Cutis verticis gyrata, or CVG, is a scalp condition where the skin forms thick, folded ridges separated by deep furrows. The pattern looks strikingly similar to the wrinkled surface of the brain. These folds typically run from front to back across the top of the scalp and can’t be flattened by pressing on them or pulling the skin taut. CVG can be something you’re born with or something that develops later due to another medical condition.
What CVG Looks Like
The hallmark of CVG is a series of rounded, parallel ridges on the scalp, most often along the crown and back of the head. The furrows between folds can be deep enough that the scalp takes on what doctors describe as a “cerebriform” appearance, literally brain-shaped. In mild cases, the folds may only be noticeable when someone parts your hair or looks closely. In more pronounced cases, the ridges are visible even with a full head of hair and can number anywhere from two to more than a dozen.
The skin within the folds is typically normal in color and texture. Hair often still grows on the ridges, though the deep creases themselves may have thinning or absent hair simply because the follicles are compressed. Over time, moisture, sweat, and dead skin can collect in those furrows, sometimes leading to odor or irritation if the area isn’t cleaned regularly.
The Three Types of CVG
CVG is classified into three categories based on its cause, and knowing which type you have matters because the treatment approach differs for each.
Primary Essential
This is CVG with no identifiable underlying cause and no associated neurological or eye problems. It appears on its own, usually during or after puberty, and is far more common in men. The scalp folds are the only finding. This form is considered cosmetic rather than medically dangerous.
Primary Non-Essential
In this form, the scalp folds appear alongside neurological or eye conditions. These can include intellectual disability, epilepsy, deafness, microcephaly, cataracts, strabismus (crossed eyes), blindness, or retinitis pigmentosa. Primary non-essential CVG tends to show up earlier in life, sometimes at birth or in early childhood, and the associated conditions are often the greater medical concern.
Secondary CVG
Secondary CVG develops as a consequence of another disease, skin condition, or even medication. The list of known triggers is long and includes acromegaly (excess growth hormone), an underactive thyroid, psoriasis, chronic pemphigus, pachydermoperiostosis, amyloidosis, insulin resistance syndrome, and certain types of skin growths like neurofibromas or congenital melanocytic nevi. In acromegaly specifically, a growth factor called IGF-1 is thought to drive the thickening of scalp tissue. There are also reports of CVG-like changes developing in melanoma patients treated with a combination of a targeted cancer drug and whole-brain radiation, though neither treatment caused the changes on its own.
Who Gets It
CVG is rare. The primary forms affect men significantly more often than women, and symptoms most commonly appear around puberty or in young adulthood. Secondary CVG has no strong sex preference because it depends entirely on the underlying condition. Someone with acromegaly or severe psoriasis can develop scalp folds regardless of sex.
How CVG Is Diagnosed
A dermatologist can often recognize CVG on sight. The characteristic parallel folds that resist flattening are distinctive enough for a visual diagnosis in most cases. The more important question is figuring out which type you have, because secondary CVG means there’s an underlying condition that needs attention.
If CVG is present at birth or appears alongside intellectual disability, seizures, or vision problems, imaging of the brain with MRI or CT is recommended to check for structural abnormalities. Blood tests may be ordered to screen for hormonal conditions like acromegaly or thyroid disorders. A skin biopsy is sometimes performed to rule out conditions that mimic CVG, such as cylindromas (benign skin tumors that cluster on the scalp) or pachydermoperiostosis, a genetic condition that thickens both skin and bone.
The conditions that can look like CVG include psoriasis with heavy scalp involvement, neurofibromas clustered on the scalp, lipomatous nevi (fatty tissue growths under the skin), and amyloid deposits in the skin. Each of these creates scalp thickening or ridging that can be confused with true CVG, but a biopsy or targeted testing usually clarifies the picture.
Daily Scalp Care
The deep furrows of CVG create warm, moist pockets where bacteria and fungi can thrive. Keeping the scalp clean is the most important daily concern. Gently washing within the folds during regular shampooing helps prevent buildup of oil, sweat, and dead skin cells that can lead to irritation, infection, or persistent odor. Some people find it helpful to use a gentle antimicrobial or medicated shampoo a few times a week, particularly if they notice recurring irritation.
Drying the scalp thoroughly after washing matters too, since trapped moisture in the folds encourages fungal growth. If you notice redness, tenderness, or unusual discharge from the furrows, that could signal a secondary infection that needs treatment.
Surgical Options
For people with primary essential CVG who want to reduce the appearance of the folds, surgery is the main option. There is no medication that reverses or reduces the scalp ridging itself. For secondary CVG, treating the underlying condition (correcting hormone levels in acromegaly, for example) can sometimes improve the scalp changes, though this isn’t guaranteed.
The surgical approach depends on how extensive the folds are. In milder cases, a scalp reduction procedure removes strips of excess skin and pulls the remaining scalp together. For more significant cases, surgeons may use tissue expanders, which are balloon-like devices placed under the scalp through small incisions. These are gradually filled with saline over weeks to stretch the surrounding normal skin. Once enough new skin area has been generated, a second surgery removes the folded tissue and advances the expanded skin to cover the area. One published case used two 550-cc expanders for a combined expansion of 1,000 cc, which improved both the furrows and areas of hair loss. That second stage also included lowering the hairline and repositioning the brow.
Recovery from tissue expansion is a months-long process because of the two-stage nature of the procedure. The expanders need to be filled gradually during office visits before the final surgery can take place. Scarring is inevitable, but surgeons typically place incisions along the hairline or within existing folds to minimize visibility.
What to Expect Long-Term
Primary essential CVG is not dangerous on its own. The folds don’t become cancerous and don’t spread to other parts of the body. The main concerns are cosmetic, psychological, and hygienic. Many people with mild CVG manage perfectly well with attentive scalp care and never pursue surgery.
For primary non-essential CVG, the long-term outlook depends more on the associated neurological or eye conditions than on the scalp folds themselves. And for secondary CVG, the prognosis is tied to whatever underlying disease is driving the skin changes. In all cases, once the folds are established, they tend to persist or slowly progress unless surgically addressed or the triggering condition is effectively treated.