Have you heard of Grover's Disease? If not, you're not alone. In fact, I learned about this skin condition just recently! My guest today will enlighten us about Grover's Disease, and share some diet and lifestyle tips that may help.
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My guest today is Dr. Raja Sivamani, a board-certified dermatologist who practices at Pacific Skin Institute.
He is an Adjunct Associate Professor of Clinical Dermatology at the University of California, Davis and Director of Clinical Research and the Clinical Trials Unit. He is also an Adjunct Assistant Professor in the Department of Biological Sciences at the California State University, Sacramento.
Dr. Sivamani engages in clinical practice as well as both clinical and translational research that integrates bioengineering, nutrition, plant science, cosmetics, and skin biology. With training in both Allopathic and Ayurvedic medicine, he takes a holistic approach to his patients and in his research.
Join us as we discuss Grover's Disease: what it is, why it develops, and how to manage it.
Have you been diagnosed with Grover's Disease? Let me know in the comments!
In this episode:
- What is Grover's Disease?
- Grover's Disease triggers
- Treatment options
- Dietary changes for Grover's Disease
- How can dairy affect Grover's Disease?
Quotes
“Typically what you get is you get all of these scaly what we call papules, essentially bumps, that scatter in the areas where you tend to have a bit more sweating on your trunk. Tends to be the chest, the stomach area, the back, maybe onto the shoulders and it doesn't really go beyond that much.” [1:03]
“I try to stay away from foods that are going to spike the insulin and IGF pathway, because some of those can also trigger your oil glands to secrete more sebum, and that's going to trap more moisture than you might need.” [17:01]
Links
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Attend the 2020 Integrative Dermatology Symposium (for practitioners + now 100% online)
Healthy Skin Show ep. 142: Psoriasis 101: What You Need To Know w/ Dr. Raja Sivamani
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159: Grover's Disease: Lifestyle + Diet Shifts To Implement w/ Dr. Raja Sivamani FULL TRANSCRIPT
Jennifer: Thanks so much, Dr. Sivamani for joining us again on the Healthy Skin Show.
Dr. Sivamani: Jennifer, I always have a lot of fun when I come on this show with you, so I'm looking forward to another great episode.
Jennifer: Yeah, today I wanted to talk to you about Grover's Disease, and I'm going to be honest with you and the listeners. I was not familiar with what this was, however, I've gotten a number of emails from listeners asking me to do an episode or some research on what it is, and are there any alternative ideas around how to address it from maybe a little bit more of an integrative standpoint, and the first person I thought of was you because you're so knowledgeable and you explain things so well. So for those who are not familiar with what this is or maybe somebody who has just been diagnosed with this, what exactly is Grover's Disease?
Dr. Sivamani: Yeah, Grover's Disease is a condition that can be very chronic and I'll describe the physical findings first. Typically what you get is you get all of these scaly what we call papules, essentially bumps, that scatter in the areas where you tend to have a bit more sweating on your trunk. Tends to be the chest, the stomach area, the back, maybe onto the shoulders and it doesn't really go beyond that much. Some people can get it to extend onto their upper legs, some people can get it onto their arms, but really it tends to be on the trunk. One of the things about it, and we don't understand why this is, it tends to happen in middle-aged folks, predominantly men, but I have plenty of women that have it as well. The official name for it is transient acantholytic dermatosis, and what that means is… and that's a very descriptive diagnosis.
Dr. Sivamani: And one of the fun things about dermatology, I never knew this Jennifer, that I was going to learn this much Latin. Of course, any Latin scholar would probably scoff at me and be like, “You don't know Latin.” But I feel like I've learned a tiny bit of Latin in here, and just talking about all of these medical terminologies, it basically is saying that transient means it comes and goes. What's happening is that you have a breakdown of the connections between what we call the epidermal cells, which is the top layer of the skin, the most superficial layer, there's a breakdown of those connections and what happens is you just don't have the normal skin barrier in that area and you get the scaling, and it can be quite itchy.
