Grover's Disease: What works to help find relief?

How often did you apply the Witch Hazel on a daily basis.

Applied generously with my hands twice daily.

Thanks. I'm doing two a day. Waiting for the miracle !!

New poster here. Grateful to Mayo for creating the platform and for the welcome, rational, thoughtful community members.
FWIW, my narrative is: 62y/o caucasian male in good general health, developed trunk lesions accompanied by mild itching 3 months ago. Chose to ignore it until distribution of lesions advanced from lower abdomen to chest and mid-back (thoracic) and itch intensity escalated. PCP suggested a steroid injection. I’m a physician who has prescribed those meds judiciously and this seemed a reasonable single treatment step. Significant reduction in itching but it only lasted a week. Went to see a dermatologist. Non-responsive to initial topical therapy so she biopsied a couple lesions, making the diagnosis of Grover’s.
She advised me I have, of the four subclasses, the “simple” variety. After a review of treatment options we tried some additional topical treatments with no real help but I figured I’d just tough it out and be patient. The number of lesions and itching intensity waxed and waned over the next few weeks. It peaked about 4 days ago- I was pretty uncomfortable and came across this discussion (I trained in ob/gyn, not derm). Mindful of the moderator’s advice that cilantro has not been fully vetted as a medicine, I made a cilantro smoothie. Wow. Full relief from itching within 24 hours! Only 3 days in but no breakthrough of itching. Lesions are, of course, still present but are less red. Excellent clinical response. Will plan to sustain this approach and check coags/metabolic profile in a couple weeks to be sure the 10 stems/day are not causing an undesirable effect.

I too had the simple variety. Did not care about appearance, only the itch. Cilantro smoothies for 7 months (one per day) and I feel cured. Total itching was gone within 5 days of first smoothie. Now back to running and other activities that aggravated the Grover’s.

With your medical background it would be appreciated if you can give us your view about heavy metals being detoxed by cilantro and if you feel this detoxing could be the reason cilantro works for about half of those posting.
To begin with cilantro worked miraculously for me. So grateful for kimass1 providing this info. It suppressed the initial stages of my typical 6 month break out (after initial breakout of 1 year have had 6 months active and 6 months inactive as a cycle) and kept it at bay for 9 months with daily cilantro smoothies. So I had a least 14 months of clear skin and took advantage of these wonderful days resuming all my outdoor activities. Sad to report but a few weeks ago a new breakout started, it's going to be a bad one.
Always hopeful about a new treatment, will continue with cilantro but will try the witch hazel mentioned recently. Although steroids can help some forms of eczema, no steroid ever helped my GD. Clindamycin I have and will use as it is antibacterial. May start using Calcipotreine (man-made form of vitamin d) again, a psoriasis treatment which may or may not help me but doesn't make it worse. When itching is at it's worse in the evening as our histamines are at their highest I apply Flanax Liniment a capsacian and menthol blend that burns initially, then will help to suppress the intense itching long enough for me to fall asleep. I buy the 2 oz bottle on Amazon adn do not touch with unprotected fingers. I use disposable vinyl gloves and also a long handled spoon to get to the back torso so no need to ask my husband for help. Never touch with unprotected hands as if not totally washed off hands and you touch your eyes or privates it will burn like mad. Fortunately for me it has never affected my sides so I can lay on my sides avoiding any pressure on the papuales and then fall asleep. I am sure you have learned that tight clothing and pressure aggravate a breakout.
Go for the cilantro smoothies. I never had any negative side effects. About the only odd thing I ever noticed is that I lost my craving for salads with other meals. I still eat them but less often as now I prefer other vegetables of all sorts. I think the cilantro filled my bodies nutritional needs for other salad greens.

I should mention I had an annual Kenalog-40 corticosteroid injection and other topical steroids tried and neither injection or topical steroids helped. I wonder if GD is like Perioral Eczema, PE, which doesn't respond to steroids in fact the steroids feed the PE.

I entered a reply earlier but included a couple of links to round out the message. Forgot that, to control spammers, messages with links by new members won’t be posted. Hopefully the mods will let it through.

Could you explain what you mean by four subclasses, the "simple" variety? I assume you are referring to GD. In all my reading have never heard of GD as having classes. I do know we manifest it differently. Looking at the photos of GD on dermnetnz.org the New Zealand Derm site the visual rashes vary widely and also although most have the rashes located on the torso, front and back, some have it travel further out. Also our degrees of itching and pain vary. It could be I never heard about the classes because my biopsy was negative but believe that may have been because I was in the last month of a 1 year breakout when I went to a new derm who immediately figured out what I had. Previously other derms assumed it was an extension of my Allergic Contact Dermatitis, ACD although after Patch Testing the year before I had eliminated contact with allergens and had no rashes elsewhere on my body. Not worth biopsying now as I perfectly fit the profile of GD.

