The method is : Tzanck smear: scraping of an ulcer base.

The key histopathologic feature of Grover’s Disease is acantholysis; acantholysis is the dissociation of keratinocytes from one another in the epidermis.

The etiology, the source of the disease, the pathogenesis and  the progression of transient acantholytic dermatosis (Grover Disease) are not known.

Studies conducted to determine etiology or pathogenesis:

–             Study of clinicopathologic findings in 78 patients concluded: Further studies of the pathogenesis of Grover’s Disease are needed because the findings were not conclusive.(7)

–             Grover’s Disease, despite histological similarity to Darier’s Disease, does not share an abnormality in the ATP2A2 gene. (24

OCCURRENCE of GROVER’s Disease:

Grover Disease affects chiefly white adults in the fifth decade or later, and appears to be around 1.6 to 2.1 times more common in men than in women. GD is considered a rare disease.

The definition of rare disease in Europe is 1 or fewer case per 2000; in the USA rare diseases affect fewer than 200,000 Americans at any given time. (34)

A 2006 study that included 385 patients concluded that GD occurs more often in the wintertime when the skin is naturally xerotic, (very dry) there is less humidity, and sweating is less frequent.(3)

A 1999 study concluded that TAD, which is frequent in elderly patients within a hospital setting, is not paraneoplastic, not associated with, and does not favor the hypothesis of a sweat-related pathogenesis. ( 26)

Literature suggests that

GROVER’s Disease  can be triggered by other medical conditions

and treatments like:

•  BRAF inhibitor monotherapy and CombiDT therapy The most common cutaneous (skin) adverse effects seen in patients receiving the single-agent BRAF inhibitor dabrafenib or vemurafenib included Grover disease (51 patients [42.9%]and 14 [38.9%], respectively [P = .67]) (15)
• Leukemia patience developed purpuric rash, diagnosed:Grover’s on day 6 after chemotherapy, (16)
• Grover was induced by RAF inhibitors, (as the standard of care for Val600 BRAF-mutant metastatic melanoma) (17)
• GD developed after heart transplantation, one case study(18)
• Anastrozole (treatment for breast cancer) induced GD , case study of 79 years old woman. (19)
• 71-year-old man exhibited Grover’s disease after Cetuximab (epidermal growth factor receptor (EGF) antagonist,) treatment for colon cancer was introduced.(21)
• Renal transplant patients, 58 years old man developed GD after transplant, as the case study described it. (22)
• Grover’s disease secondary to ribavirin, an anti-viral medication used for infections, hepatitis-S etc…(25)
• Grover’s disease should be included in the differential diagnosis of cutaneous eruptions in patients with chronic renal failure.(27)
• TAD has been observed most frequently in oncology patients who have either myelogenous leukemia or carcinoma of the genitourinary organs (28)
• 1993 : first report of a cutaneous(=derma, skin) side effect of interleukin 4 (cytokenese) This may be antibody-mediated or related to increased production of tissue-type plasminogen activator (29)
• Pyoderma gangrenosum associated with transient acantholytic dermatosis (pemphigus erythematosus-like) and paraproteinemia (31)