Dr. Sivamani: So, basically what it amounts to is scaling bumps, which can be very itchy and annoying and when I say annoying, I mean to the point it can affect sleep, it can affect your sense of sanity for some people. So it can end up being quite a big deal, so I don't want to say… When I say these small bumps, they can really affect other aspects of your life. And they're just chronic and remitting. And we can go over what causes them to worsen, what are treatments, but that in a nutshell is what Grover's Disease is. It's chronic. It's not necessarily life-threatening, but it can be lifestyle-threatening.
Jennifer: And that would be really interesting to talk a little bit about what does make it worse, I think that's a really good point of… because this like you say, itching and even sometimes things that people feel are unsightly or make people stare or ask questions, or they just feel incredibly self-conscious as you acknowledge. And I think that's an important point especially as a dermatologist, because a lot of times, people feel like they aren't being heard, or their issues are being minimized.
Jennifer: And one thing I deeply appreciate about you is your empathy that you have for your patients, and so recognizing that there are so many different factors that can go into how you feel about yourself and your self-confidence and self-worth because of what's happening to your skin in relation to other people, and then how that can be made… or how it can worsen. So, what exactly would be some… Are there triggers, or are there certain conditions that would make this worse than others?
Dr. Sivamani: Yeah, there are. Well, first of all, I'll say if you think you have Grover's Disease from what I am describing, just please make sure that you see a dermatologist to get this evaluated. This is one of those conditions that's slightly esoteric in the sense that we in dermatology see this often enough, but it's just one of those things where if you're not a dermatologist, maybe you've learned about it, maybe you haven't. So then you just want to be sure you get the right diagnosis, because there are some other conditions to make sure that you don't have. There are other conditions like something known as Darier Disease, which is more genetic and something that might come from childhood typically in those folks.
Dr. Sivamani: But you can get some autoimmune conditions too that can mimic this. There's things called pemphigus foliaceus. There's other factors like seborrheic dermatitis that can be very inflammatory. You could get a folliculitis, it could just be a folliculitis where your hair follicles are inflamed. And so, there's a whole list of treatment possibilities after you've gotten the diagnosis, correct? So, I just say that as a first step. Just make sure that you get this confirmed.
Dr. Sivamani: What we know is that people that end up sweating for whatever reason, when there's extra moisture, it causes Grover's to break out and whether that means it's from sweating from activity or sweating from the weather, or just if you're wearing really warm clothes, whatever it is, if you don't have your skin breathing or allowing it to breathe, we know there's a greater tendency for this condition to flare.
Jennifer: And so obviously, I would think people who live in more humid, hot climates could be affected by this, and it may even impact your ability to exercise.
Dr. Sivamani: Yeah, I think that one of the issues is… exactly. When you have humidity or anything that's increasing the sweat on your skin, and the key I think is when the sweat sits there. Now, if it's able to evaporate pretty quickly, I don't think it's going to be as much of an issue. There's never an end all be all in any of these conditions, because all of us are going to have different tendencies and different levels of severity of the Grover's, if you do get it. But you're right, if you are going to be exercising and the sweat's just staying pooled, make sure you wear breathable clothing.
Dr. Sivamani: That's a simple thing, and a lot of people forget that breathable clothing, cotton, things that wick moisture away are important, especially if you get the fabrics that are more wicking. That could be very important, rather than ones that will keep that moisture just stuck right on your skin.
Dr. Sivamani: And the second part of it is, yes, the environment, you can't necessarily change, but you just have to be mindful and you might have to put things on your skin that are going to help keep it dryer, keep yourself a little bit cooler if possible. And then also, if you do have a breakout, there are treatments that we can talk about as well.
Jennifer: Yeah, and really quick because we're talking about sweating, I don't know if you have any thoughts on this, this is what popped into my head right now. What about a lot of people are doing saunas, and there's a whole movement of sweating being very positive, and people are using red light therapy and all of these infrared saunas and what not. So for someone with Grover's Disease, would that be potentially contra-indicated?
Dr. Sivamani: We always have the term of relative contra-indication versus absolute absolute, means it's an absolute no-no. Relative just means be careful, watch how your skin's going to react. Yeah, if you come from the Ayurvedic perspective, just taking a step aside, when you look at Grover's, it's someone that's going to have a tendency towards sweating, and it's going to be someone that has a tendency towards inflammation. So when you look at the elements that are involved, and usually in Ayurveda, you have five elements that are involved and we won't go into much detail. But I think it's really important just to look at lifestyle tendencies.
