Davis M D, Dinneen A M, Landa N, Gibson L E
Department of Dermatology, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1999 Mar;74(3):229-34. doi: 10.4065/74.3.229.
To report the clinicopathologic findings in patients with Grover's disease.
We reviewed the medical records and biopsy specimens from 72 patients with transient acantholytic dermatosis (Grover's disease) examined at Mayo Clinic Rochester. Hematoxylin-eosin-stained biopsy specimens (from all patients) were assessed. Immunohistochemistry stains BRST-2, CAM 5.2, and CD44 were used to stain eight specimens. Direct immunofluorescence reports were reviewed. Selected specimens were stained by indirect immunofluorescence to detect major basic protein.
Of the 72 patients, 63 (88%) were men, and the mean age was 48 years (range, 31 to 85). Lesions were distributed mainly on the trunk (in 71 patients) and proximal extremities (in 25). Heat and sweating frequently were exacerbating factors. Fifteen patients (21%) were bedbound. Concurrent nondermatologic malignant disease was present in 18 patients (25%). Two patients (3%) had acquired immunodeficiency syndrome. Follow-up in 28 patients (mean, 38 months; range, 3 months to 7 years) revealed that the disease had recurred in 13, persisted in 3, and resolved in 12. Review of the biopsy specimens showed that acantholysis was pemphigus vulgaris-like in 40 patients (56%), Darier's disease-like in 16 (22%), spongiotic in 12 (17%), pemphigus foliaceus-like in 2 (3%), and Hailey-Hailey disease-like in 2 (3%). A perivascular lymphocytic infiltrate of varied intensity in 64 specimens (89%) was associated with eosinophils in 16 (22%). In nine biopsy specimens with dermal eosinophilia stained for major basic protein, varied dermal cellular and extracellular deposition of major basic protein was present. Results of direct immunofluorescence studies, performed in 17 cases, were negative or nonspecific. CD44 stained acantholytic areas in addition to sweat glands in two of eight specimens (25%).
Further studies of the pathogenesis of Grover's disease are needed. The predisposing conditions, site of involvement, and relapsing nature of this disorder may implicate acrosyringeal dysfunction as the cause.
报告Grover病患者的临床病理特征。
我们回顾了在梅奥诊所罗切斯特分院检查的72例暂时性棘层松解性皮病（Grover病）患者的病历和活检标本。评估苏木精-伊红染色的活检标本（所有患者）。使用免疫组织化学染色BRST-2、CAM 5.2和CD44对8个标本进行染色。回顾直接免疫荧光报告。选择的标本用间接免疫荧光染色以检测主要碱性蛋白。
72例患者中，63例（88%）为男性，平均年龄48岁（范围31至85岁）。皮损主要分布于躯干（71例）和四肢近端（25例）。热和出汗常为加重因素。15例患者（21%）需卧床。18例患者（25%）合并非皮肤恶性疾病。2例患者（3%）患有获得性免疫缺陷综合征。对28例患者进行随访（平均38个月；范围3个月至7年），发现13例疾病复发，3例持续存在，12例缓解。回顾活检标本显示，40例患者（56%）的棘层松解呈寻常型天疱疮样，16例（22%）呈 Darier病样，12例（17%）呈海绵状，2例（3%）呈落叶型天疱疮样，2例（3%）呈Hailey-Hailey病样。64个标本（89%）中有不同程度的血管周围淋巴细胞浸润，其中16个标本（22%）伴有嗜酸性粒细胞。在9个有真皮嗜酸性粒细胞浸润的活检标本中检测主要碱性蛋白，可见真皮内不同程度的细胞和细胞外主要碱性蛋白沉积。17例患者进行的直接免疫荧光研究结果为阴性或非特异性。8个标本中的2个（25%），CD44除了汗腺外还对棘层松解区域进行染色。
需要对Grover病的发病机制进行进一步研究。该疾病的易感因素、受累部位和复发性质可能提示顶泌汗腺功能障碍为病因。
