Cutis Verticis Gyrata (CVG) is a rare, benign scalp condition characterized by deep folds and furrows that give the scalp a convoluted, brain-like appearance. These folds result from a localized thickening and overgrowth of the scalp tissue. This article addresses the factors determining if CVG can resolve naturally and explores the management options available when spontaneous resolution is not expected.
What is Cutis Verticis Gyrata?
CVG is a descriptive term for a scalp abnormality where the skin develops soft, spongy ridges and troughs, typically affecting the central and back regions of the head. The folds are usually unable to be corrected with simple pressure. The condition is the result of an overgrowth or thickening of the scalp skin, and occurs more frequently in males, often appearing after puberty and before the age of 30.
The condition is broadly categorized into two main types: Primary and Secondary CVG. Primary CVG is divided into an essential form, where no other abnormalities are present, and a non-essential form, which is associated with other neurological or ophthalmological conditions. Examples include epilepsy, cerebral palsy, or cataracts.
Secondary CVG is a consequence of an underlying disease process that causes changes in the scalp structure. Associated conditions can include inflammatory skin disorders such as psoriasis or eczema, or systemic diseases like acromegaly. This distinction is important because the type determines the likely natural course of the condition.
Does Cutis Verticis Gyrata Resolve Spontaneously?
Primary CVG appears without an identifiable underlying cause and generally does not resolve on its own. Once the folds have developed, the condition is considered stable and permanent. The folds remain present throughout life unless they are physically removed or altered.
The prognosis is significantly different for Secondary CVG, as its course is tied directly to the disease that caused it. If the underlying condition, such as an inflammatory skin disease or a tumor causing scalp thickening, can be successfully treated, the associated scalp folds may diminish or stabilize. Treating the root cause is the most effective approach to potentially reversing the scalp changes.
Surgical and Non-Surgical Management Options
Since Primary CVG does not regress naturally, interventions are often sought for cosmetic reasons or to address hygiene issues caused by secretions accumulating in the deep furrows. For established folds, surgical excision is the only method to remove the thickened scalp tissue and flatten the contour. Small, localized areas of CVG can sometimes be removed in a single procedure.
Larger areas of involvement often necessitate more complex surgical planning, such as using serial excisions or tissue expansion techniques. Serial excision involves removing a portion of the affected scalp and allowing the surrounding skin to stretch before a subsequent removal is performed. Tissue expansion involves placing balloons under the healthy scalp tissue to stretch it over time, creating enough skin to cover the defect after the CVG is excised.
Non-surgical management includes maintaining rigorous scalp hygiene to prevent infections and unpleasant odors resulting from debris trapped in the folds. For Secondary CVG, treating the specific underlying cause remains the primary non-surgical intervention, which may include medical management of systemic or inflammatory diseases.