Cutis verticis gyrata secondary to hypothyroid myxedema

A 62-year-old woman presented with an Ii-year history of hypothyroidism and a hysterectomy performed 12 years previously. She was receiving thyroxin treatment and consulted for the appearance of asymptomatic grooves in the scalp over the past 3 years. The grooves had gradually increased in length and size. Exploration revealed multiple asymmetrically arranged grooves with raised areas in between that were especially noticeable upon palpation (Fig. 1). The rest of the physical exploration was normal. Computerized axial tomography (CAT) exploration was performed, along with an electroencephalogram and simple X-ray examination of the skull and hands; no alterations were noted, however. Analytical studies (including hemogram, biochemistry, antinuclear antibodies, and hormones: thyrotropin (TSH), T3, free and total thyroxin, basal cortisol, follicle-stimulated hormone (FSH), luteinizing hormone (LH), progesterone, estradiol, testosterone, prolactin) only found a high cholesterol concentration (274 mg/dL) and low level of growth hormone. The remaining parameters were either normal or negative. Later analytical studies made by the Endocrinology Department did not show any variations in the growth hormone levels or any other hormonal variation. The histopathologic biopsy study only revealed a slight thickening of the collagen bundles, which were arranged in the form of "collagen balls," and a diffuse colloidal iron-positive mucinous deposit infiltrating the dermis and subcutaneous cellular tissue (Figs 2 and 3).