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February 2008
By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 59-year-old man presents to your emergency department with a recurrent, intensely pruritic rash on his chest. The eruption has waxed and waned in severity over the past three years, flaring in the summer months. Topical therapies provide limited relief. Examination reveals multiple discrete, erythematous papules with mild hyperkeratosis and scale affecting the hair-bearing regions of the upper trunk and abdomen. Several lesions are excoriated.
WHAT IS YOUR DIAGNOSIS? |
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Punch biopsy of a lesion reveals Grover’s disease, or transient acantholytic dermatosis. Acantholysis refers to the separation of epidermal cells secondary to loss of intercellular adhesiveness. The condition most frequently occurs on the trunk and is most prevalent in middle-aged men. Heat and humidity are exacerbating factors. The eruption consists of multiple hyperkeratotic papules that vary in color from reddish to brown. Despite the label of “transient,” the rash may actually persist for weeks or even years, often accompanied by severe pruritus. The differential diagnosis includes bacterial and pityrosporum folliculitis as well as dermatitis herpetiformis. Topical steroids may help relieve symptoms.
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(2):27-28, 2008
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