Author Topic: Grover's disease  (Read 490107 times)

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Offline socalmom

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Re: Grover's disease
« Reply #680 on: Friday July 25, 2008, 09:04:24 PM »
Hi--I am a "newbie", but pretty desperate to get answers about what is going on with my skin.  Two years ago I broke out in what looked like flea bites on my legs and arms, and an itchy scalp---initially, nothing on my trunk.  The first dermatologist told me it was mites and treated 3 times for that until I insisted that he biopsy something.  He did a biopsy and the histopathology report indicated that I had acantholytic hyperkeratosis, most consistent with Grover's Disease--Was told nothing could be done and it would go away.  Later, it started happening on my trunk also.  Went to a second dermatologist who thought it was stress and refused to biopsy anything--although I was broken out all over my body, including the palms of my hands and going nuts.  After two years putting up with this (it is now confined to my scalp--but the itching is severe), I went to dermatologist #3, who also thought it was stress, but gave me Olux foam to apply to my scalp---it did not help.  I am now into the fourth visit with this last dermatologist and he says he has no idea what it is, and because it is limited to my scalp, he does not think it is Grover's Disease and informed me that my symptoms do not fit anything he has ever seen--he wants me to go to UCSD for Dermatology grand rounds to see if any of the 40 or so Dermatologists there has any idea.  I'm pretty lost and wondered if any of you have experienced a similar sequence of outbreaks?

Thanks so much for listening to me and for any information that you can provide,
Elaine

Offline ColoradoSue

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Re: Grover's disease
« Reply #681 on: Sunday July 27, 2008, 02:32:03 PM »
Back again.  My naturopath is willing to explore the research.  She can do the mercury testing and administer the chelaton.  Any suggestions/tips?

The spots on my back and legs are continuing to sprout up, but it's my scalp that is driving me crazy.  I hope the chelation will help.

I am also very interested in the connection to macular degeneration that Dr. Dantzig found.  My mother has age related macular and is blind.  I would sure like to avoid getting it.



Offline Dondi

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Re: Grover's disease
« Reply #682 on: Sunday July 27, 2008, 11:50:46 PM »
Hi everyone!    I wanted to add something,  after I had started to itch my husband also started having itching.  Of course the derm doc thought ok mites but mine never had any indication of mites only grovers, but my husbands and please bare with me rather long, biopsy report said spongiotic dermatitis with eosinophils, superficial to mid dermal.  note: The histopathologic differential diagnosis includes an eczematous dermatitis, a spongiotic drug eruption, scabies and a arthropod bite reaction. mutilple levels were examined and do not reveal evidence of focal acantholytic dyskeratosis, however, Grovers disease cannot be excluded.  If this process persists an additional biopsy may be useful.  Well I read this and thought 1st off the Dr. gave my husband permethrin in case it was scabies and he used it twice all over.  I never had any mention of scabies, and I was under the impression the grovers was nothing contagious.  Further he said with me that my diabetes and thyroid problems probably made the grovers break out worse then maybe it would have been.  I have had out breaks before just didnt have a name for it.  Figured it was an allergic reaction.  My husband scratches the heck out of himself with a scrub brush literally and takes steaming hot showers, cause he said it makes him feel better and I keep telling him your drying out your skin and making it worse.  I dont know why I say anything cause Im just as miserable and can understand his frustration.  I actually went as far as to try the scabie med and it is formaldehyde in a tube.  I itched so bad after.  Apparently my husband said that the Dr told him he didnt believe he had scabies/mites anyway and that he thought he had an allergic reaction to the cream.  Although that didnt explain the biosy report mentioning a bite reaction, unless the scratches he has  are of course from his horrendous scratching.  Anyway the point is 1st, maybe I need to go to another Dr altogether and have him biopsy me right off the bat (if they will)  cause Im tired of going and feel like Im wasting money.  The other Dr said the biopsy lab was very reputable but I was scratching for over 2-3 months before he finally got around to biopsing me.  Maybe these are not accurate after you have irritated the heck out of your skin and have put on tons of steroid creams.  Possible this can cause a change in your skin.   I have been trying really hard to not use the steroids but lately have been using some olux out of desperation.  I cant help noticing that my skin   seems to be changing over time and I wonder if the red marks you see ina classic case is constant or ddoes anyone find that there skin has become dry and small bumps, I have burning  and intense itching off and on.  I dont know anymore if I am developing fungus on top of this or as a result of  the meds they have given me.  Or is it really worse because of thyroid problems.  My husbands biopsy I brought up cause I was just shocked they mentioned grovers at all.  What does anyone think of this?   
Lets just take it one day at a time!

Offline schneid

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Re: Grover's disease
« Reply #683 on: Tuesday July 29, 2008, 01:18:14 AM »
Hi jd1,

Thanks so much for responding to my first post.  I agree with all of your concerns, etc.  The lab that made the initial diagnosis appeared to be less than first rate.  They just had a gross description of the specimen, no description of the histopathology findings or of any description of the cells--just a conclusion that it was consistent with Grover's Disease, but it also mentioned Darier's Disease and one other.  I have always thought that something should be re-biopsyed (sp?), but have never been successful in getting any of the other dermatologists to do it.  I have an appointment this Thursday and I am going to really push for a biopsy, before I trapse over to UCSD and feel like a specimen myself.  I'll post something after Thursday.  Thanks again for being responsive--your advice and feedback were very helpful and made sense.  I will  post anything interesting following my Thursday appointment with the dermatologist.

It has been a true nightmare--no one realizes what it is like to have severe itching 24 hours a day.  I couldn't sleep at all last night because my scalp was itching so badly that I spend the whole night scratching it --which I know I shouldn't do, but after 2 years and no improvement, I am not the most compliant patient!

