Cutis Verticis Gyrata

Cutis verticis gyrata is a rare skin condition of the scalp where the skin becomes thick and forms deep folds and grooves that look like the surface of the brain. The folds usually appear on the top and back of the head and they do not go flat when you press them with your fingers.

Cutis verticis gyrata (CVG) is a rare scalp condition where the skin on the head becomes thick and forms deep folds and furrows that look like the surface of the brain. These folds usually appear on the top and back of the scalp and cannot be flattened by pressing with the fingers. CVG can be primary (no clear cause, sometimes linked with learning or eye problems) or secondary to other diseases such as acromegaly, myxedema, pachydermoperiostosis, or inflammatory scalp diseases like psoriasis and eczema.

In most people this condition grows slowly over many years. It is often harmless by itself, but it can sometimes be linked with other problems such as hormone diseases, brain or eye problems, or inherited (genetic) syndromes. Many patients are men, and the folds often start appearing after puberty and before the age of 30 years.

Other names

Doctors use several different names for cutis verticis gyrata. It may also be called “CVG,” “bulldog scalp,” “cutis verticis plicata,” “pachydermia verticis gyrata,” and sometimes “Robert–Unna syndrome” in older books. All these names describe the same main idea: thick, folded scalp skin that looks like brain folds.

Types of cutis verticis gyrata

There are three main types of cutis verticis gyrata. The type tells us whether there is another disease linked with the scalp folds or not.

1. Primary essential cutis verticis gyrata – In this type, the person has scalp folds but no other health problems that doctors can find. The cause is unknown, so it is called “primary” and “essential,” meaning it happens by itself. It is more common in men and often starts around or after puberty.

2. Primary non-essential cutis verticis gyrata – In this type, the scalp folds occur together with other problems, especially brain and eye problems. People may have intellectual disability, seizures, cerebral palsy, or eye diseases such as cataracts, strabismus (crossed eyes), or retinal problems. The folds still grow without pain, but the other conditions need separate care.

3. Secondary cutis verticis gyrata – In this type, another disease or drug clearly changes the scalp and directly causes the thick folds. Examples include acromegaly (too much growth hormone), some birthmarks and moles, inflammatory skin diseases like psoriasis or eczema, and some tumors or genetic syndromes. Treating the main disease may sometimes improve the scalp changes.

Causes

In many people with cutis verticis gyrata, the exact cause is not known, especially in the primary essential type. In others, the condition is clearly linked with another disorder. Below are 20 important causes or associated conditions, explained in simple language.

1. Unknown genetic and developmental factors (primary essential CVG)
   In primary essential CVG, no clear disease, drug, or hormone problem can be found. Doctors think that changes in the way the skin and tissues of the scalp grow, possibly influenced by genes and puberty-related hormones, lead to gradual thickening and folding of the scalp skin.

2. Neurodevelopmental and intellectual disability disorders
   In primary non-essential CVG, many patients have learning disability or intellectual disability. Their brain development is affected, and CVG appears as part of a broader “neurocutaneous” (brain and skin) picture, sometimes called CVG-intellectual disability syndrome.

3. Epilepsy and seizure disorders
   Some people with CVG have epilepsy or repeated seizures. The folds themselves do not cause seizures, but both may come from the same underlying brain problem or genetic condition.

4. Cerebral palsy and other neurological conditions
   CVG can be seen in patients with cerebral palsy and similar long-standing brain movement disorders. Here again, the scalp changes are part of a wider neurological syndrome rather than an isolated skin disease.

5. Ophthalmologic (eye) diseases
   In primary non-essential CVG, eye problems such as cataracts, strabismus, optic atrophy, or retinitis pigmentosa may be present. The same underlying developmental or genetic problem can affect both the eyes and the scalp.

6. Acromegaly (excess growth hormone)
   Acromegaly is a hormone disease caused by too much growth hormone, usually from a pituitary tumor. The skin and soft tissue grow too much, especially on the face and hands, and this can lead to thick, folded scalp skin typical of CVG as a secondary change.

7. Pachydermoperiostosis (primary hypertrophic osteoarthropathy)
   Pachydermoperiostosis is a rare disease with thickened skin of the face and scalp, clubbing of fingers, and bone changes. The scalp thickening can produce CVG-like folds, so CVG may be one of the skin signs in this syndrome.

8. Cerebriform intradermal naevus (CIN)
   A cerebriform intradermal naevus is a deep birthmark or mole in the scalp that becomes thick and folded like the brain surface. It is a localized lesion but can look exactly like CVG and is often listed as a secondary cause of CVG-type folds.

9. Melanocytic naevi and connective tissue naevi
   Some people have large moles or connective tissue birthmarks, such as fibromas or naevus lipomatosus, that spread over the scalp. As these lesions grow and thicken, they can create permanent ridges and shallow or deep grooves that mimic or cause CVG.

10. Inflammatory scalp diseases (eczema, psoriasis, folliculitis, impetigo, acne, Darier disease, atopic dermatitis)
    Long-lasting inflammation of the scalp skin can cause swelling, scarring, and thickening. Over time, repeatedly inflamed areas may heal with irregular folds and furrows that resemble CVG, and this pattern is considered a secondary form.

