Cutis verticis gyrata associated with chronic schizophrenia in Chinese

Abstract

Cutis verticis gyrata (CVG) is an unusual conformation of the scalp, characterized by the presence of folds and furrows that impart to the scalp a corrugated or a gyrate appearance, which resembles the human cerebrum. CVG is classified into primary and secondary by etiology (Polan and Butterworth 1953). CVG caused by chronic inflammatory dermatoses , cerebriform intradermal nevus , neurofibroma, dermatofibroma, and miscellaneous systemic diseases (acromegaly, syphilis, leukemia, etc.) is secondary. When there is no identified cause, it is primary (Orkin et al. 1974). Secondary CVG is found in mentally normal persons. However, primary CVG is usually found in mentally abnormal persons, with or without neurological deficits (Orkin et al. 1974). The prevalence of CVG in the Chinese population is unknown. However, primary CVG associated with mental retardation (Tsuang and Lin 1974) and secondary CVG in three patients with acromegaly (Li 1955) have been reported. In this report, the author presents 25 cases of CVG associated with chronic schizophrenia found in a Chinese population. In July 1986, 1244 male patients hospi~i~d in Yuli Long Stay Mental Institute (located in Eastern Taiwan) were inspected by the author to screen out cases of CVG. Patients with CVG were then investigated by a consultant dermatologist to make a differential diagnosis and to establish a final diagnosis. The histories of the patients with CVG were reviewed by the author, including both physical and psychiatric illnesses, and present physical and mental status was evaluated. As disappearance of CVG after castration was reported (Hellerstrom 1933), Akesson attempted ethinyl estradiol treatment with two patients without effect (Akesson 1964). The present author attempted a further trial by administering 1.25 mg conjugated estrogen once daily for 2 months to three patients who agreed to this, but without cessation of their antipsychotic medication. Given the possibility that longterm administration of antipsychotic drugs might induce CVG, antipsychotic medication (including haloperidol, chropromazine, and thioridazine) was suspended for 2 months in 7 patients who agreed to do so, in order to test this possibility,