Thanks again,
Elaine

Offline socalmom

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Re: Grover's disease
« Reply #684 on: Tuesday July 29, 2008, 03:55:31 AM »
Dondi,

I was also biopsied and told I had Grovers in March 08.  I am a 44 year old female. Let me share my story:

My son had scabies in Jan of 08 and we treated him, twice, in early March 08. (My entire family, including me, treated just in case he gave it to us even though he's off in college. We did see him periodically during the school year) (Quick note: we visited 6 derms and allergists who never diagnosed my son's scabies outbreak.  They ALL said it was chronic urticaria and we would never know what he was allergic to.  Shoot me. He finally self diagnosed and was right.  It went away.) Then I came down with this crazy, itchy rash in the end of March. (I've always had a heat rash...but very slight) I thought I must have managed to get the scabies even after treating. I went to our derm and she told me that it wasn't scabies and confirmed Grovers with a biopsy. I couldn't believe the coincidence of having a rash but not having scabies.)  Now, July 08, my husband has had a rash very similar to mine. (We do not have any classic signs of scabies but BOTH of us now have the signs of Grovers)  I give up!  I'm thinking I now need him to be biopsied.  My son was biopsied in June after he kept getting raised welts around his pantline.  The lab results said that there was an insect reaction but no mites and the derm said he probably was still dealing with the aftereffects of the scabies from a few months ago and that his skin was on high alert.
So, my son occasionally has welts come and go with heat, I have a rash on my stomach (I'm a runner and I run 8-9 miles every other day and spin 3 days a week.  My workout tops are always WET) and my husband has a rash on his stomach similar to mine.  Thank goodness my other son has never had anything! 
Any thoughts?
Has anyone found a derm that wants to deal with skin disorders and not give botox or laser treatments? Elaine, (schneid) I live in South Orange County so if you find someone through UCSD would you refer them to me?  I need to pick someone's brains and stop the rash madness going on in my home!

Offline Dondi

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Re: Grover's disease
« Reply #685 on: Tuesday July 29, 2008, 05:24:43 AM »
Hi Elaine    Well your story does sound similar,  and I uderstand  the frustraton.  Honestly I would have appreciated my husband telling me he was also feeling itching when I first was having the problems and of course the DR was asking me if anyone else in myhome was itching too.  When I brought my husband in and he said how long he was itching I think the Dr thought something was wrong with me and I wasnt being upfront with him, but he insisted that the place he uses for biopsies was reputable and a mistake was unlikely, and he said since I also had diabetes and thyroid problems this was likely the cause also.  He told my hubby he couldnt still have scabies if he did have them at all and that he suffered a reaction, as the biopsy mentions a drug eruption.  yet it mentions scabies besides eczema dermatitis.  Thats why I think I may have to see someone else.  My insurance comapny must love me cause I have been seeing a endo doc for my diabetes and thyroid problem once a month since April, and now need surgery on a badly imflamed nerve as a result of carpal tunnel , of course all I can think of is one less arm and hand available to me to scratch.  my son is also itching now and I am telling him he has to go to a different dermie and tell him his parents are itching so that hopefully he will just do a biopsy.  I dont live in Calif.  I gather you do, Im in New York.  I hope you find someone to help you too.  Of course there are far worse things in life then this but sometimes I cant help wondering how long can we put up with this, its horrible feeling like this.  Im always searching online for answers and then you come across these people who have such terrible conditions and you feel like Im such a whiner.  But it is miserable.  I have heard of people being diagnosed with grovers and then it being partly  or completely scabies/mites  dont know why though?!  I just was shocked when they said my hubby may also have grovers as it wasnt put to me as being a contagious disease nor have I heard anyone else saying their house mates also possibly having it.  Let me know what your progress is and Ill let you know ours here.  Good Luck. 
Lets just take it one day at a time!

Offline socalmom

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Re: Grover's disease
« Reply #686 on: Tuesday July 29, 2008, 06:28:21 AM »
Dondi,

Sorry, my post was confusing.  I'm socalmom and I was including Elaine (schneid) in my post to you.  She lives close by and I'm looking for a referral for a DR.
I just found a link between scabies and Grovers.  The best article I've found.  It says that scabies can set off residual dermatitis and postscabietic pruritus (ie: Grovers) I think this is what initiated my Grovers.  Please take a look at the article.
www.emedicine.com/DERM/topic382htm#section 
I think I have incredibly sensitive skin and the scabies brought out an underlying issue I've always had, but made it full blown.  I need to speak with a Derm that specializes in skin disorders.  Does anyone have a recommendation of someone? I'm scabies free but still itching with Grovers.

Thanks!

bunnie

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Re: Grover's disease
« Reply #687 on: Tuesday July 29, 2008, 08:58:19 AM »
Hi everyone, I don't wish to intrude, especially on this board, but I just wanted to maybe help you with the scabies thing and the link you left.
 Scabies as you will know is highly contagious. The mite Ascarus Scabiei burrows under the skin and lays eggs which appear as black scratches initially. The mite is active at night apparantly and the itch is at its worst then usually. It must be treated medically, everyone in the family, everywhere, from the neck down. However if not treated immediately, that with the constant scratching can often make scabies appear like something else, making diagnosis difficult upon appearance. However a really good derm will spot it straight away.
I do not have Grovers, but I understand the cell processes of why it occurs, because a part of those cell processes occurs in my condition.
As most cases from studies have shown, Grovers patients also suffer from Atopy, resulting in various Atopic conditions, depending on the individual. Atopy is an inherited mutated gene/genes, predisposing the person to ever having a hypersensitivity  reaction to anything really, specific to you, and it tends to run in families. The pathogenic result of that hypersensitivity in you is the disease manifest. Usually the result is self-limiting, but it can take years in some cases to disappear, as with drug-induced autoimmune conditions for eg.  However the majority are idiopathic,( idio self- pathic -suffering) of no apparant specific cause, and tend to last longer.
Autoimmunity too is a mutated gene/genes, predisposing the person to ever having an autoimmune response, but in the case of Diabetes, Psoriasis , etc there is an inherited mutated gene to the disease itself.
Dondi, you say you have Diabetes, this then comes under that latter category, but the majority of cases who have the predisposition to autoimmunity, also tend to have the predisposition to Atopy! 
Anybody with the autoimmune  predisposition, can have more than one autoimmune response, resulting in something entirely different, depending on various factors, which I have related on my posts on the subject on other boards.
Scabies most certainly can stimulate this Atopic predisposition in a person. (or an autoimmune condition) It is an external "invader" and as the body responds to that invasion , (to keep it simple) these predisposing genes can be stimulated , resulting in the malfunctioning of all the subsequent immune cells within that abnormal response, the pathogenic result of which in you is Grovers. (it could be something entirely different in another person, or the scabies or whatever may not stimulate a response at all, even though you may have the genes predisposing you.) It takes a combination of multi genes and factors to result in the condition manifest.
Both predispositions wax and wane in severity and can have varying periods of remission, some lasting many years. My remission lasted 18 years for eg. Thyroid troubles too can stimulate an abnormal response to either predisposition, due to hormonal dysregulation.
Was it on here that somebody's derm said that the mercury hypothesis was an alternative approach? Well he was right! It is seen by the medical field at present as just that, a series of ancedotal hypothesis, there is no evidence that has undergone meta analysis to prove otherwise, and that is why, it is seen Globally by the medical field as alternative. I am just explaining the reason why the derm said that, nothing more.
Anyway just trying to help.
Bunnie
« Last Edit: Sunday August 10, 2008, 04:56:00 PM by bunnie »

