What is your diagnosis?
Case for diagnosis. Atypical Grover’s disease
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Atypical Grover’s disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "234" "paginaFinal" => "236" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Vargas-Mora, Diego Orlandi, Irene Araya, Claudia Morales" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Pablo" "apellidos" => "Vargas-Mora" "email" => array:1 [ 0 => "pablovargas.med@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Diego" "apellidos" => "Orlandi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Irene" "apellidos" => "Araya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Claudia" "apellidos" => "Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermopathology Section, Pathology Service, Hospital Clínico Universidad de Chile, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 765 "Ancho" => 750 "Tamanyo" => 59228 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy shows a pink background with dotted and glomerular vessels, and fine white scaling.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 55-year-old male presented to the dermatology clinic for the evaluation of progression of intensely pruritic erythematous papules and plaques on his trunk, upper extremities, neck, and face over eight months. On physical examination, the lesions were partially confluent with well-demarcated areas of spared skin and presented superficial fine scaling (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Dermoscopy showed a homogeneous pink background with glomerular and irregular dotted vessels associated with fine superficial scaling (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). His medical history was significant for gastroesophageal reflux disease, treated with esomeprazole.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">There were no significant anomalies on general lab tests (CBC, chemistry panel, hepatic profile), and HIV, hepatitis B, hepatitis C, and VDRL serologies were all non-reactive.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Two punch skin biopsies were taken, which showed suprabasal focal acantholysis with numerous dyskeratotic cells and eosinophils (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What is your diagnosis?</span><p id="par0020" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Pityriasis rubra pilaris</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Atypical Grover’s disease (GD)</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Darier’s disease</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0040" class="elsevierStylePara elsevierViewall">Pemphigus foliaceus</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">GD, also known as transient acantholytic dermatosis, is an uncommon acquired condition of unknown origin, first described by Ralph Grover in 1970.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It affects middle aged and older adults, with predominance in males (2–3:1 ratio) and Caucasians. It’s characterized by erythematous papules and occasionally vesicles, primarily on the upper trunk and proximal extremities, associated with variable pruritus.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although it was first described as a transient disease, lasting just for a few weeks, subsequent reports have shown that GD could last for several months or be recurrent.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The reported case presented with extensive facial involvement, an uncommon feature of GD. Gantz et al. conducted a systematic review of 69 patients with atypical distribution GD which showed that facial or scalp lesions were present in 24% of these cases.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Other atypical locations included palms, soles, axillae, inguinal folds, and dermatomeric or Blaschkoid distribution.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Another noteworthy aspect of the clinical presentation of this patient was the presence of well-demarcated areas of spared skin, which could be a strong diagnostic pitfall towards pityriasis rubra pilaris (PRP). However, there are case reports of PRP with histopathology compatible with GD and cases of GD with histopathology of PRP, which suggests that in some patients there is an overlap between these two diseases.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding dermoscopy, the features described include a pink background with polymorphous vessels (glomerular, dotted, lineal, and hairpin) and star- or oval-shaped yellow-white structures with a white halo, besides scaling.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Typically, histopathology shows focal acantholysis and different degrees of dyskeratosis. There are four histologic subtypes: Darier’s disease-like, pemphigus-like, Hailey-Hailey-like, and spongiotic. These subtypes can appear alone or coexist.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">First-line treatment consists of the use of emollients and topical steroids and vitamin D analogs, associated with H1 antihistamines. Therapy with systemic retinoids, oral steroids, or phototherapy is reserved for extensive or treatment-resistant cases. In the present case, narrowband UVB phototherapy was used, with a successfully response after 18 sessions.</p></span><span id="sec0031" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Financial support</span><p id="par0110" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Pablo Vargas-Mora: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Diego Orlandi: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Irene Araya: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Claudia Morales: Approval of the final version of the manuscript; conception and planning of the study; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1505262" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1366018" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "What is your diagnosis?" ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0031" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-14" "fechaAceptado" => "2020-06-19" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1366018" "palabras" => array:4 [ 0 => "Acantholysis" 1 => "Atypical" 2 => "Grover’s disease" 3 => "Transient acantholytic dermatosis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A 55-year-old male presented with an eight-month history of erythematous papules and plaques with demarcated areas of spared skin on his trunk, upper extremities, neck, and face. Grover’s disease is a rare, acquired disorder of unknown origin, which is classically characterized by the appearance of erythematous papules on the upper trunk that are usually transient. As in the present case, there are reports of atypical disease, with facial involvement, pityriasis rubra pilaris-like lesions, and a more chronic course.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Vargas-Mora P, Orlandi D, Araya I, Morales C. Case for diagnosis. Atypical Grover’s disease. An Bras Dermatol. 2021;96:234–6.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Clínico Universidad de Chile, Santiago, Chile.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 586 "Ancho" => 1500 "Tamanyo" => 109289 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Erythematous papules and plaques with well-demarcated areas of spared skin on anterior thorax and back.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 544 "Ancho" => 1500 "Tamanyo" => 115776 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A and B) Erythematous papules and plaques with superficial scaling on the face.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 765 "Ancho" => 750 "Tamanyo" => 59228 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy shows a pink background with dotted and glomerular vessels, and fine white scaling.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 558 "Ancho" => 1500 "Tamanyo" => 158170 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A and B) Suprabasal acantholysis with focal spongiosis and numerous dyskeratotic cells (Hematoxylin & eosin, ×40 and ×100, respectively).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grover disease: review of subtypes with a focus on management options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.C. 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