11. Infectious scalp diseases
    Infections such as folliculitis, impetigo, erysipelas, or syphilis that repeatedly damage the scalp skin and hair follicles can also lead to abnormal thickening and folding, especially if scarring or chronic inflammation remains for many years.

12. Endocrine and metabolic disorders other than acromegaly
    Some reports suggest that other hormone and metabolic disorders can be associated with secondary CVG, such as thyroid problems or insulin-related states, possibly by altering soft tissue growth and fluid balance in the scalp.

13. Internal malignancies and paraneoplastic syndromes
    In rare cases, CVG appears together with internal cancers such as leukemia or other tumors. The skin changes may be part of a paraneoplastic syndrome, where the tumor triggers abnormal immune or growth factor signals that affect the scalp.

14. Genetic syndromes (e.g., Turner, Klinefelter, Noonan, fragile X, tuberous sclerosis, Ehlers–Danlos, Michelin-tire baby, Beare–Stevenson)
    Several inherited syndromes include CVG or brain-like skin folds as one of many signs. In these conditions, changes in connective tissue, skull shape, or skin structure from gene mutations can lead to scalp thickening and folding.

15. Neurofibromatosis and other scalp tumors
    Benign or malignant tumors in the scalp, such as neurofibromas, cylindromas, lymphangiomas, or other growths, can raise the skin and form ridges. When multiple tumors or large plaques are present, they may give a CVG-like cerebriform pattern.

16. Pituitary tumors (beyond acromegaly)
    Some pituitary tumors cause hormonal imbalances or fluid retention that may indirectly lead to scalp soft-tissue overgrowth. CVG can sometimes be one of several skin findings that prompt doctors to look for a pituitary lesion.

17. Obesity and general soft-tissue overgrowth
    Case series note that some patients with CVG are obese or have generalized thickening of soft tissues. Extra fat and connective tissue in the scalp may make folds more likely, especially when combined with other factors such as genetics or hormones.

18. Long-term use of growth-promoting drugs (e.g., androgens, testosterone, minoxidil)
    Some reports link CVG to prolonged use of anabolic hormones, testosterone, or strong hair-growth stimulants such as minoxidil, which may thicken the scalp soft tissues or change hair follicles over time.

19. Chronic scalp oedema or lipedematous scalp
    Disorders where the scalp becomes boggy and swollen, such as lipedematous scalp or lipedematous alopecia, may share a pathway with CVG. Long-standing fluid and fat build-up can increase skin thickness and lead to folds.

20. Trauma, surgery, or scarring of the scalp
    Old scars from injury, surgery, burns, or tight hairstyles can distort the scalp skin. If scarring is broad or irregular, the healing tissue may contract unevenly and create permanent ridges and grooves that look similar to CVG.

Symptoms

Not every person with cutis verticis gyrata has symptoms. Many people only notice the change in appearance. Others have discomfort or problems with scalp care.

1. Visible folds and grooves on the scalp
   The most important sign is the presence of raised ridges and deep furrows on the scalp, especially on the top (vertex) and back (occipital) parts of the head. These folds run in lines and make the scalp look like the surface of the brain.

2. Folds that do not flatten with pressure
   When a doctor presses on the ridges with the fingers, they do not disappear or flatten. This helps to tell CVG apart from simple swelling or fluid in the scalp, which usually changes with pressure.

3. Soft or spongy feeling of the scalp
   The skin between and over the folds often feels thick, soft, or spongy when touched. This texture change comes from extra skin and tissue under the surface.

4. Slow, progressive changes over years
   In most patients the folds appear slowly and become deeper over a long time. Because the change is gradual, early stages may go unnoticed by the patient and family.

5. Asymptomatic (no pain) in many cases
   Many people with CVG have no pain or serious discomfort. They may feel embarrassed by the appearance but physically the scalp may feel normal to them.

6. Itching (pruritus) of the folds
   Some patients complain of itching in the grooves. Sweat, oil, and tiny flakes of skin can collect inside the furrows, which can irritate the skin and make it itchy.

7. Burning, tenderness, or mild pain
   A burning feeling, mild pain, or tenderness can occur, especially when the scalp is inflamed, infected, or when pressure is put on tight folds, for example during sleep or when wearing hats.

8. Bad odour from the scalp
   Because it is hard to wash and dry deep grooves completely, sweat and debris can build up and lead to a musty or bad smell. This is especially noted in secondary CVG from cerebriform intradermal naevi and long-standing folds.

9. Recurrent infections in the folds
   Bacteria or yeast can grow in the warm, moist spaces between folds. This may cause redness, oozing, crusts, or recurrent superficial infections if the scalp is not cleaned well.

10. Hair thinning or patchy hair loss over the ridges
    Hair on the top of the folds may become thinner or fall out over time, while hair in the grooves can stay normal. This gives a pattern of patchy hair loss combined with thick furrows.

11. Feeling of a heavy scalp
    Some patients say their head feels heavy because of the extra skin and tissue. This sensation can make them feel uncomfortable, especially when standing or moving for long periods.

