Those deep folds and ridges you sometimes see on a man’s scalp are caused by a condition called cutis verticis gyrata, or CVG. The skin on the top of the head thickens and grows faster than the skull beneath it can accommodate, forcing it to buckle into furrows that look strikingly similar to the folds of the brain. It’s rare, benign, and overwhelmingly affects men, though the reasons it shows up vary widely from person to person.
What Creates the Folds
On a structural level, the ridges form when bands of connective tissue develop between the skin and the tough membrane that covers the skull (called the galea). These bands act like anchors, preventing the skin from stretching out smoothly. As the skin continues to grow or thicken, it has nowhere to go but upward, bulging into the characteristic folds. Under a microscope, the affected skin can look completely normal or show thickened connective tissue, extra collagen fibers, and enlarged sweat and oil glands.
The Three Types
Doctors classify CVG into three categories based on what’s driving the excess skin growth, and the distinction matters because it determines whether the folds are purely cosmetic or a signal of something else going on.
Primary Essential
This is the most common form. The scalp folds appear on their own, with no underlying disease and no other health problems. It typically shows up in men around puberty or early adulthood, and no one knows exactly why it happens. The inheritance pattern is still debated, though some cases have been linked to chromosomal differences associated with conditions like Noonan syndrome, Turner syndrome, and Down syndrome.
Primary Non-Essential
In this form, the scalp folds appear alongside neurological or psychiatric conditions, intellectual disability, or eye abnormalities. The folds themselves aren’t caused by another disease, but they cluster with other developmental differences, suggesting a shared underlying process during development.
Secondary
Here, the folds are a side effect of something identifiable. The list of possible triggers is long: acromegaly (a condition where the pituitary gland pumps out too much growth hormone), eczema, large moles on the scalp, tuberous sclerosis, and even anabolic steroid use. In the hormone-driven cases, growth hormone and a related compound called insulin-like growth factor 1 directly stimulate the skin to produce more collagen and enlarge its oil glands, physically thickening the scalp until folds form. When the secondary cause is treated, the folds sometimes improve.
What It Feels Like
Most people with CVG have no symptoms at all. The skin between the folds usually looks normal in color, and the hair follicles remain intact. The main concern for most men is cosmetic. That said, some people do report itching, headaches, or gradual hair thinning in the furrowed areas. Pain is uncommon unless the deep folds trap moisture and bacteria, which can lead to infection.
The folds themselves can create a hygiene challenge. Sweat, oil, and dead skin cells collect in the furrows, and if they aren’t cleaned regularly, bacterial or fungal infections can develop. Folliculitis, an infection of the hair follicles, is a particular risk. Mild cases clear up on their own with good hygiene, but recurring infections can cause scarring and permanent hair loss in the affected area. Washing the scalp thoroughly and drying between the folds helps prevent this.
How It’s Diagnosed
A doctor can usually identify CVG by looking at the scalp. The folds are distinctive enough that a physical exam is often all that’s needed. The real diagnostic work comes in figuring out which type it is. If the folds appeared at birth or come with neurological symptoms, imaging of the brain with an MRI or CT scan is standard to check for structural abnormalities. In people with suspected secondary CVG, blood work typically includes an evaluation of hormone levels to rule out acromegaly or other endocrine conditions.
On imaging, the primary essential form shows thickened skin and slightly more subcutaneous fat but nothing unusual inside the skull. Secondary forms tied to acromegaly may reveal an enlarged pituitary gland. In rarer cases, brain imaging has shown cortical atrophy, abnormal calcifications, or structural differences in the brain itself.
Treatment Options
For the primary essential form, treatment is entirely optional since the condition is cosmetically bothersome but medically harmless. When someone does want treatment, the traditional approach is surgical scalp reduction, where a surgeon removes the excess folded skin under general anesthesia. Results are generally good, with significant flattening of the scalp and reduced moisture trapping in the folds.
Newer, less invasive options are emerging. Injections of a substance called hyaluronidase directly into the folds have shown promising results. This enzyme breaks down a natural sugar molecule in the skin that contributes to volume and rigidity. By loosening the tissue, the injections soften and visibly flatten the furrows. In one reported case involving a man whose CVG developed after anabolic steroid use, bimonthly injections produced sustained improvement in scalp texture with no side effects. Botulinum toxin injections to relax the scalp muscles have also been tried, with some improvement, though the evidence is limited to individual case reports.
For secondary CVG, the priority is treating whatever is causing the excess skin growth. Addressing the underlying hormonal imbalance or skin condition can slow or partially reverse the process. An endocrine evaluation is recommended whenever secondary CVG is suspected, because conditions like acromegaly carry their own serious health risks that extend well beyond the scalp.
Why It’s Almost Always Men
CVG is heavily skewed toward men, with estimates suggesting a male-to-female ratio as high as 5 or 6 to 1. The exact reason isn’t fully understood, but the link to puberty and hormonal changes is hard to ignore. Most cases of primary CVG become noticeable during or after puberty, which points toward androgens (male sex hormones) playing a role in driving the skin thickening. Men also tend to have thicker scalp skin and more active sebaceous glands than women, which may lower the threshold for fold formation. The connection to anabolic steroids in some secondary cases reinforces the hormonal link.