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an uncommon feature of GD&#46; Gantz et al&#46; conducted a systematic review of 69 patients with atypical distribution GD which showed that facial or scalp lesions were present in 24&#37; of these cases&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Other atypical locations included palms&#44; soles&#44; axillae&#44; inguinal folds&#44; and dermatomeric or Blaschkoid distribution&#46;</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&#44; which could be a strong diagnostic pitfall towards pityriasis rubra pilaris &#40;PRP&#41;&#46; However&#44; there are case reports of PRP with histopathology compatible with GD and cases of GD with histopathology of PRP&#44; which suggests that in some patients there is an overlap between these two diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding dermoscopy&#44; the features described include a pink background with polymorphous vessels &#40;glomerular&#44; dotted&#44; lineal&#44; and hairpin&#41; and star- or oval-shaped yellow-white structures with a white halo&#44; besides scaling&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Typically&#44; histopathology shows focal acantholysis and different degrees of dyskeratosis&#46; There are four histologic subtypes&#58; Darier&#8217;s disease-like&#44; pemphigus-like&#44; Hailey-Hailey-like&#44; and spongiotic&#46; These subtypes can appear alone or coexist&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;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&#44; associated with H1 antihistamines&#46; Therapy with systemic retinoids&#44; oral steroids&#44; or phototherapy is reserved for extensive or treatment-resistant cases&#46; In the present case&#44; narrowband UVB phototherapy was used&#44; with a successfully response after 18 sessions&#46;</p></span><span id="sec0031" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Financial support</span><p id="par0110" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Pablo Vargas-Mora&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Diego Orlandi&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Irene Araya&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Claudia Morales&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</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&#46;</p></span></span>"
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What is your diagnosis?
Case for diagnosis. Atypical Grover’s disease
Pablo Vargas-Moraa,
Autor para correspondência
pablovargas.med@gmail.com

Corresponding author.
, Diego Orlandia, Irene Arayaa, Claudia Moralesb
a Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
b Dermopathology Section, Pathology Service, Hospital Clínico Universidad de Chile, Santiago, Chile
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treated with esomeprazole&#46;</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 &#40;CBC&#44; chemistry panel&#44; hepatic profile&#41;&#44; and HIV&#44; hepatitis B&#44; hepatitis C&#44; and VDRL serologies were all non-reactive&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Two punch skin biopsies were taken&#44; which showed suprabasal focal acantholysis with numerous dyskeratotic cells and eosinophils &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What is your diagnosis&#63;</span><p id="par0020" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Pityriasis rubra pilaris</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Atypical Grover&#8217;s disease &#40;GD&#41;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Darier&#8217;s disease</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d&#41;</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&#44; also known as transient acantholytic dermatosis&#44; is an uncommon acquired condition of unknown origin&#44; first described by Ralph Grover in 1970&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> It affects middle aged and older adults&#44; with predominance in males &#40;2&#8211;3&#58;1 ratio&#41; and Caucasians&#46; It&#8217;s characterized by erythematous papules and occasionally vesicles&#44; primarily on the upper trunk and proximal extremities&#44; associated with variable pruritus&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although it was first described as a transient disease&#44; lasting just for a few weeks&#44; subsequent reports have shown that GD could last for several months or be recurrent&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The reported case presented with extensive facial involvement&#44; an uncommon feature of GD&#46; Gantz et al&#46; conducted a systematic review of 69 patients with atypical distribution GD which showed that facial or scalp lesions were present in 24&#37; of these cases&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Other atypical locations included palms&#44; soles&#44; axillae&#44; inguinal folds&#44; and dermatomeric or Blaschkoid distribution&#46;</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&#44; which could be a strong diagnostic pitfall towards pityriasis rubra pilaris &#40;PRP&#41;&#46; However&#44; there are case reports of PRP with histopathology compatible with GD and cases of GD with histopathology of PRP&#44; which suggests that in some patients there is an overlap between these two diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding dermoscopy&#44; the features described include a pink background with polymorphous vessels &#40;glomerular&#44; dotted&#44; lineal&#44; and hairpin&#41; and star- or oval-shaped yellow-white structures with a white halo&#44; besides scaling&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Typically&#44; histopathology shows focal acantholysis and different degrees of dyskeratosis&#46; There are four histologic subtypes&#58; Darier&#8217;s disease-like&#44; pemphigus-like&#44; Hailey-Hailey-like&#44; and spongiotic&#46; These subtypes can appear alone or coexist&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;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&#44; associated with H1 antihistamines&#46; Therapy with systemic retinoids&#44; oral steroids&#44; or phototherapy is reserved for extensive or treatment-resistant cases&#46; In the present case&#44; narrowband UVB phototherapy was used&#44; with a successfully response after 18 sessions&#46;</p></span><span id="sec0031" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Financial support</span><p id="par0110" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Pablo Vargas-Mora&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Diego Orlandi&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Irene Araya&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Claudia Morales&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</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&#46;</p></span></span>"
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        "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&#44; upper extremities&#44; neck&#44; and face&#46; Grover&#8217;s disease is a rare&#44; acquired disorder of unknown origin&#44; which is classically characterized by the appearance of erythematous papules on the upper trunk that are usually transient&#46; As in the present case&#44; there are reports of atypical disease&#44; with facial involvement&#44; pityriasis rubra pilaris-like lesions&#44; and a more chronic course&#46;</p></span>"
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