Offline Dondi

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Re: Grover's disease
« Reply #688 on: Wednesday July 30, 2008, 10:09:02 PM »
Hi SoCal    Sorry its probably my mistake, I should have looked at the post name closer.  I have tried to fully the access the site you sent, I get to it but then can not get to read anything other then the what they have listed,keeps saying error not found.  I may have read it, in the past, though.  I cant say I have found a lot of sites on the issue of grovers and mites/scabies. 

Bunnie--  You seem to have a great understanding of all this stuff, cant say I do.  I did see a allergist/ immunlogist about 6 weeks ago even though the my dermied thought it was a waste of time.  He said I had no enviormental allergies and did mention IGE or IGA (ATOPY?) and said I wasnt showing a reaction or symptoms of this, sorry I know this may be showing a little ignorance on my part, cause I do have a lack of understanding.  From the start though I have never showed signs of a scabies/mites  (whatever you want to call it)  infestation other then itching, no black lines nor white curvy lines (tunneling) under the skin or in the webbing of my hands or feet, nor has my husband.  I have looked at as many pictures as I could and it doesnt look like it.  But the fact that we started with the itching is what brought it up at the doctors.  DR had my husband try the cream  twice  and figured well if its that  it should make it let up but hubby had a reaction to the cream.  I am assuming that when they do biopsies they put down what they think  may be causing the problem?!  So we were all a little surprised they mentioned  scabies and a bite cause he had already used the cream twice before they did the biopsy but did note he had a reaction from a drug ( the cream).  I used it cause he figured he would try it again and so we both used it from top to bottom and it didnt help either of us.  My son has been itching and my daughter also  a little.  She is a gym rat and is getting it in places where there would be rubbing and my son has to wear a suitand is dressed from head to toe all day in the heat with a jacket on, so my guess is he has heat related rash of some kind, hopefully.  My skin is without a doubt sensitive and my family has had some autoimmune issues, thankfully nothing terrible as some have trouble with.  Honestly after some of the things I have seen online and heard I guess I count my blessings and feel actually whinny.  Its just you can take so much discomfort.  I appreciate your input, I wish I  had a better understanding.  The allergist actually had told me the biopsy is probably right and it is what it is and hopefully I would be in that number who has it for 6-12 months and then be gone.  Since he has hardly dealt with any grovers patients and so far none of my regular doctors know what t is I feel a little like a fish out of water.  I honestly hope grovers isnt my husbands problem too, I would be shocked as no one has ever mentioned it being contagious. One of the things they said was eczema dermatitis and they also didnt rule out grovers as in addition to the exzema. I just dont now what to think or believe anymore.
Lets just take it one day at a time!

bunnie

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Re: Grover's disease
« Reply #689 on: Thursday July 31, 2008, 12:03:15 AM »
Hi Dondi, I think the scabies thing has confused you and the doctor! To be honest a GP hasn't got the specialist skills of treating skin, thats why we have derms! They inevitably think of scabies and other mite infestation when they see a rash they don't see regulary. I was just pointing out that if it was scabies it could trigger off this reaction in you as you already have diabetes, and may also suffer from Atopy. Of course there is no reason at all why hubby may not suffer from atopy , and your kids too because it does tend to run in families. Your husband and his blood line are different of course, but if they suffer from atopy then of course his children possibly carry the predisposition , as well as from you. Although not impossible it would be rather unique for both of you to have Grovers , because it is not contagious at all.
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He said I had no enviormental allergies and did mention IGE or IGA (ATOPY?)

IgE and IgA are antibodies, or otherwise called Immunoglobulins. These are naturally produced whenever there is an immune response to an invasion by something that is not of the body, all of which are known as antigens. or if something not of the body but normally harmless to it like pollen for eg, it is called an allergen.   All cells carry a marker of "self" in animals and in humans. Anything in the body that does not carry this marker of self, will be attacked and destroyed. Antibodies  are an army of soldiers really!  They each carry a specific "key" to fit exactly the "lock" on the invading antigen. This action is called an "immune complex".  (In some conditions these immune complexes amass together like a veil, and move throughout the body, depositing in the skin in some cases and causing inflammation and damage.) They bind to the antigen  so that it can be destroyed . (See pics on my blog) They each have a specific job to do.
However if there is an abnormal immune reponse to external normally harmless things this is known as atopy, and the predisposition to this occurring only occurs in people who carry the mutated genes, with this coding in their DNA. The same applies to autoimmunity but this abnormal immune response can be stimulated by something of "self " like hormones for eg. as well as out of the body factors too. This abnormal immune response results in abnormal antibodies being produced to "self" antigens, therefore destroying self proteins. Everything else is malfunctiong and it cannot switch off.
There are 5 classes (Isotypes) of Immunoglobulin, (antibody) based on their structure and biological activity.
These are, IgM, IgG, IgA, IgD and IgE, plus 4 subtypes of IgG (IgG1-4), and 2 of IgA (IgA1, IgA2).
Different types Play different Roles in Immune defence.
IgG, (immunoglobulin G), works efficiently to coat microbes, speeding their uptake by other cells in the immune system. IgG is the most abundant class of antibodies found in blood serum and lymph and active against bacteria, fungi, viruses, and foreign particles. Immunoglobulin G antibodies trigger action of the Complement System. This is the first to meet with invasion and is very deadly.
IgM, is very effective at killing bacteria.
IgA, concentrates in body fluids, such as tears, saliva, the secretions of the respiratory, and the digestive tracts, and guarding the entrances to the body.
IgE, whose natural job probably is to protect against parasitic infections, is the villain responsible for the symptoms of allergy.
IgD remains attached to B cells and plays a key role in initiating early B-cell response.
Apart from having a name, these antibodies also have specific symbols.
Well it is a huge subject Dondi, and complicated, however I find the whole immune system its structure and function fascinating, it is utterly amazing what these cells can do. You can even see film of these processes on youtube! I left a link to my blog somewhere on this board. If you scroll down to Cells of the Immune System, it explains everything there and scroll further to Disorders of the Immune system it explains hypersensitivity, allergies and autoimmunity on there. Don't try to read it all at once it will do your head in! I'm sure you will understand the gist of it at the very least. It is half the battle when you understand why these things happen and the underlying problem.  My son has just had such a reaction himself he suffers from atopy, and it was a bad rash very itchy, but hopefully self limiting.
Bunnie
« Last Edit: Friday August 01, 2008, 10:20:10 AM by bunnie »