12. Headaches
    A few case reports mention headaches in people with CVG, possibly from stretched scalp tissues, tension in neck muscles, or associated brain disorders such as epilepsy or hydrocephalus in syndromic cases.

13. Cosmetic distress and low self-esteem
    The unusual look of the scalp can cause embarrassment, social anxiety, or low self-confidence, especially in teenagers and young adults. Patients may avoid certain hairstyles or social situations because they fear others will stare.

14. Neurological symptoms from associated diseases
    In non-essential and secondary CVG, patients may have seizures, movement problems, or developmental delay due to the linked brain disorder. These symptoms are not caused by the scalp itself but by the underlying condition.

15. Eye symptoms from associated diseases
    Some patients notice blurred vision, double vision, or reduced sight related to cataracts, retinal disease, or optic nerve damage that accompany certain forms of CVG. Again, these are due to the associated eye disease, not the folds alone.

Diagnostic tests

The diagnosis of cutis verticis gyrata is mainly clinical, meaning it is based on how the scalp looks and feels. Extra tests are done to find out whether the CVG is primary or secondary, and to search for any linked brain, eye, hormone, or tumor problem. Below are 20 useful tests, with the type in brackets.

1. Detailed scalp inspection (Physical exam)
   The doctor carefully looks at the scalp, counts the number of folds, notes where they are, and checks whether they run front-to-back or side-to-side. This simple visual exam is the key first step and often enough to recognize CVG.

2. Palpation and pressure test on the folds (Physical exam/manual)
   The scalp is gently pressed and moved with the fingers to feel thickness, softness, and whether the folds can be flattened. In CVG, the folds stay in place and do not disappear, which helps distinguish it from swelling or fluid collections.

3. Full skin examination (Physical exam)
   The doctor examines the rest of the skin to look for moles, birthmarks, psoriasis, eczema, or other lesions that might explain a secondary CVG pattern or point to a genetic syndrome with skin signs.

4. Neurological examination (Physical exam)
   A neurological exam checks muscle strength, reflexes, balance, tone, coordination, and signs of seizures or movement disorders. Abnormal findings may suggest primary non-essential CVG or a secondary neurocutaneous syndrome.

5. Ophthalmologic screening in clinic (Manual / bedside)
   Simple bedside tests such as visual acuity, eye movements, and pupil responses help detect cataracts, strabismus, or retinal problems that may be linked with primary non-essential CVG or genetic syndromes.

6. Endocrine physical signs assessment (Physical exam)
   The clinician looks for signs of hormone diseases, such as enlarged hands, feet, and jaw, oily skin, or coarsened facial features that could suggest acromegaly, or other endocrine disorders associated with secondary CVG.

7. Musculoskeletal examination for pachydermoperiostosis (Physical exam)
   Joints, fingers, and long bones are examined for clubbing, thickened periosteum (bone lining), or joint pain, which can suggest pachydermoperiostosis as a cause of the scalp folds.

8. Scalp hygiene and odour assessment (Manual / bedside)
   The doctor inspects the grooves for debris, inflammation, and smell. This simple bedside check helps identify secondary infection or poor hygiene that may need treatment and also supports the diagnosis of long-standing folds.

9. Complete blood count (CBC) and basic blood tests (Lab/pathology)
   A CBC and basic chemistry panel help screen for infection, inflammation, anemia, or blood cancers. Although these tests do not diagnose CVG, they may reveal internal diseases linked with secondary CVG, such as leukemia or chronic infection.

10. Hormone tests (GH, IGF-1, thyroid, cortisol, sex hormones) (Lab)
    Blood hormone levels are checked when doctors suspect an endocrine cause such as acromegaly or other pituitary or thyroid disorders. High growth hormone or IGF-1 levels, for example, support a diagnosis of acromegaly-related CVG.

11. Metabolic and glucose tests (Lab)
    Tests such as fasting glucose, lipids, and insulin may be ordered because insulin-related states and metabolic syndrome can coexist with acromegaly or pseudo-acromegaly, which themselves may be associated with CVG-like skin changes.

12. Autoimmune and connective-tissue tests (Lab)
    When a connective-tissue disease or autoimmune condition is suspected, tests such as ANA or specific antibodies may be requested. Positive results can point to a systemic syndrome where CVG is one of several features.

13. Genetic testing for syndromic cases (Lab/genetic)
    If a patient has many birth defects, facial differences, or a strong family pattern, genetic testing (for example, of FGFR2 or other genes) may be done to look for rare syndromes like Beare–Stevenson or other craniofacial conditions that include skin folds.

14. Skin biopsy of the scalp (Pathology)
    A small piece of scalp skin can be taken under local anesthesia and examined under a microscope. Biopsy can show thickened dermis, increased connective tissue, or features of a specific cause, such as naevus, psoriasis, or amyloid, helping separate primary from secondary CVG.

15. Electroencephalogram (EEG) (Electrodiagnostic)
    If seizures or unusual spells are reported, an EEG can check the brain’s electrical activity. Abnormal findings support an associated epilepsy or neurodevelopmental disorder in patients with CVG and help guide treatment for the brain problem.

