Case Number : Case 1927 - Dr Iskander Chaudhry (Invited) Posted By: Guest

Scale- crust, intraepidermal and subepidermal edema and mononuclear cell infiltrate point towards an insect bite reaction. Paucity of eosinophils suggests that it could be due to flea or mosquito bites.

Mmmh...Itching, multiple lesions on trunk and forearms, histologically half acantholytic half spongiotic, half bullous...what about a Grover's disease?

Perforating dermatoses.

This is really difficult to judge without more clinical details. Is there a crater in the lesion? Does the patient have co morbidities like DM and/or CRF? The infiltrate is too heavy and deep (upto the panniculus) for it to be Grover's and the epidermal lesion is too broad for a perforating disorder. Let's see what Iskander Bhai thinks about it. BTW, best wishes to all on the occasion of Deepavali, the festival of lights!

From

Dr Chaudhry

Dear All 

I have added one more image to give you a final clue!!

Hailey-Hailey like Grover's

Yes, this makes it Grover's

Very nice case!!!

Clinical sounds like Grover but morphology not so much. Other differentials include arthopod reaction (too superficial for it), bullous dermatomycosis.

Dear All - thank you for your comments. The patient had a family history of Hailey-Hailey disease although I suggested the two differentials Hailey-Hailey like Grover's and Hailey-Hailey disease; clinician preferred the latter despite the clinical presentation. 

Grover disease.

Thomas Paulo MD

Natal RN , Brazil