Dr. Sivamani: You have earth, water, air, fire, ether. Those are the five elements, and we can do another podcast maybe on what all of these mean, but without jumping into that too much, if you look at Grover's, you have too much sweating which is a resemblance of the water element, and then you have too much inflammation, which is a resemblance of the fire element. So when you look at both of those, when you go into something like a sauna, you are adding more moisture to the skin. So if you are dehydrated, or if your skin is extremely dry, then you might have an opportunity where you're going to hydrate your skin.
Dr. Sivamani: But people with Grover's, they're having too much moisture sitting on their skin. So, saunas would definitely have a higher risk of inflaming Grover's, so you do have to watch for that.
Jennifer: Okay, that's a really good point to make. Again, because a lot of people see all this stuff online and they want to give it a try because it's working for so… It appears to work for so many people, but we always have to remember every single one of us is unique. We are different from everyone else, so our circumstance may make someone's… What is it? Someone else's… something like what works for someone else can be almost like poison to you.
Dr. Sivamani: Yeah, one person's treasure is another person's poison. Right. Exactly.
Jennifer: Yes, exactly. Exactly. So, what are some things that you found to be helpful as far as treatment options? Obviously, I think the lifestyle issues around trying to keep the body cooler, wicking sweat away is really important, but if someone has no idea how to deal with this and they're just literally… It's almost like playing whack-a-mole, just trying to deal with things and flares as they arise, what are somethings that they could do, and I assume the dermatologist would be helpful in identifying these steps for them?
Dr. Sivamani: Yeah, the key is to think about what are the different reasons that Grover's develops, and then go after each of those reasons, and really the main reasons and issues at hand with Grover's is that firstly, there's too much heat. And that could be local heat or just overall, like if someone has a fever or they get sick, sometimes Grover's can break out in that situation too because you're going to be sweating more. So there's too much heat and the heat could be local too, if you're trapping the heat for whatever reason. Secondly, there's too much moisture. And then thirdly, there's too much inflammation. And really, when you break it down, those are the three subsets of reasons why Grover's flares. And so you can try to identify each of those things.
Dr. Sivamani: So if we start with… and we'll come back to heat at the end. If you look at, “I have too much inflammation.” Let's start there, because that's really where the symptoms come in. If you have too much inflammation, there are a variety of things that people do. Steroids, topical steroids are used temporarily to get inflammation down, and steroids are very effective. If you're seeing a dermatologist, that is probably one of the first things that they are going to do. But when it comes to a steroid, think about how that steroid's being delivered. Is it coming in an ointment? Is it coming in a cream? is it coming in a lotion? We have to balance a couple things here.
Dr. Sivamani: When you have Grover's, your skin is broken down in those areas, so when you put any sort of a topical formulation on your skin, if there's more of an alcohol base, it may sting your skin for some people. But for others, if you put on something that's too heavy like an ointment, that may actually trap more moisture. So it's one of these Goldilocks principles where you just have to find the right formulation. It's not a one size fits all, so you have to figure out, “Okay, if I'm going to get a steroid, is it going to be an ointment, which is thick? A cream, which is kind of in between? Sometimes can sting, or can it be just a solution that's easy to put on, very watery and liquidy, but sometimes that can sting more, and for some people, it turns out to feel really good.
Dr. Sivamani: But that's the first thing. So you have steroids. The second thing is sometimes when it gets really bad, you might be given antibiotics for several reasons. One, there could be a secondary infection, because the skin is broken down in this area. You could get a secondary infection, so you have to watch out for that. Probably the more common reason why you might get an antibiotic is that antibiotics, rather than treating an infection, they're reducing inflammation.
Dr. Sivamani: And again, one of the tenets of treating Grover's is to reduce inflammation. So, the antibiotics can get in and get in through the system, so they may be topical or oral antibiotics, but typically ends up being a course of oral antibiotics. That is sometimes used to reduce the inflammation, and some dermatologists and some practitioners may use an oral antifungal. They just give you a tiny burst.
