Table of Contents

Grover’s Disease

LEGEND

Characterized by multiple small, discontinuous foci of intraepidermal acantholysis

  • Acantholysis is defined as a loss of cohesion between keratinocytes (intercellular bridges are lost), and the detached solitary cells take on a rounded shape.

In Grover’s disease, changes resembling those seen in other acantholytic conditions may be present, but they are much more subtle and discontinuous compared to those conditions.

There are four (4) pathological variants:

  • Darier-like Grover’s disease: predominance of hypergranulosis, focal acantholytic dyskeratosis, and a column of parakeratosis
  • Hailey-Hailey-like Grover’s disease: predominance of acantholysis with only a few dyskeratotic cells
  • Pemphigus vulgaris or foliaceus-like: suprabasal separation, acantholytic cells, and “tombstone” foci (vulgaris pattern)
  • Spongiosis with acantholysis: predominant spongiosis with minimal acantholysis and mononuclear cells in the dermis and epidermis

  • Histologic changes may be very subtle in early stages: focal subepidermal inflammation or focal hypergranulosis may be the only clues to Grover’s disease

Grover’s Disease

LEGEND

  • “Purple dyskeratosis”: round bodies sometimes contain abundant irregular keratohyalin granules, creating a characteristic pattern of “purple dyskeratosis” (resembles focal areas of hypergranulosis).

    This may sometimes be the only clue to Grover’s disease on deeper sections

Grover’s Disease

LEGEND

  • Acantholytic keratinocytes become dyskeratotic with a small, hyperchromatic (pyknotic) nucleus and very eosinophilic (pink) cytoplasm

  • They take on the form of round bodies and grain bodies

Vesicular Grover’s Disease

Large intraepidermal vesicle created by marked acantholysis

Acantholytic keratinocytes become dyskeratotic with a pyknotic, hyperchromatic nucleus and very eosinophilic cytoplasm

Grover’s Disease

LEGEND

  • Foci of acantholytic dyskeratosis

  • Foci of subepidermal inflammation

Grover’s Disease

LEGEND

  • Acantholytic dyskeratosis with formation of fine intraepidermal clefts

  • Foci of “purple dyskeratosis” resembling focal areas of hypergranulosis

  • Dyskeratotic keratinocytes forming round bodies and grain bodies

  • Columns of parakeratosis