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Grover's Disease with Acrosyringeal Acantholysis: A Rare Histological Presentation of an Uncommon Disease.

Joshi R, Taneja A - Indian J Dermatol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology P. D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India.

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Sir, Transient acantholytic dermatosis (Grover's disease) was first described as a distinct entity in 1970 by Grover... It usually occurs in middle-aged and elderly people as a discrete pruritic, papular or papulo-vesicular eruption favoring the trunk... The eruption may persist in some patients and the term “papular acantholytic dermatosis” is a preferred term to describe this entity... A 48-year-old male shopkeeper presented with sudden onset of innumerable small (2-3 mm) pruritic erythematous papules with an eroded surface restricted to the abdomen and flanks... A punch biopsy taken from one of the erythematous eroded papules showed acrosyringeal acantholysis and dyskeratosis, which was seen in a concentric fashion involving acrosyringeal keratinocytes at the mid spinous level... Based on the clinical presentation of discrete severely pruritic erythematous eroded papules on the trunk and focal acrosyringeal acantholysis on histology a diagnosis of Sudoriferous acrosyringeal acantholytic variant of Grover's disease was made and the patient was started on capsule doxycycline 100 mg twice daily, topical beclomethasone cream and oral levocetirizine 5 mg twice daily for the pruritus... On follow-up at 2 weeks, there was satisfactory improvement in the pruritus and the rash had subsided by 25%... Continuation of the medication was advised for another 2 weeks, but the patient was lost to further follow-up... Grover's disease appears to be distinctly uncommon in India as we could not find any case reports published in Indian journals... It may be an under-recognized entity, especially because the histological picture can be very variable and biopsy may not reveal the pathological findings unless several sections are examined... Our case fits in very well with the clinical description of Grover's disease with innumerable discrete erythematous pruritic eroded papules on the trunk in a middle-aged man... The histological picture of acrosyringeal acantholysis is very rare with only six cases described in world literature... We report this case to draw attention to this uncommon condition, which has received very little attention in Indian dermatological literature.

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Related in: MedlinePlus

Low power view showing acrosyringium at left side of section, hyperplastic epidermis, perivascular lymphocytic infiltrate in dermis. H and E, ×40
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Figure 3: Low power view showing acrosyringium at left side of section, hyperplastic epidermis, perivascular lymphocytic infiltrate in dermis. H and E, ×40

Mentions: A punch biopsy taken from one of the erythematous eroded papules showed acrosyringeal acantholysis and dyskeratosis, which was seen in a concentric fashion involving acrosyringeal keratinocytes at the mid spinous level. There was partial separation of the acrosyringeal keratinocytes with few dyskeratotic cells with pyknotic nuclei and pink cytoplasm [Figures 3–5]. The adjacent epidermis was mildly hyperplastic and showed mild spongiosis with a thickened basket weave horny layer containing occasional parakeratosis [Figure 6]. The upper dermis was mildly edematous and had a moderately dense perivascular infiltrate of lymphocytes and few extravasated erythrocytes.


Grover's Disease with Acrosyringeal Acantholysis: A Rare Histological Presentation of an Uncommon Disease.

Joshi R, Taneja A - Indian J Dermatol (2014)

Low power view showing acrosyringium at left side of section, hyperplastic epidermis, perivascular lymphocytic infiltrate in dermis. H and E, ×40
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4248512&req=5

Figure 3: Low power view showing acrosyringium at left side of section, hyperplastic epidermis, perivascular lymphocytic infiltrate in dermis. H and E, ×40
Mentions: A punch biopsy taken from one of the erythematous eroded papules showed acrosyringeal acantholysis and dyskeratosis, which was seen in a concentric fashion involving acrosyringeal keratinocytes at the mid spinous level. There was partial separation of the acrosyringeal keratinocytes with few dyskeratotic cells with pyknotic nuclei and pink cytoplasm [Figures 3–5]. The adjacent epidermis was mildly hyperplastic and showed mild spongiosis with a thickened basket weave horny layer containing occasional parakeratosis [Figure 6]. The upper dermis was mildly edematous and had a moderately dense perivascular infiltrate of lymphocytes and few extravasated erythrocytes.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology P. D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Transient acantholytic dermatosis (Grover's disease) was first described as a distinct entity in 1970 by Grover... It usually occurs in middle-aged and elderly people as a discrete pruritic, papular or papulo-vesicular eruption favoring the trunk... The eruption may persist in some patients and the term “papular acantholytic dermatosis” is a preferred term to describe this entity... A 48-year-old male shopkeeper presented with sudden onset of innumerable small (2-3 mm) pruritic erythematous papules with an eroded surface restricted to the abdomen and flanks... A punch biopsy taken from one of the erythematous eroded papules showed acrosyringeal acantholysis and dyskeratosis, which was seen in a concentric fashion involving acrosyringeal keratinocytes at the mid spinous level... Based on the clinical presentation of discrete severely pruritic erythematous eroded papules on the trunk and focal acrosyringeal acantholysis on histology a diagnosis of Sudoriferous acrosyringeal acantholytic variant of Grover's disease was made and the patient was started on capsule doxycycline 100 mg twice daily, topical beclomethasone cream and oral levocetirizine 5 mg twice daily for the pruritus... On follow-up at 2 weeks, there was satisfactory improvement in the pruritus and the rash had subsided by 25%... Continuation of the medication was advised for another 2 weeks, but the patient was lost to further follow-up... Grover's disease appears to be distinctly uncommon in India as we could not find any case reports published in Indian journals... It may be an under-recognized entity, especially because the histological picture can be very variable and biopsy may not reveal the pathological findings unless several sections are examined... Our case fits in very well with the clinical description of Grover's disease with innumerable discrete erythematous pruritic eroded papules on the trunk in a middle-aged man... The histological picture of acrosyringeal acantholysis is very rare with only six cases described in world literature... We report this case to draw attention to this uncommon condition, which has received very little attention in Indian dermatological literature.

No MeSH data available.


Related in: MedlinePlus