the vacuoles; dermoepidermal junction has lymphocytic infiltrate

  • Dysmaturation - Little hyperchromasia; nuclear pleomorphism; disordered maturation of keratinocytes

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