What is your approach to managing Grover's Disease (Transient Acantholytic Dermatosis) that has failed topical steroids?

I'm a big fan of low-dose naltrexone for Grover's Disease (and Hailey-Hailey and Darier's Disease). It's a safe and effective treatment that I've seen work very well. The dose ranges between 1-5mg daily. It seems like 3mg is often the sweet spot. Patients sometimes report more trouble sleeping and/or vivid dreams for the first 1-2 weeks. Most people enjoy it, but it can be a problem for some. Adding a little melatonin (1-5mg) an hour before bed can help. The best way to get low-dose naltrexone is from a compounding pharmacy. There is a publication that discusses prescribing ten 50mg tablets and crushing it into 500mL of orange juice to make 1mg/mL. This makes it more affordable since the 50mg tablet will likely be covered by insurance. When...

Oral minocycline or doxycycline can help along with topical calcipotriene. Nb-UVB can also work for grovers if patients have access to treatment.

IM Kenalog q 3-4 months.

For resistant persistent cases, Dupilumab has been effective and pretty safe.