Offline socalmom

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Re: Grover's disease
« Reply #690 on: Friday August 01, 2008, 04:55:34 AM »
Oh my goodness Bunnie...i can only imagine what you do for a living! Like Dondi, I am such a layman at this, I can barely keep up with what you're stating. It sounds like Dondi and I have very similar stories, yet i do not have diabetes. My husband is itching and my son has reoccurring welts around his waistline on his pants. My itching and rash is increasing...I WILL NOT GIVE UP WORKING OUT! (yet I am paying for it) I agree Dondi...compared to so many stories...I have it so easy ...yet....metally after experiencing the whole scabies thing with my son... and his roommates... and his college athletic team...oh my gosh...will it ever end? I have been pretty stressed out with trying to control this thing.  Everytime we itch I think..."Is it scabies?" or "Is it Grovers?" I'm pretty sure we're all scabies free but believe me, it does do something to your psyche. Really, I thought I could just grin and bear this yet everytime I sweat...it gets worse. I'm more than a little uncomfortable.

I got a copy of my biopsy results today.  Bunnie, hopefully you can tell me what a comment means.  The diagnosis says: FOCAL ACANTHOLYTIC DYSKERATOSIS CONSISTENT WTH GROVERS DISEASE (see comment) COMMENT: Clinical correlation is essential. (I can pick apart the meaning of the comment but what the heck are they actually saying?)

Thank goodness for you all...I would never speak with friends or family about this...you're lifesavers!

bunnie

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Re: Grover's disease
« Reply #691 on: Friday August 01, 2008, 03:30:38 PM »
Hi all,
First let me apologise for another long post. There is no short simple way of explaining these processes, because these cells interact and communicate with one another by chemically induced signalling, to effect another function of the immune response. ( I don't mean enviromental chemicals, but  totally different natural cellular chemicals of the body)Add to that a dysfunction, then the explanation is complicated. To make matters worse , it is even more difficult to explain simply, if the people who are reading do not understand the names and function of each of the cells which make up the immune system. That is why it is important to learn the structure and function of the cells of the immune system first. You can if interested learn from this overview here...
http://wassail-allthatilove.blogspot.com/
http://www.niaid.nih.gov/publications/immune/the_immune_system.pdf

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i can only imagine what you do for a living!

A nurse, Lo-on-g retired! Please do not be too critical at my endeavours to explain, I am not a pathologist! I only wish to help with the understanding, because a huge part in the distress of coping with these diseases is the frustration as to why we have them in the first place. The stress of which in some cases exascerbate the situation. If you read the following slowly and carefully you will understand it. I have tried to explain everything simply.
I did send a great article summing up on all that follows to Anndrew when we were pm-ing, but my in and outbox was full, so I had to empty it and lost the bloomin' article. If you have it still Anndrew in your inbox , could you send it back please so that I have a copy?
socalmom....
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yet i do not have diabetes.
you do not have to have diabetes to have this predisposition. However if you have Grovers you most certainly do have genes which carry in their DNA the predisposition to having an adverse immune response or an allergic/hypersensitivity response, which results in the malfunction of immune cells produced within that response, and causing (in you) loss of cohesion of desmosomes and acrosyringeal dysfunction. (Grovers)
Explanation of the biopsy...
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FOCAL ACANTHOLYTIC DYSKERATOSIS CONSISTENT WTH GROVERS DISEASE

the above gives the faulty cell process by which Grovers is determined.

FOCAL
A localized area of disease
ACANTHOLYSIS (Ac -an-th-olly-sis
the loosening, separation, or disassociation (loss of cohesion)of individual prickle cells within the epithelium from their neighbor, often seen in conditions such as pemphigus vulgaris and keratosis follicularis.  (this occurs in my condition)
DYSKERATOSIS   dis-ker-a-toe-sis
abnormal, premature, or imperfect keratinization of the keratinocytes

Here is an excellent link which shows what this is....
http://www.eucerin.co.uk/skin/skincell_2.html
Note from that link....
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The epidermis consists of up to 90 percent  keratinocytes, the actual epidermal cells, that are held together by what are called desmosomes. The epidermis is differentiated into five layers:

Note the Prickle-cell layer (stratum spinosum)
It is these cells in this layer that have loss of cohesion.

As to the cause of acantholysis in Grover’s disease.....from the link  below
http://www.mayoclinicproceedings.com/inside.asp?AID=2529&UID=
Quote
Electron microscopic studies demonstrated that dissolution of desmosomal attachment plaques  is the likely cause of acantholysis in Grover’s disease.
(Note from above that the epidermal cells are held together by desmosomes. The "attachment plaques"  define the area of the desmosome and there are quite a few components to these attachment plaques, each with a specific job, and each acting as a bridge between one another. One of these components of the  desmosomal attachment plaques is the "central dense layer"  and this is the site of adhesive reaction, which forms the basis of the mechanical joining of cells by desmosomes)

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Immunohistochemical studies showed the loss of intracellular desmosomal proteins (desmoplakin I and II and intercellular desmosomal protein desmoglein)(the names of the proteins) from the desmosomes and their diffusion into the cytoplasm of the acantholytic cells. Previously, CD44 was reported to have a normal pattern on the surface of acantholytic and periblister cells, an implication that desmosomal adhesion molecules may be more important than nondesmosomal adhesion molecules in Grover’s disease.


