OSCE — Grover's disease (transient acantholytic dermatosis)

Brief (to candidate)

You will assess a patient with a presentation consistent with Grover's disease (transient acantholytic dermatosis).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Grover's disease (transient acantholytic dermatosis, TAD) is an acquired, usually self-limiting, intensely pruritic papulovesicular eruption on the trunk of middle-aged to elderly men, characterised histologically by focal acantholysis. The eruption is precipitated by heat, sweating, prolonged bed rest and xerosis, and runs a course that ranges from a few weeks to several years. Four histological patterns (Darier-like, pemphigus-like, Hailey-Hailey-like, spongiotic) may coexist in the same biopsy. Diagnosis is confirmed by punch biopsy from a fresh, intact papulovesicle; direct immunofluorescence is characteristically negative. Management is stepwise: trigger avoidance, emollients, topical corticosteroids, with systemic options for extensive or persistent disease.^[1]

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[2]