Grover's disease affects the epidermis, the outermost layer of skin.There are four distinct patterns to epidermal involvement, some of which are alike in appearance to other skin diseases. The most common pattern looks similar to pemphigus vulgaris, which has distinct tombstone-like shapes under a microscope. A Darier-like pattern affects various levels of the epidermis, while the Hailey-Hailey pattern appears in all epidermal layers. Finally, a spongiotic-like pattern involves epidermal swelling.

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