Cutis verticis gyrata
What is cutis verticis gyrata?
Cutis verticis gyrata (CVG) describes a scalp condition with convoluted folds and deep furrows that resemble the surface of the brain.
CVG is a progressive condition. It is mainly troublesome due to the cosmetic appearance. Rarely, it can be complicated by malignant melanoma developing within a melanocytic nevus.
CVG occurs more commonly in males. The primary form of CVG has a reported male-to-female ratio of 5:1. The incidence of CVG may be reported as lower in women because longer hair may camouflage the condition.
Most primary cases develop after puberty and typically occur before age 30. Some secondary forms of CVG, like cerebriform intradermal nevus, can be present at birth.
What does it look like?
CVG typically affects the central and back of the scalp, but some forms can involve the entire scalp. The folds are typically soft and spongy. The folds are unable to be corrected with pressure. The skin color is not affected. The number of folds can vary from 2 to more than 10.
CVG is classified according to the underlying cause as primary essential, primary non essential and secondary.
Primary means the cause of the condition in unknown. Primary essential CVG has no other associated abnormalities. Primary nonessential CVG can be associated with neuropsychiatric disorders including cerebral palsy, epilepsy, seizures and ophthalmologic abnormalities, most commonly cataracts.
Secondary CVG occurs as a consequence of a number of diseases that produce changes in scalp structure. These conditions include:
- Acromegaly (excessive growth hormone, due to pituitary gland tumour)
- Melanocytic naevi (moles)
- Birthmarks, including Connective tissue naevi, fibromas and naevus lipomatosus
- Inflammatory processes (e.g., eczema, psoriasis, Darier disease, folliculitis, impetigo, atopic dermatitis, acne).
The management of CVG includes good scalp hygiene to avoid accumulations of secretions in the furrows of the scalp. Definitive treatment by surgery may be requested for appearance reasons. Small localised lesions can be excised in one procedure. Larger lesions can be removed with serial excision, requiring multiple procedures.