Understanding Cutis Verticis Gyrata: Causes, Diagnosis, and Treatment Options

You might have noticed those peculiar grooves appearing at the top of your head. This condition is known as Cutis Verticis Gyrata (CVG), also commonly referred to as Bulldog Scalp Syndrome. In this post, we're diving deep into what CVG is, who gets it, its causes, clinical features—with plenty of photographs to aid your understanding—how it's diagnosed, and finally, the treatment options available.

To start, let's explore what Cutis Verticis Gyrata actually is. Essentially, it's an overgrowth of the scalp skin that results in convoluted folds and deep furrows, resembling the surface of the brain. This condition can be classified into primary essential, primary non-essential, and secondary causes, which we'll delve into later. For instance, you might see a gentleman with CVG mainly affecting the back of his scalp.

Next, who gets Cutis Verticis Gyrata? The condition has a five-to-one male-to-female ratio, making it more prevalent in males. Most primary cases develop after puberty, typically before the age of 30, although it can occur at any age. This is evident in clinical photos, where both adults and children are affected.

Now, let's discuss the causes of CVG. As mentioned earlier, the causes can be categorized into three main types:

1. **Primary Essential CVG**: This form occurs without any associated abnormalities. It just happens without an underlying cause.

2. **Primary Non-Essential CVG**: This type is associated with neuropsychiatric disorders and eye issues such as cerebral palsy, epilepsy, seizures, and cataracts.

3. **Secondary CVG**: This form is caused by other conditions affecting the scalp, such as acromegaly or inflammatory disorders like psoriasis and eczema.

To give you a clearer picture, let's look at some clinical photographs. For example, the first photo shows a gentleman with CVG affecting the back of his scalp. Another photo displays an infant with CVG impacting the lateral aspect of the scalp. Generally, CVG affects the central and back areas of the scalp, but it can sometimes involve the entire scalp. The folds are usually soft and spongy, and they don't correct with pressure. The skin color typically remains unaffected. The number of folds can vary from as few as two to more than ten.

In some cases, the CVG is less noticeable due to hair covering the scalp. However, in other instances, it becomes more apparent when there's a lack of hair. For example, a gentleman with secondary CVG caused by acromegaly shows a more pronounced appearance of the condition. If you're interested, there's a full video on acromegaly available on this channel.

When it comes to diagnosing CVG, it can usually be done clinically without any special tests. A doctor simply needs to examine the scalp to make the diagnosis.

As for treatment, it's crucial to maintain good scalp hygiene to avoid accumulations and secretions in the scalp's furrows. However, it's important to note that treatment is not usually necessary and is often done purely for cosmetic reasons. This doesn't come without complications, so it's essential to weigh the pros and cons.

For instance, consider a gentleman who underwent corrective surgery for CVG. Before the procedure, his scalp had multiple furrows, but after the surgery, the appearance was significantly improved. Such surgeries are typically done for cosmetic reasons. Smaller, localized lesions can be excised in one procedure, while larger lesions may require multiple procedures (serial excision). However, surgery comes with its own set of complications, such as infections, pain, or the procedure not working as intended.

In conclusion, understanding Cutis Verticis Gyrata involves recognizing its causes, who it affects, and the available treatment options. While treatment is often cosmetic, maintaining good scalp hygiene is essential for those living with CVG.

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