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Cutis verticis gyrata (CVG), also known as “bulldog” scalp syndrome was originally described in 1837 by Jean-Louis-Marc Alibert. CVG is a descriptive term for a condition of the scalp manifesting as convoluted folds and furrows formed from thickened skin of the scalp resembling cerebriform pattern. In 1953 Polan and Butterworth classified CVG into two forms: primary and secondary. The primary form can be divided in essential and non-essential, where the essential form do not present other abnormality (while primary nonessential can be associated with other pathologies or a combination of this. In the primary essential form, the etiology is not known, and, though most of the cases seem sporadic, autosomal recessive and autosomal dominant inheritance with variable expression have been described. In the primary nonessential form, the pathogenesis (beside the genetic determination) may have an endocrinologic basis. In the secondary form, the etiology depends on the underlying process (eg,inflammatory, neoplastic). Our patient was a 25 year old caucasian male who presented for three years scalp skin redundancy, with deep cerebriform folds and wrinkles, located in frontoparietal regions He denied comorbidities. He referred fronto temporal headache often unilateral with casual trigeminal diffusion, described as chronic and burning pain with allodinia. For those he performed a 3T MRI of head with a 3D reconstraction of scalp that excluded abnormality of the brain lobes and essentially revealed thickened dermis and a slight increase in the volume of subcutaneous fat and irregularly distributed cutaneous folds characteristic of CVG. Because neurologist considered patient with CM and inadequate response or intolerance to previous two prophylactic treatments he was treated with pericranial injections of about 150 UI of BoNT-A with the proposal to repeat treatment every 3–4 months and the purpose to increase dose up to 200 U in case of no response. After 3 months unfortunately patient achieved minimal reduction of pain of about 20–30% in headache frequency and intensity and during the 3 months follow-up period. The first weeks after BonT-A treatment he reduced NSAIDs and analgesics consumption but unfortunately after first stage he preferred to avoid further botulinum injections due to mini invasive procedure on scalp. Primary essential cutis verticis gyrata firstly because is a cosmetic problem, but also because eventual pain symptoms and psychological repercussions are very important issues. In this case both pain relief and reduction of folds width could be beneficials and therefore we encouraged the patient to treat both CM and CVG with BonT-A Injections. |
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