Dr. Sivamani: So, I just bring that up as another possibility, that they may talk to you. And finally, one of the things that happens, that you're trying to treat with inflammation, is you're trying to reduce the cells from what we call turning over or having that, those… because when those connections break down, you want to turn those cells over and then reduce how active those cells are being, so it kind of settles into a state where they don't break down as easily.
Dr. Sivamani: And so, you might use what's known as a retinoid. So you could use either oral Acitretin, or some people use Isotretinoin, which is the generic for Accutane. A lot of us don't like to do that in that case, but Acitretin is one that many of us will use orally. And then you might use a topical retinoid.
Dr. Sivamani: You have to be careful with the topical retinoid, though. They can be very aggravating. Okay. So that's the inflammation part of things. There are numerous things in the medical literature, by the way Jennifer, like what happens in these sorts of conditions is that if there isn't one known treatment, we try like 10s and 10s of them, and none of them work perfectly. But kind of just giving you a flavor. Second thing, when you're looking at the moisture issue, you want to bring that down. So the way to bring the moisture down is a couple ways.
Dr. Sivamani: There are some oral medications that can reduce sweating. We try not to go there if we don't have to, but that is an option. It would be off-label, so I just want to put a disclaimer here that some of the things that I'm mentioning are off-label. You really do need to speak to your doctor about these things, but just generically, there are ways that we try to approach reducing sweating. The other thing is putting on something astringent.
Dr. Sivamani: Can you have some sort of an astringent herb that you put on? And a common one is Witch Hazel. You can use something that's just going to be astringent so that it can absorb the moisture, or it can be something like an absorptive powder that you put on your body, to try to improve as well. So, those are some factors, and the heat part of it, what kind of clothes are you wearing? Can you wear more breathable clothes? Are you wearing things that get sweaty and stick to your skin, or they wick moisture away?
Dr. Sivamani: These are all factors that you think about. And then finally, the itching. Sometimes what we can do is we can give anti-itch lotions. Some of them have chemicals like menthol and camphor that can really reduce the itching or sometimes if it's really out of control and you're just trying to get it under control, they can give you anti-itch medications that you could take orally as well.
Jennifer: Wow, so is this generally a life long issue that you've found in your practice?
Dr. Sivamani: It's a funny thing, it's something that doesn't show up until… for many people, until their 40s and 50s. And it does last for a few years, and for some people, I don't know why, it just gets better. And for some people, it's as simple as they were a little bit overweight, and they were sweating more easily and then they lost that weight and their body was in a different state and then it went away. And for other people, they lose all the weight they can, get into shape and they still deal with it. So, we don't have the total handle on why it comes on and how quickly it's going to go away, but for some people, it does get better. It goes into a remittive state.
Jennifer: One last question, have you found in working with these patients any specific diet tricks that you've given to them that… I think diet from the perspective of maybe… I mean, obviously, let's clean up our diet, right?
Dr. Sivamani: Yeah.
Jennifer: So if you're eating a really junk food diet, the first thing, and it's an easy thing is, “Hey, let's start integrating in more colorful whole foods,” and what not. But do you have any tips for someone who may be dealing with a lot of inflammation, right? That's driving this. Are there any foods that might be helpful that you've found from working with these patients?
Dr. Sivamani: Yeah, try to stay away from… and by the way, I think that's a great question. I try to stay away from foods that are going to spike the insulin and IGF pathway, because some of those can also trigger your oil glands to secrete more sebum, and that's going to trap more moisture than you might need, because it tends to be on the chest and back and stomach area, and especially the chest and back, your oil glands are pretty active, the sebaceous glands. So I get people to stay away from high glycemic foods as much as possible. It's probably better for their overall health and better for weight control too. Dairy, I get people off dairy. Are these proven associations? No, they're not. But I'm trying to think of the mechanisms that are involved at this point.
Jennifer: And dairy, from my understanding, diary can actually… Is it that it increases the growth factors, or that it stimulates them in the body? Is that the connection there?
