Case Number : CASE 4502 - 23 April 2024 Posted By: Admin_Dermpath

Could be Grovers if it's pruritic

On 01/05/2024 at 13:20, Neil Catterall said:

Could be Grovers if it's pruritic

Agree. There is focal acantholysis.  Solar lentigo like pattern has been described in Grover's disease. 

On 01/05/2024 at 10:50, Neil Catterall said:

Could be Grovers if it's pruritic

DD icludes Galli Galli disease in appropriate clinical setting.

Same thought. Grover. 

Adenoid seborrhoeic keratosis

Dermatopathia pigmentosa reticularis

Dowling Degos disease

Dowling Degos disease

Dowling Degos disease

Dermatopathia pigmentosa reticularis

Thank you for your comments. 

The final diagnosis is:  Dowling Degos disease

The differential diagnoses to consider are:

Adenoid seborrhoeic keratosis
Congenital dyskeratosis
Dermatopathia pigmentosa reticularis
Naegeli Franceschetti Jadassohn syndrome

I can understand how Dowling-Degos disease was suspected here.  The digitate downgrowths are definitely delving dermally (as per Edward Wilson-Jones) but they aren't particularly more pigmented than the surrounding skin.  If you have a look at case 2004 (posted 9th February 2018) you'll see what I mean about the expected hyperpigmentation of the tips of the rete.

This rare genodermatosis usually presents much earlier in life, and with the acantholysis I would have suspected Grover's to be a more likely diagnosis at this age. 

If it is Dowling-Degos disease clinically, then I would agree with Neil Catterall that the acantholysis would push it into the Galli-Galli variant.