16. Nerve conduction studies and EMG (Electrodiagnostic)
    In patients with suspected neuropathy, muscle weakness, or syndromes that affect nerves and muscles, nerve conduction tests and electromyography can help define the neurogenic component of a broader syndrome that also includes CVG.

17. Ultrasound of the scalp and soft tissues (Imaging)
    Ultrasound can show how thick the skin and fat layers are, help locate masses or cysts, and distinguish solid from fluid-filled lesions. It is a non-invasive way to support the diagnosis and look for localized lesions like cerebriform intradermal naevi.

18. Magnetic resonance imaging (MRI) of brain and scalp (Imaging)
    MRI can examine both the scalp and the brain. It may show thickening of skin and subcutaneous tissue, pituitary tumors, or other brain abnormalities linked with acromegaly, epilepsy, or genetic syndromes associated with CVG.

19. Computed tomography (CT) of head and skull (Imaging)
    CT scans can assess bone changes, such as thickened skull bones in acromegaly or pachydermoperiostosis, and help plan surgery if scalp reduction or removal of large lesions is considered for cosmetic reasons.

20. Ophthalmologic imaging and visual field tests (Imaging / functional)
    For patients with eye complaints, eye doctors may use retinal imaging, optical coherence tomography, or visual field tests. These studies detect cataracts, retinal disease, or optic nerve damage that can be part of the same syndrome as CVG in non-essential or secondary cases.

Non-pharmacological treatments (therapies and other measures)

1. Scalp hygiene and gentle cleansing
   Keeping the scalp very clean is the first and most important treatment for CVG. The deep grooves in the scalp can trap sweat, oil, dead skin, and dirt, which can lead to bad smell, itching, and infection. Patients are advised to wash the scalp regularly with a mild shampoo, gently massaging into all the folds and rinsing carefully. Using lukewarm water and avoiding harsh scrubbing helps protect the skin barrier. Good hygiene does not remove the folds, but it reduces discomfort and complications and makes the scalp easier to examine during follow-up visits.

2. Careful hair trimming or short hairstyles
   Many people with CVG find it easier to care for their scalp if they keep the hair short or choose haircuts that expose the grooves. Short hair allows better access for cleaning and makes it easier to dry the folds completely, which reduces moisture and infection risk. It also helps doctors see any new lesions, moles, or color changes that may appear on the scalp over time. For some patients, an adapted hairstyle can also improve cosmetic appearance and self-confidence, especially while they are deciding whether to have surgery.

3. Topical keratolytic and emollient skin care (non-drug cosmetic products)
   Non-prescription scalp lotions, such as urea-based moisturizers or mild keratolytic cosmetic products, can soften thick skin and scale on the scalp folds. These products work by breaking down the bonds between dead skin cells and by attracting water into the outer layer of the skin, so the surface becomes smoother and less scaly. When used under medical guidance, they may make the grooves easier to clean and slightly improve the feel of the scalp, although they cannot reverse the structural overgrowth. Regular use is needed for ongoing benefit, and products must be chosen carefully to avoid irritation.

4. Weight management and healthy lifestyle for secondary CVG
   In some patients, CVG appears as part of a broader metabolic or hormonal disorder, such as acromegaly, insulin-resistance states, or thyroid disease. For these people, non-pharmacological management of weight, diet, and exercise can help control the underlying condition, which may stabilize or partially improve the scalp changes. A healthy lifestyle supports cardiovascular health, blood sugar control, and hormone balance, reducing further progression of secondary CVG and improving overall quality of life, even though it may not fully flatten existing folds.

5. Psychological support and counselling
   CVG often causes visible cosmetic changes that can attract unwanted attention and affect self-esteem. Some patients feel embarrassment, social anxiety, or depression because of the unusual appearance of their scalp. Psychological support, such as counselling, support groups, or cognitive-behavioural techniques, can help people cope with body-image concerns and social stress. This type of therapy does not change the physical folds but can greatly improve overall well-being, social functioning, and treatment satisfaction, especially when surgery is not yet planned or possible.

6. Education on scalp self-examination
   Doctors often teach patients how to check their scalp folds at home. By using a mirror, good lighting, or the help of a family member, patients can look for redness, scaling, oozing, new bumps, or changes in existing moles. This simple habit helps detect infections or suspicious skin lesions early. It is especially important in CVG that arises over a melanocytic nevus or other lesions, where there is a small but real risk of skin cancer developing in the abnormal skin. Early detection means earlier treatment and better outcomes.

7. Protection from excessive heat and sweat
   Because the grooves can trap sweat and moisture, heat and heavy sweating may worsen itching, maceration, and odor. Patients are usually advised to avoid very tight hats, long exposure to high heat, or any situation where the scalp stays wet for a long time. Using breathable headwear and drying the scalp carefully after exercise or baths can reduce irritation. This strategy is simple but important for daily comfort and helps reduce episodes of secondary infection in the folds.

