Grover Disease — SCE Dermatology MCQ

Correct answer: D — Moderate-potency topical corticosteroids and emollients

The correct answer is D, moderate-potency topical corticosteroids and emollients. Grover disease is a self-limiting, non-curable dermatosis and management is symptomatic rather than disease-modifying, aimed at reducing pruritus and inflammation while the eruption resolves. Topical corticosteroids of moderate potency address the inflammatory acantholytic papules directly, and emollients restore the skin barrier and reduce the heat, sweating and friction that classically trigger flares in bed-bound or febrile elderly men, as in this patient after prolonged bed rest post-hip surgery. This approach is recommended as initial therapy in essentially all cases before escalation is considered, reserving systemic agents for refractory or extensive disease. The clinical picture (elderly man, truncal pruritic keratotic papules after immobility, biopsy showing focal acantholytic dyskeratosis) is textbook Grover disease, and this remains a topical, first-line problem, not one requiring systemic immunosuppression. Why the other options are wrong: A. Oral Prednisolone: systemic corticosteroids are not first-line for a self-limiting dermatosis; they carry disproportionate risk (especially post-operatively, with infection and bone healing concerns) compared with topical therapy for a mild-to-moderate eruption. C. Rituximab: this is a B-cell depleting biologic used in autoimmune bullous disease and refractory pemphigus, not indicated for Grover disease, which is not primarily an antibody-mediated blistering disorder. B. Phototherapy: UV-based treatment is reserved for cases refractory to topical therapy, and is impractical as initial management, particularly in a post-surgical, immobile patient. E. Oral Dapsone: dapsone is a second or third-line option for persistent, treatment-resistant Grover disease, requiring G6PD testing and monitoring, and is not appropriate before a trial of topical treatment. Key point: Grover disease is managed symptomatically with moderate-potency topical corticosteroids, emollients and trigger avoidance (heat, sweat, friction), with systemic agents reserved for refractory disease only.

Reference: DermNet NZ, Transient Acantholytic Dermatosis (Grover Disease), 2023, https://dermnetnz.org/topics/transient-acantholytic-dermatosis