Recalcitrant Grover’s Disease Successfully Managed with Dupilumab and Naltrexone in a Middle-Aged Woman: A Case Study

Abstract

Introduction: Grover’s disease, or transient acantholytic dermatosis, is a common benign papulovesicular disorder that often affects elderly men. It is typically managed with topical therapeutics in this population. We present here an uncommon case of Grover’s disease, occurring in a relatively younger patient, that was recalcitrant to typical therapeutics modalities. Case Report: A 45-year-old woman presented to our clinic with a several month history of discrete, pink, ill-defined pruritic papules on her torso with sparing of her extremities. Grover’s disease was diagnosed based on her clinical presentation and subsequently biopsy-confirmed. She failed multiple topical medications, oral acitretin, and only experience minimal relief when transitioned to Naltrexone. Dupilumab was added to her regimen, with rapid improvement. She was eventually transitioned down to dupilumab monotherapy, and has remained clear since.  Conclusion: Grover’s disease is not common among middle-aged women. Novel therapies, such as biologics, have been efficacious in elderly (especially male) populations with this condition. Our case demonstrates the importance of attempting new treatment modalities such as dupilumab for patients with recalcitrant disease. Novel application of these biologic treatments may be needed in particular for atypical cases, such as when patients do not fit the known epidemiologic profile.