Grover (whom the condition is named after)  reported statistically significant associations between transient (considered as being false as some are persistant) acantholytic disease and asteatotic eczema, allergic contact dermatitis, atopic dermatitis, and irritation from adhesive tape; these relationships imply that nonspecific irritation and inflammation may facilitate the development of Grover’s disease.
These are Atopic conditions. Atopy runs in families, and occurs through having mutated genes predisposing the person to ever having an abnormal immune response due to a hypersensitivity to something. that "something" depends upon the individual. The cause which triggered the hypersensitivity in one person (the pathogenic result of which in you is Grovers) may be a different in you, and from person to person. That is why it says "non-specific". Also this same hypersensitivity can result in a totally different pathogenic result (a different condition)in another person.

Note from this link my notes in blue
Quote
The predisposing conditions,(refering to the genetic predisposition) site of involvement, and relapsing nature of this disorder (all atopic and autoimmune conditions wax and wane in this way)may implicate acrosyringeal dysfunction as the cause.

The acrosyringium (the eccrine coil of the eccrine glands).......
Any of the numerous small sweat glands distributed over the body's surface that produce a clear aqueous secretion devoid of cytoplasmic constituents and important in regulating body temperature. The eccrine coil at the base of this intraepidermal gland is called the acrosyringium . (accro-syringe-ee-um) The eccrine glands are more numerous and are more generally situated over the body, unlike apocrine glands which are associated with hair.
 
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ABSTRACT
Three selected cases of transient acantholytic dermatosis were studied because of their definitive correlation with sweating due to fever and/or bed-ridden situations. Biopsy specimens were serially sectioned and acantholysis was found in the acrosyringium or traced to connect to the acrosyringium in all biopsy specimens. Carcinoembryonic antigen (CEA) and eccrine gland-specific monoclonal antibody, IKH-4, were positive in acantholytic cells. Electron microscopy revealed electron dense material filling the lumen (the hollow part of a tube) of intraepidermal eccrine ducts. This material leaked into lateral intercellular spaces of the luminal cells, passing tight junctions. Marked oedema and numerous lysosomes ( these were reminiscent of those found when eccrine acrosyringium is formed in the embryo; this suggested that an occluded and damaged eccrine intraepidermal duct was being rebuilt via lysosomal digestion.
lysosomes.....
These are organelles which are a part of all cell structure in animals/humans. They are the cells trash can!
Scroll to the bottom and read phagocytosis and autophagy
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=cooper.section.1519
 
For socalmom
See how a dust mite can cause itchiness and red welts which can be severe, especially if you suffer from atopy
http://www.cellsalive.com/mite1.htm

In understanding these processes it is then easy to understand how an abnormal immune response caused by a hypersensitivity ( in you) to some  exogenous  (not of the body) factor, can target a focal/non-focal area , resulting in Grovers (in you).
Bunnie
« Last Edit: Saturday August 16, 2008, 11:06:50 AM by bunnie »

Offline socalmom

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Re: Grover's disease
« Reply #692 on: Saturday August 02, 2008, 03:34:39 AM »
Bunnie,

Wow what a post!!!! I honestly am going to print and reread it countless times to be able to absorb as much information as possible! What an incredible asset you are to this forum!
I am leaving on vacation tomorrow and staying on the beach for a week.  (Oh joy) My goal is to not exercise (no sweating), spend time in the ocean and hopefully have the salt water will give me some relief! I will be hanging out underneath the cabana this year avoiding the sun.  Hey, I am already a candidate for skin cancer...I am quite tan from running outside as much as I do. I will just hang on to the farmer's tan I ususally get rid of on our beach vacations.
Thanks again for all of your info!

Socalmom

bunnie

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Re: Grover's disease
« Reply #693 on: Saturday August 02, 2008, 10:03:29 AM »
Hi again, I forgot to explain the rest of Hashimoto's research conclusions (the 5th quote down) I don't want to bore you with this, but remember there are others reading not just on this board, but out on the web who may want to understand, and it proves my point that just one little factor in a biopsy, represents a huge explanation, which a derm has not the time to explain.  In that quote it say's.....
Quote
Previously, CD44 was reported to have a normal pattern on the surface of acantholytic and periblister cells, an implication that desmosomal adhesion molecules may be more important than nondesmosomal adhesion molecules in Grover’s disease.
What those CD numbers mean:
CD Markers. Cluster of Differentiation (CD)
The cluster of differentiation (CD) is a protocol used for the identification and investigation of cell surface molecules present on leukocytes.(white blood cells). CD molecules can act in numerous ways, often acting as receptors or ligands (the molecule that activates a receptor) important to the cell. A signal cascade is usually initiated, altering the behavior of the cell. Some CD proteins do not play a role in cell signalling, but have other functions, such as cell adhesion. There are approximately 250 different proteins.

The CD system is commonly used as cell markers; this allows cells to be defined based on what molecules are present on their surface. These CDmarkers are often used to associate cells with certain immune functions or properties.

While using one CD molecule to define populations is uncommon (though a few examples exist), combining markers has allowed for cell types with very specific definitions within the immune system.
It is important to note that, while CD molecules are very useful in defining leukocytes, they are not merely markers on the cell surface. While only a fraction of known CD molecules have been thoroughly characterised, most of them have an important function.
In the example of CD4 & CD8, these molecules are critical in antigen recognition.  To sort out what each cell can actually do, CD molecules are utilized in cell-sorting, using various methods including flow cytometry.
Cell populations are therefore defined using a '+' or a '–' symbol to indicate whether a certain cell fraction expresses (shows or has)  or lacks a CD molecule.
For example, a "–" cell is one that expresses CD34, but not CD31. Bearing in mind that these are all leucocytes (of which there are groups and sub groups) and within each group there are other groups, but each with specific functions. These CD numbers represent a function
This particular CD combination,* CD34+, CD31-* typically corresponds to a stem cell, opposed to a fully-differentiated endotheliel cell. ....in other words each function of the cell is displayed in molecules on its surface, and each has been given a number. When seen in biopsy the technician can determine what the function/functions of the cell is (from the presence of the particular molecules on its surface, and its function number)
Types of cells, and their CD markers.
Stem Cells= CD34+, CD31-
All Leukocyte Groups =CD45+
Granulocytes = CD45+, CD15+
Monocytes  =CD45+,CD14+
T Lymphocytes= CD45+,CD3+
T Helper Cell =CD45+,CD3+,CD4+
Cytotoxic Tcell = CD45+,CD3+,CD8+
B Lymphocyte = CD45+,D19+ CD45+, CD19+ or CD45+,CD20+
Thrombocyte =CD45+,CD61+
Natural Killer cell =CD16+, CD56+, CD3-
Cell Adhesion =CD44+

