A case of cutis verticis gyrata, induced by misuse of anabolic substances?.

Abstract

Conflict of interest: there are no competing interests. Cutis verticis gyrata (CVG) is a descriptive term used for a rare condition of the scalp manifesting as convoluted folds and furrows in a cerebriform pattern, which are caused by thickening of the skin. CVG may be categorized as primary essential, primary nonessential, and secondary. The aetiology of primary essential CVG is still unknown, although genetic and endocrinological factors are suspected to be of pathogenetic relevance. Primary nonessential CVG is strongly associated with psychiatric or neurological disorders such as schizophrenia, epilepsy and mental retardation. Additionally, ophthalmological symptoms including cataract and blindness may be observed. In secondary CVG, systemic diseases, inflammatory dermatoses, naevoid abnormalities, and trauma are considered to be underlying conditions.1 We describe the case of a 26‐year‐old male bodybuilder of Mediterranean descent, who developed CVG after extensive misuse of anabolic substances. He presented with a 6‐month history of slowly progressing vertical linear folding and deep furrows in the occipital and parietal area of his scalp (Figs 1 and 2). The patient had gained 55 kg during the 2 years prior to presentation, increasing his bodyweight from 60 to 115 kg (body mass index increasing from 19.2 to 36.7). Clinical examination was otherwise unremarkable. A skin biopsy specimen of the scalp showed acanthosis of the epidermis, dermal thickening of collagen bundles, and a lymphohistiocytic perivascular infiltrate in the upper corial plexus. He was otherwise well. Laboratory investigations showed elevated liver enzymes (alanine amino transferase 58 U/L, aspartate amino transferase 81 U/L, and gamma glutamyl transferase 56 U/L). Sex hormone profile was unremarkable. Acromegaly and pachydermoperiostosis could be excluded by laboratory (growth hormone level < 0.5 ng/mL) and radiological examination. The patient denied any intake of medication, but admitted to have taken several different anabolic steroids, obtained on the black market, to gain muscle mass. The intake ceased 3 months prior to his first presentation in our clinic.