8. Management of associated skin conditions (non-drug measures)
   Secondary CVG can occur on top of other scalp diseases such as psoriasis, eczema, or seborrheic dermatitis. Non-pharmacological care for these conditions includes gentle cleansing, avoiding scratching, using non-medicated moisturizers, and identifying personal triggers like harsh hair products. Controlling these background problems reduces inflammation and scaling in the folds, making the CVG easier to manage overall, even before or alongside drug therapy for the primary skin disease.

9. Physiotherapy and occupational therapy (for syndromic cases)
   Some forms of CVG occur together with neurological disorders or developmental syndromes that affect movement or daily functioning. In these situations, physiotherapy and occupational therapy can help patients maintain independence, posture, and muscle strength. While these therapies do not treat the scalp folds directly, they address the broader syndrome, reduce disability, and may make it easier for patients or caregivers to look after scalp hygiene and attend medical appointments.

10. Sun protection of the scalp skin
    The ridged scalp surface may expose some skin areas more directly to sunlight, especially if hair coverage is reduced. Regular use of hats or shade helps protect the scalp from ultraviolet damage and reduces the risk of sunburn, precancerous changes, and skin cancer. Sun protection is particularly important when surgery has been performed or when there are pre-existing nevi or scars in the scalp folds. Simple measures like wide-brimmed hats and avoiding midday sun are effective and easy to apply.

(Because CVG is rare and mainly managed with hygiene and surgery, the evidence for many other “non-pharmacological therapies” such as massage, light-based procedures, or fat grafting is limited to case reports. For word-limit reasons I have listed 10 of the most realistic and evidence-linked options rather than 20.)

Drug treatments (evidence-based, mostly for underlying diseases)

Very important: there are no medicines specifically approved by the FDA to cure cutis verticis gyrata itself. Drugs are mainly used to treat diseases that cause secondary CVG (for example acromegaly or thyroid disease) or to manage associated skin or infection problems. Information below is based on FDA prescribing information for each drug, but doses and schedules are examples only and must always be adjusted by a specialist. Never start or change prescription medicines without a doctor.

1. Octreotide (Sandostatin / Sandostatin LAR)
   Octreotide is a synthetic version of somatostatin, used to lower growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in acromegaly. By reducing these hormones, it can improve many acromegaly symptoms and may help stabilize or partially regress secondary CVG linked to this disorder. Typical adult dosing starts with subcutaneous injections several times daily and may switch to long-acting intramuscular injections every 4 weeks, but exact doses are individualized. Common side effects include abdominal pain, diarrhea, gallstones, changes in blood sugar, and injection-site reactions.

2. Oral octreotide capsules (Mycapssa)
   Mycapssa is an oral capsule form of octreotide approved for long-term maintenance treatment in patients with acromegaly who have already responded to injectable somatostatin analogues. Taking the drug by mouth can be more convenient than injections while still suppressing GH and IGF-1 levels. Dosing is typically twice daily on an empty stomach, and the amount is adjusted according to hormone levels and symptoms. Side effects are similar to injectable octreotide, including gastrointestinal upset, headache, gallbladder problems, and changes in glucose control.

3. Octreotide acetate injection (Bynfezia Pen)
   Bynfezia Pen is a ready-to-use octreotide injection device approved to lower GH and IGF-1 when other treatments are not suitable or adequate. It delivers octreotide subcutaneously, usually two or three times daily, but dosing is individualized by an endocrinologist. By controlling hormone excess in acromegaly, it can help prevent further progression of scalp thickening in secondary CVG linked to this disease. Side effects again include gastrointestinal symptoms, gallbladder disease, changes in thyroid function, and possible injection-site pain or redness.

4. Hyaluronidase injections (Hylenex, Vitrase and similar)
   Hyaluronidase is an enzyme that breaks down hyaluronic acid in the skin and soft tissue. FDA-approved hyaluronidase products are indicated mainly as adjuvants to increase absorption of other injected drugs or fluids, not specifically for CVG. However, recent case reports describe off-label intralesional hyaluronidase injections directly into CVG folds, with partial softening and flattening of thickened scalp tissue. Dosing regimens vary and must be designed by experienced specialists. Potential side effects include local swelling, redness, allergic reactions, and, rarely, systemic hypersensitivity.

5. Injectable poly-L-lactic acid (Sculptra)
   Poly-L-lactic acid (PLLA) is a biocompatible filler approved to treat facial lipoatrophy and certain wrinkles by stimulating collagen production in the deep dermis. Its labelled use is cosmetic facial contour correction, not CVG. Some reports have proposed using PLLA or similar injectables in carefully selected CVG cases to adjust contour after surgery or improve cosmetic symmetry. Typically the product is injected in small volumes in a grid pattern, with sessions spaced weeks apart. Side effects can include nodules, bruising, swelling, and local inflammation, so use must be cautious and off-label.

6. Topical corticosteroid preparations (for associated inflammatory scalp disease)
   In patients whose secondary CVG is linked to psoriasis, eczema, or other inflammatory dermatoses of the scalp, topical corticosteroid lotions, foams, or shampoos are commonly prescribed. These drugs reduce inflammation, redness, and scaling by suppressing immune activity in the skin. Potency and frequency depend on the condition and location, and they are usually used for limited periods to minimize side effects such as skin thinning or telangiectasia. By calming the background disease, they can make the folds less inflamed and easier to clean.

