Cutis Verticis Gyrata in Men Affected by HIV-Related Lipodystrophy

We report the occurrence of cutis verticis gyrata (CVG), a disfiguring dermatological condition, in four patients with HIV-related lipodystrophy (HIVLD). These four patients had abnormal metabolic and hormonal lab values which we compare with metabolic and hormonal perturbations cited in previous HIVLD cohorts. In addition, we describe the sole use of poly-L-lactic acid as a potential treatment for decreasing the appearance of CVG-associated ridges. 1. Introduction HIV-associated lipodystrophy (HIVLD) is a condition characterized by an atypical distribution of body fat and metabolic abnormalities including insulin resistance and dyslipidemia. It is estimated to affect 13–62% [1–3] of HIV-positive patients on highly active antiretroviral therapy (HAART) and occurs more commonly with regimens including thymidine analog nucleoside reverse transcriptase inhibitors (NRTIs) and selected protease inhibitors (PIs) [4]. We report four patients with HIVLD who developed cutis verticis gyrata (CVG). Our clinic sees approximately 1,000 HIV-positive males each year. This is the first case series associating these two conditions. CVG is a dermatological condition defined by the formation of ridges on the scalp with a cerebriform or gyrate appearance [5, 6], Figure 1(a). In its primary form, it predominantly affects males, has a post-pubertal onset, and is associated with various neuropsychiatric conditions [7]. In contrast, secondary CVG manifests asymmetrically, has a variable age of onset, and has been linked with various metabolic and hormonal disturbances such as hypothyroidism [5], diabetes mellitus [7], corticosteroid treatment [6], and anabolic steroid usage [8]. Although secondary CVG has a relatively low prevalence, with less than 500 cases reported prior to 2003 worldwide [6], it is disfiguring and associated with other conditions that could have serious long-term metabolic consequences. Currently, surgical resection is the main treatment for reducing the appearance of CVG-associated scalp folding [9, 10]. Figure 1 2. Materials and Methods Patients were seen in the Dermatology Clinic in San Francisco General Hospital and referred to the hospital’s Genera Clinic Research Center. Patients were evaluated with a standardized intake questionnaire, fasting blood samples, and DEXA scans. 3. Results and Discussion All four patients were male. At the time of presentation, their ages were 50, 52, 59, and 61, and they had been aware of their HIV-positive status for 16, 13, 30, and 16 years, respectively. Their most recent CD4 counts were 470, 531, 399, and 560