Cutis verticis gyrata

What is cutis verticis gyrata?

Cutis verticis gyrata describes a scalp condition with convoluted folds and deep furrows that resemble the surface of the brain.

Cutis verticis gyrata 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 naevus.

Cutis verticis gyrata occurs more commonly in males. The primary form of cutis verticis gyrata has a reported male-to-female ratio of 5:1. The incidence of cutis verticis gyrata 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 cutis verticis gyrata, like cerebriform intradermal nevus, can be present at birth.

What does cutis verticis gyrata look like?

Cutis verticis gyrata 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 colour is not affected. The number of folds can vary from 2 to more than 10.

Cutis verticis gyrata

Cutis verticis gyrata

Courtesy Dr Mohammad Mahmoud

Classification of cutis verticis gyrata

Cutis verticis gyrata is classified according to the underlying cause as primary essential, primary nonessential and secondary.

Primary means the cause of the condition is unknown. Primary essential cutis verticis gyrata has no other associated abnormalities. Primary nonessential cutis verticis gyrata can be associated with neuropsychiatric disorders including cerebral palsy, epilepsy, seizures and ophthalmologic abnormalities, most commonly cataracts.

Secondary cutis verticis gyrata 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 (eczema, psoriasis, Darier disease, folliculitis, impetigo, atopic dermatitis, acne).

Treatment of cutis verticis gyrata

The management of cutis verticis gyrata 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.