Atypical features and systemic associations in extensive cases of Grover disease: A systematic review

Abstract

Background: Grover disease is an acantholytic disorder that typically occurs on the trunk of older individuals, primarily white men, in association with heat and xerosis. Cases with extensive and/or atypical distributions have been reported.

Objective: To review the literature characterizing the population, morphology, associations, and disease course of extensive or atypical eruptions of Grover disease.

Methods: A systematic literature review identified 50 articles with 69 cases.

Results: Patient age ranged from 14 to 83 years (mean age, 56 ± 15), with 71% of patients being male and 29% female. Areas of involvement included the trunk (90%), upper and lower extremities (63% and 61%, respectively), face/scalp (28%), neck (21%), groin (11%), buttocks (8%), and axillae (6%). The most common associations included a history of malignancy (61%), recent chemotherapy (38%), and recent transplant (20%).

Limitations: Extensive cases with typical clinical morphology may not have been examined by biopsy or reported; thus, this review may have publication bias toward more severe or atypical presentations.

Conclusions: Greater variability exists among patients affected by extensive or atypical Grover disease than among those with typical disease. Malignancy is a common association, and there may be a role for immunosuppression in the pathogenesis of extensive or atypical Grover disease.

Keywords: Grover disease; atypical; extensive; malignancy; toxic erythema of chemotherapy; transient acantholytic dermatosis.