At the risk of cluttering the board with an overly technical explanation, here’s a cut and paste from a “Derm 101” site that will, unfortunately, sunset tomorrow. My apologies if it’s not useful. The key is distinguishing it from other conditions.

GROVER'S DISEASE

Grover's disease, named originally “transient acantholytic dermatosis” by Ralph Wier Grover, occurs in men and women who, almost always, are over 40 years of age and usually are over 60. The condition consists of papules that tend to erupt on regions exposed routinely to sunlight, especially the V of the chest and the upper extremities. Although the disease itself sometimes is transient, at other times it is persistent, not lasting for weeks but for years. The papules are of two types, one with a smooth surface and the other with a rough one as a consequence of its being keratotic.

The denominator in common for diagnosis histopathologic of Grover's disease is acantholytic dyskeratotic cells in one or more epidermal loci, a pattern designated “focal acantholytic dyskeratosis.” Without acantholytic dyskeratotic cells, a diagnosis of Grover's disease cannot be made. Four variations in arrangements histopathologic of acantholytic dyskeratotic cells are responsible for Grover's disease bearing a resemblance to Darier's disease, Hailey-Hailey disease, superficial pemphigus (pemphigus foliaceus), and deep pemphigus (pemphigus vulgaris). One particular combination of findings in the epidermis is unique to Grover's disease, namely, spongiosis in conjunction with focal acantholytic dyskeratosis; it is not found in the purely Darier, Hailey-Hailey, or pemphigus variants of Grover's disease.

Sections from a biopsy specimen of the Darier type of Grover's disease may be indistinguishable from those of authentic Darier's disease, consisting as they do of superficial perivascular infiltrates of lymphocytes above which are loci of suprabasal clefts atop which acantholytic, dyskeratotic cells punctuate the spinous and granular zones. Some parakeratotic cells at the summit of those loci also may be acantholytic. The only clues to differentiation of the Darier type of Grover's disease from true Darier's disease is the presence, as a rule, of more loci of acantholytic dyskeratotic cells per unit area of tissue and the propensity for eosinophils to appear in the upper part of the dermis. Neither of those findings, however, is seen consistently in Grover's disease. Sometimes Darier's disease, unlike Grover's disease, is unaffiliated with any infiltrate of inflammatory cells. Clinically, lesions of the Darier type of Grover's disease with their parakeratotic surface, just like those in Darier's disease, are perceived on palpation to be rough.

The Hailey-Hailey type of Grover's disease is characterized by loci of acantholytic dyskeratotic cells that extend throughout most of the thickness of the epidermis. Despite several findings in common between true Hailey-Hailey disease and the Hailey-Hailey type of Grover's disease, the latter usually can be distinguished from the former by the distinctly focal nature of it. Except for the very earliest stage in the evolution of Hailey-Hailey disease, acantholytic dyskeratotic changes tend to be confluent, not focal as in Grover's disease. The pemphigus vulgaris type of Grover's disease, like pemphigus vulgaris itself, displays suprabasal clefts and acantholytic cells, and no prominent parakeratosis. Unlike authentic pemphigus vulgaris, however, the pemphigus vulgaris variant of Grover's disease contains some acantholytic cells that are dyskeratotic. The superficial pemphigus type of Grover's disease is typified by a split in the granular zone with acantholytic dyskeratotic cells present slightly above and below the zone of separation. That variant of Grover's disease also differs from true pemphigus foliaceus by the focal nature of the process. Clinically, the papules in the Hailey-Hailey and pemphigus types of Grover's disease are smooth.

One type of Grover's disease is typified not only by acantholytic dyskeratotic cells in foci, but by spongiosis in close proximity. In none of the other four variants of Grover's disease is spongiosis a feature, nor is spongiosis a component of true Darier's disease. Therefore, when a histopathologist sees spongiosis in association with foci of acantholytic dyskeratotic cells, the diagnosis almost certainly is Grover's disease. If, in addition, there are numerous eosinophils in the infiltrate, a diagnosis of Grover's disease is confirmed. Parenthetically, the more eosinophils present in the dermis of Grover's disease, the more maddening is the pruritus associated with it and the more refractory the condition is to therapy.

In conclusion, a variety of clues enable Grover's disease to be differentiated from diseases that simulate it histopathologically, those being Darier's disease, Hailey-Hailey disease, pemphigus vulgaris, and pemphigus foliaceus. Among those clues are spongiosis, serum, crusts, and evidence of excoriation. Any of them alone, particularly spongiosis, in conjunction with changes of focal acantholytic dyskeratosis signifies Grover's disease.