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As we grow older, wrinkles on the face and other part of the body is no surprise event. However, wrinkles over the surface of the scalp (skin overlying the head) is an astonishing medical condition. This condition is called BULLDOG SCALP SYNDROME or CUTIS VERTICIS GYRATA (CVG). It is characterised by thickening of the scalp and formation of folds.

It is a rare condition but often seen in men than women with an estimated prevalence of 1 in 100, 000 males compared to 0.026 in 100, 000 females. It is saddening to know that there is no cure for CVG. The soft and pliant scalp folds cannot be permanently flattened with any medication except through surgery.


Scalp wrinkles can be classified into:

  • Primary essential CVG
  • Primary non-essential CVG
  • Secondary CVG

Primary essential CVG is where the cause of the condition in unknown. It has no other associated abnormalities. This occurs mainly in men, with a male:female ratio of 5:1 or 6:1, and develops during or soon after puberty. Because of the slow progression of the condition, which usually occurs without symptom, it often passes unnoticed in the early stage.

Primary non-essential CVG can be associated with neuropsychiatric disorders including cerebral palsy, epilepsy, seizures, and ophthalmologic abnormalities, most commonly cataracts.

Secondary CVG occurs as a consequence of a number of diseases or drugs that produce changes in scalp structure. These include: acromegaly (excessive growth hormone levels due to pituitary gland tumours), and theoretically, the use of growth hormone itself or the use of drugs that mimic the effect of growth hormone. It may also arise in association with melanocytic naevi (moles), birthmarks (including connective tissue naevi, fibromas and naevus lipomatosus), and inflammatory processes (e.g. eczema, psoriasis, Darier disease, folliculitis, impetigo, atopic dermatitis, acne).



Scalp hygiene is very important to avoid accumulation of skin debris which may cause unpleasant smell and itching.

The permanent treatment for CVG is plastic surgery for cosmetic reason. The choice of surgical repair is largely determined by the size and location of the wrinkle. Surgical methods available are:

  • Total resection and grafting
  • Placement of skin expander on healthy areas and grafting
  • Partial resection of most prominent portion of the lesion



  1. Okamoto K, Ito J, Tokiguchi S, Ishikawa K, Furusawa T, Sakai K (October 2001). “MRI in essential primary cutis verticis gyrata”. Neuroradiology43(10): 841–4.