Two commonly used CD molecules are CD4 and CD8, which are, in general, used as markers for helper (CD4) and cytotoxic T cells,(killer tcells) (CD8) respectively. When defining T cells, these molecules are defined in combination with CD3+. Other leukocytes also express these particular CD molecules. Some macrophages (cells which devour invaders =antigens that have been presented by dendritic cells ,and break them down) express low levels of CD4. Dendritic cells (antigen presenting cells) express high levels of CD8.

CD44 is a transmembrane glycoprotein.  CD44 is found in a wide variety of tissues including the central nervous system, lung, epidermis, liver, and pancreas, Variants of CD44 (cd44v) are expressed in tissues during development, including embryonic epithelia. ( as the research points out in the quote)
Known functions of CD44 are cellular adhesion (aggregation and migration), hyaluronate degradation, lymphocyte activation, lymph node homing, myelopoiesis and lymphopoiesis, angiogenesis, and release of cytokines. The functions of CD44 are principally dependant on cellular adhesion in one setting or another.
hyaluronate degradation -(hy-aloo-ro-nate)
Hyaluronan is also a major component of skin, (a salt or ester of hyaluronic acid), where it is involved in tissue repair. When skin is excessively exposed to UVB rays, it becomes inflamed (sunburn) and the cells in the dermis stop producing as much hyaluronan, and increase the rate of its degradation. Hyaluronan degradation products also accumulate in the skin after UV exposure. ( ?? Could it be  these accumulated Hyaluronan degradation products that are then engulfed by the lyosomes, hence the abundance of lyosomes seen in Grovers in biopsies??) While it is abundant in extracellular matrices, hyaluronan also contributes to tissue hydrodynamics, movement and proliferation of cells, and participates in a number of cell surface receptor interactions, notably those including its primary receptor, CD44.
myelopoiesis -(Mye-lo-poy-ee-sis)
The formation of bone marrow or of blood cells derived from bone marrow
lymphopoiesis,- (Lympho-Poy- ee-sis)
The formation of lymphocytes
angiogenesis
The process of developing new blood vessels.
Cytokine- see the definition of cytokine here....
http://www.answers.com/topic/cytokine
Cytokines are Chemical Messengers, a diverse and potent group of proteins and peptides that are signalling compounds, produced by immune cells to communicate with one another. They act via cell-surface cytokine receptors, and are the chief communication signals of T cells.Clever they are!
So you can see how very complex just one specific immune response is! (regarding Grovers in this case) and this is just a teeny fraction of it. However when you read what these cells do, and the presence of some of them seen in your biopsy, and what their function is, it all makes sense.
Bunnie
« Last Edit: Wednesday August 06, 2008, 09:32:22 AM by bunnie »

Offline Dondi

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Re: Grover's disease
« Reply #694 on: Saturday August 02, 2008, 07:23:26 PM »
Bunnie      Like SoCal   I will haveto reread this over and over.  My brain is not that scientific.  Somewhat I think I get what your saying as that one thing can trigger another as a response to a immune  response,or stress?  I think I phrased that halfway  right.  I know that  the word focal was used on my  hubbys biopsy,  they said multiple levels were examined and do not reveal evidence of focal acantholytic dyskeratosis, however, Grocer's disease cannot be excluded.    Where mine says Grover's disease (transient acantholytic dermatosis) and goes on to say spongiosis, acantholysis, dyskeratosis and a suprerficial perivascular mixed inflammatory cell infilitrate.  I did see a dermatologist not a GP, I saw a allergist immunologist to check and make sure something else wasnt causing it or adding to it such as food allergies etc.  I was desperate.  And on bloodwork  I had a slight increase in eosinophils and autoesinophils ( hope I spelled that correctly).  Allergist said I didnt test positive for something in the IG's you mentioned and I imagine it had to do with food allergies as I was thinking that maybe there was something there.  I did test positive though for TPO ab when my thyroid was rechecked, not overwhelmingly, but its my understanding that positive for antibodies is just that positive.  I do understand that basically grovers seems to be a disease where the skin does not seperate properly, and I guess thats the real short version  LOL.  I see you have medical  background so therefore you are much more aware and as SoCal said an asset here.    And SoCal  have a great vacation, and my hubby said the same thing about salt water. He  wanted to go to the beach and soak and see if it helped.  Im real fair and break out in a rash from the sun after a short time now ( didnt use to)  I think a lot of it may be meds I take.  Let me know though if it helps you, I can always get a big umbrella,  or just get sea salt for the tub.  That sounds so sad.   I havent been to the gym in months due to this and when I go out and its humid I start itching, so I am living in my a/c this summer.    Anyway thanks for the input. 
Lets just take it one day at a time!

bunnie

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Re: Grover's disease
« Reply #695 on: Saturday August 02, 2008, 09:12:16 PM »
Hi Dondi, that is the best way to understand it, read it over so that it becomes more understandable.
However, in this last post I was just explaining what CD44 is. Such a little thing with a great big explanation, and if you want people to understand, you can't abbreviate it. Another reason for the detailed explanation is to offer you an explanation of the medical evidence that is known concerning Grovers.
The  previous post is showing what a CD44 marker is, and its presence in biopsies shows that it is there because it is a cell involved in holding the proteins which make up the prickle cell layer  of the epidermis together. Ancantholysis is the seperating of these cells and the loss of the cohesion molecules in this condition. (and some others like my own.)
Quote
that one thing can trigger another as a response to a immune  response,or stress?
No I'm afraid that isn't right Dondi. Severe stress can exascerbate an already existing condition.
When the skin is damaged, or when invaders manage to enter the body, cells are destroyed, and the dying cells trigger an immune response to the invasion, which is inflammation. The inflammation also causes blood vessels to dilate, increasing the blood flow.
Inflammation is the body's alarm bell. Once it goes off, it draws defensive cells to the damaged area in great numbers. Increased blood flow helps defensive cells reach the place where they're needed quickly, and it also accounts for the redness and swelling which ensues. This helps isolate the foreign substance from further contact with body tissues.
These barriers form the body's first line of defense. The next line of defense involves white blood cells that travel through the bloodstream and into tissues, searching for, and attacking micro-organisms and other invaders.

