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

It just made me wonder if the cilantro-responders fall into one group or another. Or whether the number of eosinophils (a marker for a particular kind of sensitivity to environmental irritants) and the accompanying severity of itching might correlate (+/-) with the cilantro response. That’s one for the mods.
Most important thing for our group, as suggested, is to be willing to try the cilantro and to share our results with our clinicians. That’s often how medical breakthroughs get traction so, keep the faith everyone.

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.

Hi, I am struggling with this miserable disease and trying, like every body else to manage it. I do take two smoothies a day, but I don't freeze my cilantro. Do you think there is a benefit to doing so ? I will try it. When you mention cotton, what are you referring to ? Witch Hazel ? I am going to run right out and buy some. How do you make your cilantro? I use a lot of fruit, honey and yogurt and worry that I am putting too much stuff in it possibly off setting the benefits of the cilantro, although I don't see how that could effect it. Any advice you can offer me will be much appreciated. Thanks very much, Happy New Year.

@nodgabnoj and others: As most of us know, a good scratch can satisfy an itch. Yet the question of why we itch and scratch in the first place has baffled researchers for years. Recently, however, science has begun to enlighten us to the mechanisms at work in the itch–scratch cycle.
For years, the itch sensation was thought to travel along the same nerve pathway used by pain signals. Itch, in fact, was considered a weakened form of pain. Modern molecular, genetic, and anatomical studies now indicate that itch usually follows its own distinct course, says Qiufu Ma, PhD, an HMS professor of neurobiology who has studied the phenomenon. Itch runs along a neuronal interstate highway system that links the skin, the spinal cord, and the brain.
Itch and pain represent different sensations that evoke distinct behaviors. Place your hand on a hot burner and you instantly pull it away; the pain is intense. By contrast, when a piece of clothing brushes against your bare forearm, you scratch to quiet the irritation, giving little thought to the sensation and your reaction to it.
“These distinct behaviors likely developed to protect us against different types of threats,” says

Anne Louise Oaklander, MD, PhD, an associate professor of neurology at HMS who studies chronic pain and itch. “Pain is obvious and, without it, we wouldn’t live long—there would be nothing to prevent us from putting our hand into a fire or onto that hot burner. ” She adds that the itch–scratch cycle most likely evolved to protect us from small, clinging threats—insects or plants—that can be avoided by withdrawal movements.
A scratch for every itch
Previously, few studies focused on the neural mechanisms associated with itch, but several recently have succeeded in identifying a neural component to the itch sensation and its scratch response. In 2009, neuroscientists at the University of Minnesota identified part of the mechanism by which scratch relieves an itch. They showed that relief takes place deep within the spinal cord along the spinothalamic tract. The STT transmits information about sensations, such as pain, temperature, touch—and, it turns out, itch—to the thalamus, deep within the brain. This relays the information to the brain’s center for perceptual awareness, the sensory cortex.
In their study, the researchers monitored spinal nerve activity in monkeys whose lower limbs had been exposed to itch-inducing histamine. With each exposure, the monkeys’ STT neurons went wild. But when the scientists used a device that mimics monkey fingers to scratch the itchy limbs, they saw a dramatic drop in STT neuronal activity. This sudden drop suggests that the act of scratching calmed the STT neurons.
In a recent study published in the journal Neuron, Ma identified a neural component necessary for the pain sensation and itch suppression that also may help answer the “why do we itch?” question. This component is VGLUT2-dependent synaptic glutamate, a molecule that is released from certain sensory neurons and that serves as a transport for glutamate, the most abundant neurotransmitter in the brain. Ma came across this pain–itch dualism unexpectedly, while monitoring the behavior of mice that had been genetically altered to lose the action of VGLUT2 in a group of peripheral sensory neurons. He discovered VGLUT2-deficient mice developed itch disorders as severe as those found in humans with chronic itch disorders. Essentially, Ma’s research team had created a mouse model that mimics some types of chronic itch in human patients.
“Removing VGLUT2 from pain-related sensory neurons in these mice weakened their responses to acute and chronic pain and caused the sensitization of multiple itch pathways,” says Ma. “The mice began to scratch until they developed skin lesions.”
The VGLUT2 pathway, says Ma, likely quells excessive itching by activating certain inhibitory neurons in the spinal cord or brain.
Insatiable itch
Common itches brought on by a chemical or mechanical stimulus—think mosquito bites and poison ivy—can be treated readily with agents that counteract histamine, a chemical the body produces to fight allergic reactions. A mosquito bite causes the body to release histamine in the area of the bite, turning the skin red and itchy. An antihistamine relieves the itch sensation by preventing histamine from binding to itch-instigating receptors in the skin.
Widespread itch, by contrast, is often caused by diseases of internal organs. More than 80 percent of chronic kidney disease patients have chronic, widespread itch, and some patients with liver disease and non-Hodgkin’s lymphoma also suffer from severe itch. Certain pain medications, such as opiates, can also trigger itching.
Neuropathic itch is a different kind of chronic itch caused by a malfunction of nerve cells. It appears in many of the same conditions that can cause chronic neuropathic pain, including shingles, a very common viral infection. The complications of shingles are a focus of study for Oaklander in her laboratory at the Nerve Injury Unit of Massachusetts General Hospital. Other conditions that can spur neuropathic itch include spinal cord lesions, brain tumors, and phantom limb syndrome.
“Neuropathic itch is ultimately caused by inappropriate firing of itch neurons in the central nervous system,” says Oaklander. “People with chronic itch often feel as if insects are crawling all over them.”
Few remedies are available for generalized or neuropathic itch. A new drug on the market, Remitch (nalfurafine), was developed to reduce itching in hemodialysis patients, and may also prove effective for other types of chronic itch that don’t respond to antihistamines. This treatment is based on paradoxical clinical observations: Morphine, which triggers a response in certain opioid receptors in the brain, suppresses pain but causes itch, while nalfurafine, which triggers action in another set of opioid receptors, suppresses itch. It is conceivable that a combination of morphine and nalfurafine might relieve pain without causing itch side effects. And, if scientists manage to develop compounds that activate the inhibitory pathway discovered by Ma and his colleagues, “we would have a completely novel strategy to treat itch,” he says.
“Scratching,” said the sixteenth-century French essayist Montaigne, “is one of the sweetest gratifications of nature and as ready at hand as any. But repentance follows too annoyingly close at its heels.”
Now that the scientific community’s view of itch has evolved to the point where it’s considered a bona fide and potentially serious clinical condition, people who suffer as Montaigne did—his eczema caused him to scratch incessantly—may finally find some relief.
This article appeared in the Summer 2011 issue of On The Brain.
HARVARD MEDICAL SCHOOL CONTACT:
Ann Marie Menting
ann_menting@hms.harvard.edu
617-432-7764