7. Topical antifungal agents (for Malassezia-related conditions)
   Some patients with CVG have co-existing seborrheic dermatitis or pityrosporum-related inflammation on the scalp. In such cases, antifungal shampoos or lotions containing agents like ketoconazole are often used to reduce yeast overgrowth. These treatments help relieve scaling and itching and may indirectly reduce discomfort in the folds, although they do not change the structural thickening. Side effects are usually mild and limited to local irritation or dryness when used as directed.

8. Systemic therapies tailored to the underlying disease
   Secondary CVG may improve when the causative systemic illness is treated with appropriate drugs. Examples include thyroid hormone replacement for myxedema, biologics or systemic immunosuppressants for severe psoriasis, or specific therapies for amyloidosis. In each case, the medicine is chosen based on the underlying disorder and its guidelines, not CVG itself. As the systemic disease comes under control, scalp thickening may stabilize or modestly regress, though folds often remain to some degree and may still require surgical correction.

(Because no medicine is directly approved to cure CVG and most pharmacologic options are off-label or indirect, listing 20 separate named drugs with detailed FDA-approved CVG indications is not medically accurate. The drugs above are the most relevant, evidence-linked options connected to conditions that frequently cause secondary CVG.)

Dietary molecular supplements

For CVG there are no specific supplements proven to reverse the scalp folds, but general skin and metabolic health can be supported. All supplements should be discussed with a doctor to avoid interactions with prescription drugs.

1. Omega-3 fatty acids
   Omega-3 fatty acids from fish oil or algae support anti-inflammatory pathways in the body and may help reduce chronic low-grade inflammation in the skin and cardiovascular system. Typical supplemental doses range from about 500–1000 mg of combined EPA and DHA daily, but higher medical doses must be supervised. The main mechanism is competition with omega-6 fatty acids in cell membranes, leading to production of less-inflammatory eicosanoids. Side effects can include mild stomach upset or a fishy after-taste, and they may increase bleeding tendency at high doses.

2. Vitamin D
   Vitamin D affects immune regulation, skin barrier function, and bone health. Low vitamin D levels are common in people with chronic inflammatory or endocrine diseases, some of which can coexist with CVG. Supplementation doses vary depending on blood levels but often range from 600–2000 IU per day for general support, under medical supervision. Vitamin D works by binding to nuclear receptors and modulating gene expression related to cell growth and immune activity. Excessive intake can lead to high calcium levels and kidney problems, so monitoring is important.

3. Vitamin B-complex
   B-group vitamins (B1, B2, B6, B12, folate, and others) support energy metabolism, nerve function, and healthy skin turnover. In some systemic diseases linked to secondary CVG, such as malnutrition or endocrine disorders, B-vitamin status may be suboptimal. A typical B-complex supplement provides daily recommended intakes of each vitamin. These vitamins act mainly as co-factors in enzyme reactions, helping cells use carbohydrates, fats, and proteins efficiently. Excess water-soluble B vitamins are usually excreted, but very high doses of specific B vitamins can have side effects and should only be used with medical advice.

4. Zinc
   Zinc is an essential trace element important for wound healing, immune function, and skin structure. It serves as a cofactor in many enzymes and influences keratinocyte proliferation and repair. Supplement doses are often in the range of 10–20 mg per day in adults, depending on diet and deficiency status. In people with chronic skin conditions, appropriate zinc levels may support better barrier function and healing after any scalp surgery. Excess zinc can cause gastrointestinal upset and may interfere with absorption of copper and some drugs if taken in high doses.

5. Biotin
   Biotin is a B-group vitamin often marketed for hair and nail strength. It acts as a co-enzyme in carboxylation reactions that help metabolize fats and amino acids. In people who are biotin-deficient, supplementation can improve hair quality and skin rash, although strong evidence for benefit in otherwise healthy individuals is limited. Typical supplement doses are 30–100 mcg daily, but many commercial products contain higher amounts. Very high doses can interfere with some laboratory tests, so doctors should be informed about use before blood tests.

(Additional general supplements such as selenium, vitamin C, or collagen peptides may support overall skin health, but evidence for specific benefit in CVG is lacking; they should be individualized by a clinician.)

Regenerative / “immunity booster” / stem-cell-related drugs

At present, there are no established stem cell or regenerative drug therapies that specifically treat CVG. Some case reports describe autologous fat grafting or other local procedures to remodel the scalp tissue, but these are procedural rather than systemic “stem cell” drugs and should only be performed in specialist centers. Claims of immunity boosters or stem-cell injections for CVG found online are usually experimental and not supported by strong clinical trials. Patients should be cautious about unproven therapies and discuss any such options with qualified dermatologists or plastic surgeons.

Surgical treatments

1. Scalp reduction with direct excision
   For small or moderate areas of CVG, surgeons can cut out (excise) the thickened folds of scalp and bring the remaining healthy skin edges together. This procedure is usually done under local or general anaesthesia. The goal is to remove the most prominent ridges and create a smoother scalp contour. It is mainly performed for cosmetic reasons and to make hygiene easier. Risks include scarring, bleeding, infection, and hair pattern changes, but experienced surgeons can usually achieve a good cosmetic result.

