What Was Causing the Strange Grooves in the Man’s Scalp?

“Is there anything else?” asked Dr. Jason Mathis. His patient, a 58-year-old man, had come with his wife to see the young dermatologist at the University of Utah for his annual skin check. Mathis had looked over the handful of moles and skin tags and found nothing alarming. What else was bothering the man?

There was one thing, the patient said after a pause. At the top of his head in the back, the skin seemed to sink into the bone in a few spots. It didn’t hurt; it was just weird. He asked another dermatologist about it a few years earlier. That doctor looked at his head, then checked in a textbook and said it was something or another — he couldn’t remember what the dermatologist called it. But he told the patient not to worry about it, and as far as that doctor was concerned, that was the end of it.

Mathis looked at the scalp, still covered by mostly dark hair. It looked normal enough, but a light touch revealed several irregularities. He carefully moved the hair away to reveal four linear grooves distributed around the crown and back of the man’s head. Each was an inch and a half to two inches long. The patient described it as hair growing into the skull, but Mathis could see that it was actually folds of what looked like excess scalp bulging upward into little mounds, as if there were too much skin in too small an area. The lumps were firm and couldn’t be smoothed out. The skin there seemed thicker than on the rest of the scalp.

Mathis recognized it immediately. It was a condition known as cutis verticis gyrata (C.V.G.), from the Latin meaning skin whorled at the scalp. It was first described in the mid-19th century by a French physician who called it cutis sulcata — furrowed skin. It’s rare, and progressive and usually benign, Mathis explained. It’s seen much more frequently in men than women, though it may be underdiagnosed in women because they wear their hair longer.

And that first dermatologist was right, he added. Most of the time it comes on at puberty or early adulthood, and while it’s strange, it’s nothing to worry about. “But,” the man’s wife interjected, “he didn’t have it when we got married in 1982. It started maybe 15 or 20 years ago.”

The man had discovered it one day in the shower. He was washing his hair and felt a strange dent on his scalp, then another, and another. He wasn’t sure how long they’d been there, but he never noticed them before. “Feel my head,” he asked his wife later that morning. She noted the grooves and furrows. “What is that?” she asked. No idea.