Transient acantholytic dermatosis

What is transient acantholytic dermatosis?

Transient acantholytic dermatosis causes a truncal rash characterised by acantholysis on histopathology. It can be transient, as the name suggests, in contrast to the rare and persistent inherited acantholytic dermatoses, Darier disease and Hailey-Hailey disease.

Transient acantholytic dermatosis is also known as Grover disease.

Who gets transient acantholytic dermatosis?

Transient acantholytic dermatosis most often affects men over 50. It is less common in women or younger people. It is common in those who are unwell in some way, but can arise in quite healthy people as well. It has been reported in association with several medications, including:

• Anastrozole
• Vemurafenib
• Dabrafenib
• Cetuximab
• Mercury
• D-penicillamine.

What causes transient acantholytic dermatosis?

The cause of transient acantholytic dermatosis is unknown. Sometimes, it follows sweating or some unexpected heat stress, so there has been suspicion that it may relate to sweat or sweat ducts. But it also may arise in quite dry skin. Many affected individuals are sun damaged.

What are the clinical features of transient acantholytic dermatosis?

Transient acantholytic dermatosis often starts quite suddenly. It is more common in winter than in summer. Characteristics include:

• The most common sites are central back, mid chest.
• Lesions are small red, crusted or eroded papules.
• There may be vesicles and non-follicular pustules.
• Lesions may bleed.
• Although frequently itchy, transient acantholytic dermatosis may cause no symptoms.

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Complications of transient acantholytic dermatosis

Transient acantholytic dermatosis may be complicated by the development of dermatitis, usually in a discoid pattern i.e with round or oval, dry or crusted plaques.

The plaques start on the chest and back, and may spread to affect other areas of the body.

How is transient acantholytic dermatosis diagnosed?

Transient acantholytic dermatosis is usually diagnosed clinically, but a skin biopsy may be necessary.

The pathology of transient acantholytic dermatosis is characteristic, with acantholysis (separated skin cells) with or without dyskeratosis (abnormal rounded skin cells). Spongiotic dermatitis may also be noted.

What is the differential diagnosis for transient acantholytic dermatatosis?

Disorders that may appear similar to transient acantholytic dermatosis are:

• Darier disease
• Pemphigus foliaceus (erosions)
• Seborrhoeic dermatitis (involvement of skin folds and hair-bearing sites, flaky)
• Discoid and other forms of dermatitis (larger dry or blistered plaques)
• Folliculitis (affects the hair follicles, best seen with dermoscopy).

Treatment of transient acantholytic dermatosis

There is no curative treatment for transient acantholytic dermatosis, but the following suggestions may be helpful.

• Remain cool, as sweating may induce more itchy spots.
• Moisturising creams or antipruritic lotions containing menthol and camphor can reduce the desire to scratch.
• Apply a mild topical steroid such as hydrocortisone, if possible as a lotion. It can be applied frequently to the affected areas to relieve itching.
• Dermatitis, if present, responds topical and systemic steroids.
• Calcipotriol has been reported to be of benefit.
• A course of tetracycline or an oral antifungal medication such as itraconazole helps some patients.
• Phototherapy can be helpful, but may also provoke the disease.
• Oral retinoids such as acitretin or isotretinoin have been reported to be helpful, and may be required for several months. However, they have important side effects and are not necessary for mild cases.
• Methotrexate and etanercept that also have been reported to help.

How can transient acantholytic dermatosis be prevented?

Keep cool. Wear garments designed to prevent sweat rash.

What is the outlook for transient acantholytic dermatosis?

The duration of transient acantholytic dermatosis is variable—from days to decades, when it is known as persistent acantholytic dermatosis. It can come and go, often with a seasonal variation.