2. Serial excision and staged scalp reduction
   When CVG involves a larger area, removing all folds in one operation could be unsafe or too tight for closure. In such cases, surgeons may plan several operations over time. In each stage, a portion of the abnormal skin is excised and the scalp is gradually tightened, allowing tissues to stretch and adapt between surgeries. This staged approach aims to minimize tension on the wound and reduce complications while progressively improving the appearance. It requires patience and careful planning but can give better long-term cosmetic outcomes.

3. Tissue expansion with flap advancement
   Tissue expansion is a technique where a balloon-like expander is placed under nearby normal scalp and gradually filled with fluid to stretch the skin. After enough expansion, surgeons remove the CVG folds and move the expanded normal scalp over the area. This method preserves hair-bearing scalp and can provide a more natural hairline than simple excision. It is particularly useful for large or complex CVG deformities. Drawbacks include multiple procedures, temporary distortion during expansion, and risks such as infection or expander exposure.

4. Subcision and contouring procedures
   Subcision is a minimally invasive technique where a needle or special instrument is inserted under the skin to cut fibrous bands and release tethered tissue. In some reports, subcision combined with other treatments such as fillers has been used to adjust the contour of CVG-affected scalp. The goal is to break up tight connections that accentuate folds and to stimulate new collagen formation. Results vary, and the procedure is best reserved for selected patients and performed by dermatologic or plastic surgeons experienced with scalp anatomy.

5. Autologous fat grafting adjunct procedures
   Recently, case reports have described autologous fat grafting, where a patient’s own fat is harvested from another area (like the abdomen), processed, and injected into specific scalp zones to improve contour after CVG surgery or in milder cases. The fat provides volume and may have regenerative properties due to adipose-derived cells. The purpose is to smooth irregularities, enhance cosmetic results, and sometimes soften scar tissue. Possible complications include fat resorption over time, lumps, infection, and the need for repeat procedures.

Prevention tips

Because many CVG cases are primary and of unknown cause, it cannot always be prevented. However, the following measures may reduce complications or help in secondary forms:

1. Control systemic diseases such as acromegaly, thyroid disorders, and psoriasis with regular medical care.

2. Maintain good scalp hygiene to prevent infections and unpleasant odor in the folds.

3. Protect the scalp from excessive sun exposure to lower the risk of skin cancer in abnormal skin.

4. Avoid harsh chemical hair treatments that may irritate or inflame the scalp.

5. Seek early evaluation for any persistent scalp swelling, ridging, or thickening so secondary causes can be treated promptly.

6. Manage body weight and metabolic risk factors to reduce the severity of insulin-resistant states associated with some secondary CVG cases.

7. Avoid chronic scratching or trauma to the scalp, which can worsen inflammation in underlying dermatoses.

8. Keep regular follow-up with dermatology and endocrinology if a systemic disease is present.

9. Discuss family history of neuro-cutaneous syndromes with your doctor, as this may guide earlier monitoring.

10. After any surgery, follow wound-care instructions carefully to reduce scarring and infection risk.

When to see a doctor

A person should see a doctor, ideally a dermatologist, if they notice new or progressive folds or ridges on the scalp, especially if they appear after puberty or together with symptoms such as headaches, vision problems, enlarged hands or feet, weight changes, or fatigue. These features may point to an underlying hormonal or systemic disorder that requires prompt investigation. Medical review is also important if the folds become painful, ooze fluid, smell bad, or show rapid change in color or the appearance of new moles, since these could signal infection or, rarely, skin cancer. Anyone considering surgery or injectable treatments for CVG should be assessed in a specialist clinic where options and risks can be discussed in detail.

Diet: what to eat and what to avoid

For CVG there is no special “magic” diet, but a balanced eating pattern supports general skin and metabolic health and can help control secondary causes like obesity, diabetes, or thyroid disease. A diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats gives the skin the vitamins, minerals, and antioxidants it needs for repair and immune defence. Limiting highly processed foods, sugary drinks, and excess saturated fat helps keep weight, blood sugar, and cholesterol levels in a healthier range, indirectly supporting management of secondary CVG. Moderate salt intake and adequate water support circulation and skin hydration. Any supplements, such as omega-3 or vitamin D, should be chosen with a clinician, especially when other medicines are used.

Frequently asked questions (FAQs)

1. Is cutis verticis gyrata dangerous or life-threatening?
   On its own, primary CVG is usually a benign condition that mainly affects appearance and hygiene rather than survival. The scalp folds can be annoying, but they do not usually damage the brain or cause neurological problems. However, secondary CVG may signal underlying diseases such as acromegaly, thyroid disease, or inflammatory dermatoses, which can have serious health consequences if untreated. For this reason, full medical evaluation is important when CVG is first diagnosed.

2. Can the folds ever go away completely?
   In many people, CVG folds are permanent once they have formed. In secondary CVG, treating the underlying disease sometimes leads to partial regression or softening of the folds, especially if treatment starts early. In primary CVG, folds are usually stable or slowly progressive and do not disappear without surgery. Surgical excision or tissue expansion can significantly reduce or remove the ridges, but scarring and changes in hair pattern are expected and must be discussed before surgery.

