Plica Polonica: Symptoms, Causes, Treatment and Prevention RichFeel

Plica Polonica also known as Plica neuropathica is a rare disorder of hair shaft that presents as matted hair, which are entangled to form a sticky mass. It gets the name Plica Polonica due to its high prevalence in poland in the 19th century. In Poland, Plica Polonica was seen very commonly due to deficient care of the hair as well as Polish custom of wearing tight fur caps and some other superstitions. The scalp hair has been a prime target of superstitious beliefs all over the world. In some cultures it is believed that unhealthy scalp and hair actually improves internal health. In India, it is a common religious custom to raise a plica or have long locks as an offering to God or to have divine image in the public. Plica Polonica may be caused due to external factors; however, those with religious beliefs towards formation of Plica Polonica deliberately create the irregular scalp hair mass by applying wax, tar, camphor, ash or some herbal mixtures. This article explains the clinical features, symptoms, causes and treatment of Plica Polonica.

What is Plica Polonica ?

Plica Polonica appears as compact or solid mass of scalp hair with irregular twists. The hair is irreversibly entangled to form plaits. The hair plaits get very hard over time as the keratin mass gets cemented together with dirt and exudates. The scalp hairs have matted appearance that is impenetrable. Plica Polonica is also known as birds nest due to its resemblance to irregular twists of a nest.

Background of Plica Polonica

Plica Polonica was first mentioned by Le Page in 1884 to describe a case of a patient with hysteria who developed sudden onset of entangled hair. In India, the mention of matted hair of Plica Polonica dates back to 2500 BC with the Hindu scriptures of Lord Shiva and his followers. The scriptures mention the condition as “JaTaa” meaning twisted hair dreadlocks. The religious followers known as “sadhus” would maintain the dreadlock with belief that knotted hair kept the energy within the hair and the body, which makes a person strong and healthy. The term Plica Polonica was coined for matted hair as this hair condition was very common in Poland in the 19th century among people who had poor hair hygiene and ignored self – care.

Symptoms of Plica Polonica

Plica Polonica shows some very typical symptoms such as,

Irregular twists and tangles in scalp hair
Formation of hard keratin mass that is impenetrable
Foul smell from hair mass
Hair cemented together with formation of pus, blood, crusts and dirt
Hair loss from rest of the scalp
Infestation with nits and lice
Inflammation of scalp

Causes of Plica Polonica

The causes of Plica Polonica are not known completely. However, the experts believe that Plica Polonica is caused by a combination of physical, chemical and behavioural factors.

The common causes of Plica Polonica include,

Frequent use of harsh shampoos that causes hair splitting
Poor scalp hygiene
Infestation with lice
Irritant contact dermatitis of the scalp
Psychological disturbances
Vigorous rubbing of hair

While these are some of the most common causes of Plica Polonica. In some cases Plica Polonica could be created for religious beliefs and superstitions by applying material such as gums, waxes, tar, and some herbal hair masks.

Risk factors of Plica Polonica

Plica Polonica has been reported in adults as well as children. Factors that include the likelihood of developing tangles and twisted hair include,

Having kinky hair
Women with long curly hair
Longitudinal splitting and weathering of the hair
Habit of vigorously rubbing, pulling or twisting hair
Mental condition such as schizophrenia, depression, hysteria or other
Pyoderma scalp
Taking specific medication e.g. azathioprine
Febrile illness
Excessive sweating on the scalp
Wearing tight caps of scarves that increase friction on the scalp

Treatment of Plica Polonica

The treatment of Plica Polonica begins once the diagnosis of hair matting is confirmed on the basis of appearance of twisted hair mass and careful examination of scalp. Trichoscopy may be used to detect hair twisting, formation of hard keratin mass and, nits and lice infestations.

The treatment for severe Plica Polonica is usually difficult. People with psychological disturbances may get aggressive during treatment while those with religious belief may totally deny the treatment.

The early stage of Plica Polonica can be performed by,

Thorough washing of hair with shampoo
Manually separating the entangled hair using organic solvents

In severe case of Plica Polonica where an inflammation of scalp, infestation with lice, and formation of hard keratin mass is observed the treatment includes,

Cutting the matted hair
Completely shaving off the head
Overnight application of insecticides such as 1% permethrin lotion for lice infestation
Broad-spectrum oral antibiotics to treat bacterial infection