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Results Results That That Deliver Deliver Chronic Back and Neck Care That Works • 98% patient satisfaction • 150% increase in Lumbar range of motion & strength • 123% increase in Cervical range of motion & strength • 73% of patients rate their headache reduction between 50-100% • 73% of patients rate their use of medications decreased 50-100% ...Without Surgery, Injections or Drugs 5 Convenient Twin Cities Locations Edina 952-908-2700 Chanhassen 952-908-2730 Burnsville 952-908-2710 Coon Rapids 952-908-2580 Maplewood 952-908-2727 www.PDRclinics.com A 50„YEAR„OLD MAN presents with red, itchy bumps on the chest of approximate six months duration. He reports that they itch mildly most of the time, but sometimes, with increased activity, they itch more. He is otherwise healthy, taking no regu- lar medicines (except a daily baby aspirin) and has an allergy to penicillin. Diagnosis: Grover's disease Grover's disease is an inflammatory pro - cess characterized by a pruritic, papular and, uncommonly, a papulovesicular erup- tion of unknown cause ažecting persons over 40 years of age (and usually over 60), often in photodistribution but sometimes widespread. Although named originally "transient acantholytic dermatosis," the condition usually persists for many months and even for years. The clinical presentation can be mild, e.g. a few scattered papules, to significant. Integration: Clinically, papules are the common denominator of Grover's disease, and histopathologica lly, the common denominator of individual lesions is the presence within the epidermis of some acantholytic cells. The papules have either a smooth or keratotic surface. Those with a smooth surface show acantholytic cells in a pattern that simulates those of pem- phigus vulgaris, pemphigus foliaceus and Hailey-Hailey disease. Keratotic papules show changes that closely resemble those of Darier's disease. The papules of Grover's disease are noto- riously pruritic, and the most pruritic of all are those in which numerous eosinophils reside in the upper part of the dermis. The cause of Grover's disease is not known. Therapy: Topical corticosteroids, local antipruritics and systemic antihistamines may be helpful in alleviating the intractable pruritus. Retinoids given systemically have sent the eruption into remission and caused lesions in some patients to involute. In my experience, reassurance is all that is needed for asymptomatic patients. For patients with significant pruritus, I have had excellent success with triamcino- lone o.1 percent cream applied twice daily for two weeks, then once daily for two to four weeks, combined with narrow-band UVB phototherapy for four to six weeks. Repeat series with flares, and most (but not all) cases will resolve in one to three years. F o r m o r e i n f o r m a t i o n , c o n t a c t C h a rl e s E . C r u t c hf i e l d I I I , M D , a t C r u t c h f i e l d D e r m a t o l o g y o r v i s i t c r u t c h f i e l d d e r m a t o l o g y . c o m . ■ BY CHARLES E. CRUTCHFIELD III, MD Case of the Month with Crutchfield Dermatology 1 0 1 0D I A G N O S T I C S