Dr. Sivamani: It is actually become even more complex. It does both of what you're saying. It can stimulate flares and increases in insulin and in IGF-1. But it also may directly once it absorbs some of the dairy proteins, may also directly get to the skin surface and then activate the skin in other ways. We've done some early studies looking at cell culture and so I think dairy has multiple ways that it has its actions. Of course, this is why babies need dairy when they're growing up, because it helps them grow.
Jennifer: Absolutely.
Dr. Sivamani: But at some point, you don't need that insulin spike over and over again, and it can show up in a variety of ways, such as weight gain and sometimes, it can have extra oil on the skin. So, yes. I do get people off dairy, and also going to low fat. I just want to make this point. Going to low fat actually may be worse, because low fat dairy tends to have even more filler content in there, which can be oligosaccharides and whey. And then going to milk alternatives, if there's still dairy, it's still dairy. So going to A2 milk or lactose-free milk doesn't change that.
Dr. Sivamani: It's still got the dairy proteins in there. You really do have to just go off of dairy altogether, and I have had questions. “Oh, what about dairy like almond milk?” And I just want to remind everyone that almond milk, I know the word milk is in there, but that is dairy-free. If you go to something like almond milk or cashew, or macadamia. They have so many great nuts now, pistachio and oat, that's another great milk. So, a lot of alternatives that are available.
Jennifer: Absolutely. And what about ghee? Do you have any thoughts on… Would you still consider ghee a problem if the proteins have been removed, or would that maybe be the one possible okay dairy?
Dr. Sivamani: It's a good question. In Ayurvedic medicine, we always talk about ghee as being much less of an issue compared to butter, and I think that is true. Having a little ghee in your food is okay, but for a lot of folks, if you're dealing with too much moisture and what not, you don't really need the ghee either. I think using it is probably safer, but if people are willing to come off the ghee, I'm fine with that too. That one, I'm really either/or.
Jennifer: It's on the fence.
Dr. Sivamani: It's on the fence, because I think it is better for your health. I don't see it as being as much of an issue, and many times when people put ghee in, they're not taking tremendous amounts. They're putting in a tiny bit to oleate their food, so it's a little different.
Jennifer: Exactly. Exactly. Well, I just want to thank you so much for enlightening all of us about this issue, and I'm excited now for people who were asking about Grover's Disease, so that they now have a different perspective, and I love that you brought in the Ayurvedic perspective as well. It's not just a skin issue, this is a life issue. You know? You have to look at your diet, you've got to look at the products you use. You need to look at all of these different factors, and make some shifts to be in better balance with your own body.
Jennifer: So, first of all, I want to thank you for being here yet again and I want to encourage everyone to go check out your website, especially those who are listening who are health practitioners, doctors, other nutritionists, dieticians, acupuncturists, et cetera, anyone in the field of really helping people and you're really interested in this whole integrative approach to dermatology, LearnSkin.com is an excellent resource for practitioners to really connect with other like-minded practitioners around skin issues, but also to become incredibly educated on these issues from this more… I think it's a very forward-thinking position, and you've also got a great podcast as well, which I've been on. And we'll have to share the links to that show.
Jennifer: So I just want to encourage everyone to really connect with you, because I think the work that you're putting out there and everything that you are doing is… We're starting to see this elevation and awareness that there's so many more things to your skin than just your skin, and I love that.
Dr. Sivamani: Oh, that's absolutely true, Jennifer. And thanks for doing what you do as well, and this is fun. The times are changing, we're getting to really thinking about ourselves holistically, and so it's the better way to go.
Jennifer: Absolutely. Well, thank you so much for joining us, I appreciate it.
Dr. Sivamani: Of course.
I learned a lot from this interview discussing Grover’s disease. I enjoy exercising but I sweat easily. Can swimming in a chlorinated pool cause Grover’s to recur? What exercise is suggested? Thank you.
I have had Grovers for decades. Recently started Humira and it has exploded. Searching for maybe a link.
33 yr old female, 2 biopsies confirmed Grovers. 3 years thus far with breakout. Isolated to my legs with slight breakouts on neck and hands. No solution found thus far has helped breakout in any way. Im open to any suggestions.