The cells which make up the immune system (body's defence system) each have a specific job to do. In order to do that job they each need a signal from another specific cell in order to be activated. I am explaining that at the simplest level, there is much more to it as each cell has a different function. That is what I was refering to in saying each cell acts upon another to make the defence response efficient. If the body is invaded by a virus or whatever, it is met first by the complement system. These cells act quickly and are deadly. They mark the invaders to pin point them for destruction, and quickly activate other cells to finish off the job.  If you carry a genetic predisposition to having a hypersensitivity to something, Be it an "out of the body" factor (exogenous)  or something of *self* like hormones, and other gland/cell secretions, (endogenous) then if you come into contact with this factor, in a specific combination of (multigenous factors/factors not of the body, and factors of the body), then because you carry the predisposition it can trigger  this hypersensitivity, and  then an adverse immune response will occur, and within that response, the resulting malfunctioning cells of the immune system will target certain proteins in certain areas of skin, or organs or blood etc. the result of which is the disease which you have.
That link I left to my blog explains it really simply. You may not understand it all but you will certainly get the "gist" of it, and most you will understand anyway.
With regard to your biopsy, I explained Acantholysis dyskeratosis previously in the first post. However, Spongiosis, means oedema  between (intercellular) the cells (Keratinocytes) of the epidermis. (caused by the loss of cohesion molecules,(Desmosomes) which produces acantholysis (seperating of the proteins in the epidermis) The resulting spaces inbetween the cells fill with an abnormal accumulation of fluid in the tissues , causing swelling.
Superficial Perivascular mixed inflammatory cell infilitrate, is when inflammatory cells are clustered around blood vessels. Usually if it says superficial, then the blood vessels of the dermis are not involved. Obviously in superficial and deep , all are affected. I presume by the use of the word "mixed" it is refering to mixed inflammatory cells, such as neutrophils and eosinophils basophils, and mast cells , all of which contribute to inflammation. (see my blog to learn what these are and their function.) I have not heard of autoeosinophils before to be honest. Do you think Dondi he may have said "autoantibody IgE" instead? Unless they have been produced within an autoimmune response, which would explain that, however I understand the jury is still out as to whether or not Grovers is in fact an autoimmune disease. After reading every post on here it seems that it possibly is! I can see symptoms typical of autoimmunity in every post.
Eosinophils, Basophils. and Mast cells are Granulocytes, granule-containing cells in tissue.
Eosinophils are so named because their cytoplasmic granules stain red with the dye eosin. (You know Like the stuff you can put on wounds) They are also known as eosinophilic leukocytes.
Eosinophil granulocytes, usually called eosinophils (or, less commonly, acidophils), are white blood cells of the immune system that are responsible for combating infection and parasites . They also control mechanisms associated with allergy and asthma. They are granulocytes that develop in the bone marrow before migrating into blood.
Within their cellular cytoplasm are a diverse collection of chemical mediators, such as histamine, and proteins such as eosinophil peroxidase, RNase, DNases, lipase, plasminogen, and Major Basic Protein.These mediators are released by a process called degranulation, following activation of the eosinophil, and are toxic to both parasite and host tissues.
They are found in the medulla and the junction between the cortex and medulla of the thymus and, in the lower gastrointestinal tract, ovary, uterus, and spleen, and lymph nodes, but not in the lung, skin or oesophagus, or some other internal organs under normal conditions. The presence of eosinophils in these latter organs is associated with disease. Eosinophils persist in the circulation for 8-12 hours, and can survive in tissue for an additional 8-12 days in the absence of stimulation.
See where I have altered your quote below...
Quote
I do understand that basically grovers seems to be a disease where the skin cells do seperate
and of course they shouldn't. Sorry Dondi, :hugs:
Atopy
Quote
Atopy is an inherited predisposition  which causes a tendency to suffer from one or more of the following “atopic diseases” such as: allergic asthma, allergic rhino-conjunctivitis and atopic dermatitis. The diagnosis of “atopy” is not based on one single distinctive clinical feature or laboratory test, but rather results from a combination of patient and family history and clinical findings.
Grovers stems from....
a genetic predisposition in your DNA, predisposing you to atopy,
which if stimulated, results in an abnormal immune response,
the pathogenic result of which in you,
causes the cells, (desmosomes)
which hold together the cells of the epidermis, known as (keratinocytes)
to come apart,( Acantholysis)
filling with fluid, and causing oedema in the tissue.(Spongiosis)
there is abnormal, premature, or imperfect keratinization of the keratinocytes (dyskeratosis),
and it also affects some cases by targeting the acrosyringium of the eccrine coil in sweat glands, and causing acantholysis and acrosyringium dysfunction. (a dysfunctioning sweat gland )

I hope this helps your understanding Dondi.
Bunnie


« Last Edit: Wednesday August 06, 2008, 09:49:51 AM by bunnie »

bunnie

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Re: Grover's disease
« Reply #696 on: Sunday August 03, 2008, 12:15:21 PM »
For socal, Hi! I didn't explain what Clinical Correlation meant in your biopsy report.
When interpreting a biopsy, or an  imaging study (xray, CT, ultrasound, or MRI, among others), sometimes a particular finding can mean different things in different clinical situations. When a lab technician  or radiologist comes across a finding which may mean multiple things, they say "please correlate with clinical findings" or "clinical correlation requested" or "essential"  to indicate that the finding may mean several things,  in different circumstances.
This again proves the point , because acantholysis, dyskeratosis, and spongiosis, are often found together in many other conditions, especially Bullous (blistering )conditions like my own, and indeed it does say in the literature, that findings in Grovers are representative of other conditions, in particular pemphigus vulgaris a bullous  disease, that falls in the category of my own condition. These processes can also appear seperately in some other conditions.   
So that completes the explanation of your biopsy!
The reason biopsies and blood are taken with skin diseases is because a full blood spec is the physicians main diagnostic tool It is like a map of what is going on in your body. Anything that is naturally and should be there, showing the specific levels of essential nutrients, everything, or shouldn't be there, will show up in your blood spec.
Again a biopsy shows exactly what is going on in the skin. Usually two biopsies are taken, one from skin with lesions and one from skin that is normal (or has none.) Anything affecting the skin will be in that biopsy. Now through special blood testing alone they can confirm if a person has the condition affecting the much deeper layers of the skin in the dermis. I have had this done. As yet this technique is only available in Japan as far as I know, and normally blood samples are sent there, however my derm knew how to do it and he and the lab techs did the set up, and we got the result. My derm said many many hours were taken up, to just do the set up, and again to do the actual testing, nealy 3 weeks he told me before they could even start.
Bunnie

