What are the other Names for this Condition? (Also known as/Synonyms)

• Benign Papular Acantholytic Dermatosis
• Grover's Disease (GD)
• Persistent Acantholytic Dermatosis

What is Transient Acantholytic Dermatosis? (Definition/Background Information)

• Transient Acantholytic Dermatosis is a skin disorder that is characterized by itchy lesions (papules and vesicles) on the chest and back presenting acantholysis (a histological description indicating a loss of cohesion between epidermal cells, known as keratinocytes). Even though termed transient, the condition can last for several years to decades and be persistent
• The cause of Transient Acantholytic Dermatosis is not well understood. Some of the significant influencing factors include adverse effect of medications, sweating, and sun exposure, even though the condition is more common during winters. Transient Acantholytic Dermatosis is also known as Grover's Disease (GD) and is more common in middle-aged and older men

Who gets Transient Acantholytic Dermatosis? (Age and Sex Distribution)

• Transient Acantholytic Dermatosis are generally observed in middle-aged and older men (onset age is between 40 and 50 years)
• The condition is rare in children and younger individuals
• Both males and females are affected, although more men are affected than women (men-women ratio is around 2:1)
• Worldwide, there is no racial or ethnic preference observed. However, the condition is uncommon in dark-skinned individuals

What are the Risk Factors for Transient Acantholytic Dermatosis? (Predisposing Factors)

The risk factors for Transient Acantholytic Dermatosis may include:

• Adverse effect of medications such as:
  • Anastrozole
  • Cetuximab
  • Cetuximab
  • Dabrafenib
  • D-penicillamine
  • Interleukin-4
  • Mercury-based medications
  • Ribavirin
  • Sulfadoxine-pyrimethamine
  • Vemurafenib
• Heat stress and sweating may be a risk factor
• Sun exposure, since the lesions may be noted in sun damaged skin surfaces
• Ionizing radiation
• End-stage renal disease (particularly individuals on hemodialysis)
• Mechanical irritation
• Prolonged bed rest
• Bacterial and viral infections
• Malignancy
• An association with the following skin conditions have been seen in some cases:
  • Atopic dermatitis
  • Contact dermatitis
  • Pyoderma gangrenosum
  • Xerosis cutis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Transient Acantholytic Dermatosis? (Etiology)

Even though the exact cause of development of Transient Acantholytic Dermatosis is unknown, the condition is associated with several triggering factors including:

• Use of medications
• Heat, sweating, and exposure to sunlight
• Presence of other coexisting skin diseases

What are the Signs and Symptoms of Transient Acantholytic Dermatosis?

The signs and symptoms of Transient Acantholytic Dermatosis may include:

• Sudden appearance of severely itchy red skin eruptions following a triggering factor such as abrupt sun exposure, sweating, or heat-related activity
• The rashes are characterized by small papules (raised tender bumps), vesicles (fluid-filled lesions), and pustules (pus-filled blisters)
• These are more common during the colder months (winters) than warmer months (summers)
• The mid-chest and central back are frequently affected; other locations include the arms and legs (thighs). The rashes may progress over a period of 6-12 months
• Bleeding from the lesions is known to occur, which is followed by crusting
• Some individuals are asymptomatic and may not have itching and irritation from the lesions

The transient skin lesions are known to become chronic and persistent over time.

How is Transient Acantholytic Dermatosis Diagnosed?

A diagnosis of Transient Acantholytic Dermatosis may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Blood tests, analysis of pus, and culture of the fluid being drained (for causative pathogen), as needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis is important to exclude other conditions that present similar signs and symptoms. These may include:

• Discoid eczema
• Folliculitis
• Keratosis follicularis
• Pemphigus foliaceus
• Seborrheic dermatitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Transient Acantholytic Dermatosis?

The possible complications due to Transient Acantholytic Dermatosis include:

• Emotional stress due to cosmetic issues
• Superimposed bacterial and fungal skin infections
• Development of other forms of dermatitis (inflammatory skin conditions)
• Recurrence of the condition following treatment; the condition can become persistent
• Treatment complications
• Complications may arise from an underlying condition if any

How is Transient Acantholytic Dermatosis Treated?

There are presently no well-defined treatment measures available for Transient Acantholytic Dermatosis. However, the healthcare provider may recommend the following:

• Undertaking treatment of an underlying/coexisting condition, if any present
• Avoid the triggering factors, where possible, such as discontinuing the offending medication
• Use of moisturizing creams for dry skin
• Avoiding excess sweating and heat stress; staying in cooler environments, when possible
• Application of topical cortisone creams for mild cases; oral steroids or cortisone injections for severe cases
• Anti-itch creams
• Oral doxycycline for more severe lesions
• Antibiotic therapy or antifungal treatment for secondary skin infections, if needed
• Oral retinoid therapy
• PUVA phototherapy
• Other medications used include topical calcipotriol (vitamin D), methotrexate, and etanercept

Regular follow up visits with the healthcare provider is important and recommended.

How can Transient Acantholytic Dermatosis be Prevented?

Currently, it is not possible to prevent the occurrence of Transient Acantholytic Dermatosis. However, the following steps may be considered to lower incidence of the triggering factors in the vulnerable individuals:

• When possible, the offending medication may be discontinued and/or alternatives prescribed
• Avoid strenuous physical activities
• Minimize sun exposure, where possible
• Wear cotton garments
• Undertake early diagnosis and treatment of any coexisting skin condition

What is the Prognosis of Transient Acantholytic Dermatosis? (Outcomes/Resolutions)

• The prognosis of Transient Acantholytic Dermatosis is generally good with adequate treatment
• However, the duration of this skin condition is highly variable. Some individuals have it for a few days, while in others, Transient Acantholytic Dermatosis may last for decades

Additional and Relevant Useful Information for Transient Acantholytic Dermatosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/