Hi Brandi, I’m glad that you found this episode of the show. Perhaps consider contacting Dr. Sivamani to see if he could be of assistance to you. Grover’s is not my wheelhouse, but I did have several people who asked me to do an episode on it. If I discover anything else on this topic, I’ll certainly share!
I have Grovers Disease all over my back, chest, stomach and arms. It drives me crazy at times. I’m on an antibiotic and topical steroids. They help some but not nearly enough.
Hi
am 34 year old male , had 2 biopsy’s done . both confirmed grovers imf was negative .
I seem to also have it in my mouth has ulcers and scalp . The Demotologists ive been to are not really sure if the biopsys are correct but were done in two different labs . Is it possible for it to be something else ?
ive had it for almost 3 years now its more of like watery blister .
Was just thinking if the cause was heat and sweating how does that explain it occurring in my mouth ?
I honestly do not have an answer for you as I don’t personally have experience supporting anyone with Grover’s. That would be a question for a dermatologist with experience with Grover’s to ask. If I do another podcast on this topic, I’ll be sure to ask about that!
Hi, I’m not sure if you are still following this thread but I’ve had Grover’s for almost 30 years. It is the worst now it’s ever been. I had many years of “remission” but after many x-rays and a huge amount of stress over impending open spine surgery, it’s back with a vengence. I’ve never had any “ulcers” or any Grover’s rash in my mouth or ever heard of any other patient with that symptom. I know I have read about another disease that does have a connection with the mouth. I’m very sorry to say I cannot remember its name. If you are good at research on the internet, you will find it. Just spend the time and you’ll find it. I find new info constantly and am amazed. Just keep trying to describe your symptoms as concisely as you can and as simply as possible and it will be there. Always mention “in the mouth” because that’s the most dissimilar symptom to these skin diseases. I hope you can find it and find a good dermatologist to help you in your search. Mayo Clinic has a support group for Grover’s Disease. There are others. You could try the Rare Disease Association (not sure if I’ve got the name exactly right) and ask them for help. Don’t give up! There’s got to be help for you; you just haven’t connected with them yet.
Wondering if there are nutrient deficiencies related to Grover’s and/or are there trends with Grover’s in stool testing. Are there toxicity issue that cause the break outs? Eating for liver support helpful?? I know it is not a very common disease so these may be some things to study for future insights with Grover’s. It can be emotionally debilitating disease due to the INTENSE ongoing pain with break outs.
Hi Theresa, unfortunately I have no idea. I’ve never worked with a client who has had Grover’s and I don’t think that enough stool panels have been run on Grover’s patients at this point that someone has put that type of data together. I think at this point, it is a lot of trial and error and moving through a case as best you can based on clinical knowledge.
I have Gover Disease for about 10 years. It comes and goes. Mostly on my back and stomach. I have not found a answer to how I got it. It seems to flare up when I am sick. I just got a flare up last week as I had the flu with a high fever and was in bed for a few days. If anyone has any ideas that would help please send me a response.
Quick background: career military with several assignments in desert conditions with extensive outdoor field duties. I have Grovers and have used three dermatologists over a period of 12 years due to my former relocations throughout Texas. Two of the three doctors prescribed steroidal creams and hydroxyzine. Likewise, two of the three doctors additionally included UV treatments three times a week. In fairness, all approaches worked to a fairly high degree with regard to controlling the symptoms, but again, I have had this condition for some 12-plus years (supported with two biopsies) and was hoping for a medical breakthrough – probably not going to happen. I recently had melanoma surgery which is perhaps related to extensive outdoor activity in a desert environment.
I have biopsy confirmed Grover’s. My Grover’s flares with extensive bed rest (when ill) and I have suffered after drinking wine, beer and fruit juices. In addition I can’t eat anything with citrus acid.
I suffer with it on neck, hair, shoulders, chest, small of my back and the worst is in my private parts. I was wondering if it is related to food or drink as that is one of my triggers.
I’m not entirely sure. There are so many different connects that have yet to be explored and since I don’t have any experience working with Grover’s cases, I’m not the best person to ask. BUT I will say that when there are flare ups with food or certain beverages, it does make me wonder what’s going on from a gut function and gut microbiome perspective!