BH11 Cutis verticis gyrata associated with chronic traction

Abstract

Abstract Cutis verticis gyrata (CVG) is a rare condition characterized by overgrowth of the skin of the scalp, leading to skinfolds and deep convoluted furrows that resemble the cerebral cortex gyri. Cases of CVG have been classified into primary essential, primary nonessential and secondary. Primary essential CVG has no associated abnormalities. Primary nonessential CVG is associated with neurological or ophthalmological abnormalities. Secondary CVG is due to a local inflammatory or neoplastic process, or an underlying endocrine or genetic cause. We present two cases of CVG associated with chronic traction alopecia. The main clinical features in both cases were thickened skinfolds in the central scalp, which did not extend to the lateral scalp, recession of the frontal hairline with fringe sign and a negative hair-pull test. Histological findings from the zone of alopecia included nonscarring hair loss with the presence of fibrous tracks within the skin but preservation of the sebaceous glands, consistent with chronic traction alopecia. Both patients were advised to reduce tension on the hair and were treated with topical minoxidil and advised on hair transplantation. Patient 1 was a 15-year-old Sikh boy who developed CVG secondary to chronic traction applied from tying his hair at the top of his scalp when wearing a turban. Owing to cultural practices, the patient could not cut his hair, representing a challenge of treating CVG associated with chronic traction in this group of patients. Patient 2 was a 16-year-old girl with a background of joint hypermobility and recurrent hip dislocations, currently undergoing genetic testing for Ehlers-Danlos syndrome. She developed CVG following chronic traction due to hairstyling. Interestingly, cutting her hair resulted in some improvement of the appearance of CVG, possibly due to reduced hair tension. Chronic traction is an uncommon cause of CVG, with only a few cases reported in the literature. It is likely that the persistent tension of tight hairstyles pulls the scalp into folds and contributes to the appearance of CVG. These cases highlight the importance of ascertaining whether a history of traction styling is present in the diagnosis and management of CVG.