Offline Dondi

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Re: Grover's disease
« Reply #697 on: Sunday August 03, 2008, 06:04:14 PM »
Hi Bunnie   Thank you for the explanation.  I do understand it better but I doubt I could repeat, to explain to someone else yet.  LOL!    :)  I looked at the bloodwork sheet to check, it says Auto EOS#  0.8  High ( ref range) 0.0-0.5 )  And there is Auto next to Neut#  LYMP MONO  BASO and then a another list of the same without AUTO before it  on the eosinophils it has 7.4 high  (ref range-0.0-0.7 )  The Dermatologist just said it showed a slight increase, and that seems to be what it is slight.  I do have to say, in your final few sentences, it made me think  and Im not sure if I a completely incorrect in this.  But Prior to my thyroid issue becoming out of hand I was a heavy sweater, I apparently was sub clinical for a while , but for whatever reason my thyroid levels suddenly tripled in a months time so I guess something had been going on internally, not that it doesnt in some many others, it is so common.  But I had noticed over the months before my skin drying  the fact that I was not really perspiring as much.  When I went to he gym I would sweat but not like before, and my skin would get goose bumpy.  I was getting strange blisters and they were on the base of my back that were fluid filled and it was itchy.  I couldnt see them and of course I scratched and that is when I realized they had fluid .  I just didnt think much of it even when it happened again. But then it happened on my hand and wrist and I actually had one on my inner lip and sides of my mouth.  But they disappeared so quick I wasnt able to show the dermatologist, and he said you should have come in.  Unfortunately it wasnt on days he was in his office, and they then they are gone and just a brownish red mark is left.  But to get back to the sweating question I had cause I am getting off track,  Would the sudden lack of sweating from the thyroid problem and the antibodies bring this out?   I also had a 3 stents put in my heart 2 drug eluting brought me to 5 stents.  I had a infection in the radial site they used for the angioplasty and had to have minor surgery to open the site and clean it out, on strong antibiotics, then had a major ear infection that took  over a month to clear up and again antibiotic drops and strong antibiotics pills.  Started to feel really bad and gained 25 pounds, just felt wicked, could barely move myself.  And then  a lot of stress around the holidays and then  there I am scratching and scratching.  To make it more confusing, I have heard of some people being allergic to some of the drug eluting stents due to polymer being used to coat them, and I have read of people a year later starting to itch, breaking out in hives.   If I am scratching itchy little hives just come out.  Im not sure if this a reaction to my scratching the initial itch or if it is hives coming out and thats why Im itching so intensely.    Sorry for the long winded post and I hope I made sense and didnt go off track to much.
Lets just take it one day at a time!

Offline Dondi

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Re: Grover's disease
« Reply #698 on: Sunday August 03, 2008, 06:22:53 PM »
Bunnie     Just started reading your blog.  WOW! 
Lets just take it one day at a time!

bunnie

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Re: Grover's disease
« Reply #699 on: Sunday August 03, 2008, 07:28:37 PM »
Hi Dondi, I cannot say for certain what is going on in you because you have had such a lot going on, you poor thing!
All I can say is I think....  see in blue
Quote
there is Auto (this could be autoantibody, but whether it is associated with the Grovers, ie an autoimmune response resulted in Grovers, or whether because you have already an autoimmune condition ie: the diabetes, or it is the antibodies in the thyroid test, I honestly don't know) next to Neut#  (neutrophils)   LYMP (Lymphocytes) MONO (monocytes) BASO (basophils)and then a another list of the same without AUTO before it  on the eosinophils it has 7.4 high  (ref range-0.0-0.7 )
 If there is a list with auto in front as you say, then "auto" is Greek for *self.*    Do you think yourself that the appearance of your condition is like grovers? I honestly can't say about the sweating Dondi, I really don't know. However, people who suffer from autoimmunity generally suffer from Atopy too, which makes you hypersensitive to many different things. Any hypersensitivity to (anything really) could have triggered this off in you, especially as you already have diabetes, and thyroid problems. The result of a specific response to something non-specific has resulted in Grovers in you. That is what it means by idiopathic. It is a specific combination of genetic predisposition, non-self factors, and/or self factors, but specifically, exactly what the non-self and or self factor is, that the response was mounted against, is unknown.=idiopathic.
The reason why you itch.....
The itch is a symptom of your disease. Basically, there are two types of itch, sensory, and allergic.  A sensory itch differs from an allergic itch, because there is no external rash and no irritation at the itch site. It is still in research but it is known that an "itch" can only come from superficial layers of skin (the Epidermis) mucous membranes and conjunctiva.  The  bundles of nerves in these tissue types are the only ones which carry itch signals. They are pain receptors which are either uninsulated or lightly insulated, called nocioceptors. It is thought that scratching is one of the best ways to excite these uninsulated pain receptors, and the signal that  scratching sends to these pain neurons temporarily overwhelms or covers up the itch sensation. Of course one also stimulates the inflammation so it becomes like an ever increasing circle.
To be absolutely honest Dondi , if it were me, I would go to a derm who specialises with autoimmune bullous (blistering )diseases, and get a second opinion. You are perfectly right to do so, nearly everyone gets a second opinion with these conditions.
Quote
I just didnt think much of it even when it happened again. But then it happened on my hand and wrist and I actually had one on my inner lip and sides of my mouth.
That quote is my reason for suggesting that.
 Bunnie
« Last Edit: Sunday August 03, 2008, 09:32:44 PM by bunnie »