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

How is Plica Polonica prevented?

Prevention tips for plica Polonica or matted hair include,

• Regular cleaning of the hair with mild cleansers
• Avoiding harsh chemicals or shampoos
• Regular scalp massage with oil
• Regular use of hair conditioner
• Keeping the hair moist or hydrated by using good moisturizer
• Gentle combing to avoid entangling
• Regular hair trimming
• Avoiding piling hair over the crown while washing
• Avoiding backcombing for prevention of tangles
• Changing habit of twisting hair