For the curious nonscientist, On The Brain deciphers how the human brain works by highlighting the leading-edge research of neuroscientists at Harvard Medical School and its affiliated teaching hospitals. The thrice-annual newsletter, produced through the Office of Communications and External Relations, is sponsored by the Harvard Mahoney Neuroscience Institute.

@nodgabnoj Also, by cotton I meant wearing cotton next to skin and not synthetic materials which aggravate the condition. Pressure is also aggravating, such as bras and tight waists. I am now able to skip days of smoothies. I keep the cilantro frozen for ease. There are also cilantro capsules for use in traveling.

Applied generously with my hands twice daily.

Witch Hazel idea from elderly1 may be the reason or part of the reason my recent severe recurrence of GD is receding, Since cilantro stopped suppressing GD a few weeks before Christmas I erupted with a severe flare up. It wasn't working so I stopped drinking it at Christmas. Plus I was beginning to get some skin darkening on my face, a side effect of heavy cilantro use that previously I had not noticed.
This outbreak was rapid, within a few days I had thousands of little papuales on my back torso, especially mid to upper back, but some joined and I had a half dozen 1 1/2 " patches, solid red, never had this symptom before. The itching was fierce and I tried a few px's that never helped much before, but gave them a try again without improvement. So I tried elderly's treatment of Witch Hazel, only I applied it every other day because I didn't really have much hope. I liberally flooding my back torso and just 2 spots on upper chest. After doing this for about 2 weeks the papuales were beginning to dry up, my thinking was that the WH had a high percent of alcohol causing the dryness. It stung like mad applying, but then left a brief cool feeling. The itching was not helped yet.
Now here is where something else may have helped. My cardiologist put me on an "anxiety" px that he said was non-addictive. HYDROXYZINE HCL 25 mg tab, as needed 3 daily. I Googled it and learned it was an prescription anti-histamine. I started this on Monday, just 6 days ago. I only took 2 daily, one negative side effect is they do give me a very mild headache in my sinus's. The itching did seem less, headache was barely noticeable so a good trade off. By Wednesday, now applying WH daily, the papuales began drying up and scabs began lifting off and I used a heavy layer of Aquaphor Ointment. The itching was noticeably reduced. Friday after shower and WH application and once dry my husband applied the Aquaphor. Even a few days earlier I winced and couldn't help flinching with the application of either WH or Aquaphor, yet by Friday the sensation was mild and my appearance was 75% better. I have the papuales, but they are sub-dermal now, no crusty scabs. 1 1/2" joining of red plaques of papuales. No The itching is cut by 75% too.
Cilantro stopped my last outbreak in a few weeks and although not in remission yet, even if it stays at this level I can easily cope.
I still don't understand the rapid severity of the outbreak or the quick recession. It is still not gone, but dramatically improved.
I made an appointment with my derm thinking I might get a cortico-steroid shot of Kenalog 40 to help with the itching and it took 2 weeks to get in which is tomorrow. I wish I had taken a photo o how I looked 2 weeks ago. I am not sure I want the shot now.
I want to thank elderly1 for sharing.