3. Is CVG a type of tumor or cancer?
   CVG itself is not a cancer. It represents thickened and folded scalp skin, sometimes with enlargement of connective tissue or glands. However, CVG can occur over or alongside other skin lesions, such as melanocytic nevi or intradermal nevi, which can rarely transform into melanoma. For this reason, regular dermatologic examinations and prompt evaluation of suspicious moles or color changes within the folds are recommended.

4. Does CVG always mean I have a brain or eye problem?
   Not always. In “primary essential” CVG, the scalp folds occur without any associated neurological or ophthalmic disease. In “primary non-essential” CVG, the folds are accompanied by conditions such as intellectual disability, epilepsy, or eye abnormalities, and evaluation is needed to identify them. In secondary CVG, the scalp changes are caused by another systemic or skin disease. Your doctor will decide which tests are needed based on your history and examination.

5. At what age does cutis verticis gyrata usually start?
   Primary CVG most often appears after puberty and before the age of 30, particularly in males. Some secondary forms, such as cerebriform intradermal nevus-associated CVG, may be visible at birth or in childhood. Because hair can hide early folds, the condition may not be noticed until hair thinning or a very close haircut draws attention to the scalp surface.

6. Is CVG more common in men or women?
   CVG is reported more often in men, with primary forms showing a strong male predominance in published series. One reason may be that short hairstyles in men make the folds more visible, whereas longer hair in women can conceal scalp changes and delay diagnosis. However, women can definitely develop CVG, and awareness among clinicians is important so cases are not missed.

7. Can I dye or style my hair normally if I have CVG?
   Many people with CVG continue to dye or style their hair, but they should avoid very harsh chemical processes or tight hairstyles that put extra tension on the scalp. Gentle techniques, patch tests for hair dyes, and good hydration of the scalp folds can reduce irritation. If scalp disease such as psoriasis or eczema is present, hair products should be chosen carefully with advice from a dermatologist.

8. Will losing weight cure the scalp folds?
   Weight loss can improve metabolic and hormonal balance and may help in cases where secondary CVG is linked to insulin resistance or obesity-related endocrine changes. However, once thick fibrous folds have formed in the scalp, weight loss alone is unlikely to flatten them completely. It is still recommended for general health and may make surgery safer and recovery easier.

9. Can children have cutis verticis gyrata?
   Yes, CVG can occur in children, especially when secondary to congenital lesions such as cerebriform intradermal nevus or in association with neurodevelopmental syndromes. In such cases, pediatric dermatologists and neurologists usually work together to investigate associated problems and consider the timing of any surgical treatment. Long-term follow-up is important as the child grows and scalp size changes.

10. Is there a genetic test for CVG?
    For most people with primary CVG, no single gene test is available, and the exact cause is still unclear. Some syndromic forms that include CVG as one feature may have known genetic mutations, but these are investigated based on the full clinical picture, not the scalp folds alone. Genetic counselling may be suggested when CVG appears as part of a broader syndrome with other physical or neurological signs.

11. Can CVG come back after surgery?
    Surgical removal of affected skin provides long-lasting improvement in most reported cases, but recurrence or new fold formation can happen, especially if the underlying disease remains active or if only part of the affected area was removed. Long-term follow-up and continued control of secondary causes (such as acromegaly) are important to reduce this risk.

12. Does CVG cause hair loss?
    Hair loss can occur over some thickened areas because the hair follicles may be distorted or replaced by fibrotic tissue, but hair within the grooves often remains relatively normal. Over time, some patients notice patchy alopecia on the ridged areas. Surgical techniques and scar placement aim to preserve as much hair-bearing scalp as possible, but changes in hair density or direction are common after surgery.

13. Can I treat CVG at home with over-the-counter creams?
    Home care such as gentle shampoos, moisturizers, and careful drying of the folds can improve comfort and hygiene but cannot remove the structural folds. Over-the-counter products should not replace medical evaluation, because important associated diseases could be missed. Some treatments advertised online as “cures” for CVG have no scientific support and may cause irritation or harm. Consulting a dermatologist is the safest way to build a home-care plan.

14. What type of specialist should manage CVG?
    People with CVG are usually managed by a dermatologist, often with input from plastic or reconstructive surgeons when surgery is considered. If secondary causes are suspected, endocrinologists, neurologists, or other specialists may be involved for hormonal and systemic evaluation. A multidisciplinary team helps ensure that both cosmetic and medical aspects of the condition are addressed appropriately.

15. What is the long-term outlook for someone with CVG?
    The long-term outlook depends on the type of CVG and on any associated diseases. Primary essential CVG often remains stable or slowly progressive and mainly causes cosmetic and hygiene issues, which can be improved with good care and, if desired, surgery. When CVG is secondary to serious systemic disease, the prognosis depends on how well that disease is controlled. With appropriate diagnosis, regular follow-up, and individualized treatment, many patients maintain good quality of life.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: February 03, 2025.