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CASE REPORT
Year : 2014  |  Volume : 6  |  Issue : 2  |  Page : 69-70  

Felted hair in rupoid psoriasis: A rare association


Department of Dermatology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Date of Web Publication13-Aug-2014

Correspondence Address:
Nidhi Kamra
Department of Dermatology, Guru Gobind Singh Medical College and Hospital, Saadiq Road, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7753.138592

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   Abstract 

Plica polonica is an acquired condition characterized by irreversible matting of hairs. It has been most commonly reported in association with psychiatric disorders. Here, we report a case of felting in rupoid psoriasis in a 13-year-old female.

Keywords: Felted hairs, plica polonica, rupoid psoriasis


How to cite this article:
Brar BK, Mahajan B B, Kamra N. Felted hair in rupoid psoriasis: A rare association. Int J Trichol 2014;6:69-70

How to cite this URL:
Brar BK, Mahajan B B, Kamra N. Felted hair in rupoid psoriasis: A rare association. Int J Trichol [serial online] 2014 [cited 2020 Sep 27];6:69-70. Available from: http://www.ijtrichology.com/text.asp?2014/6/2/69/138592


   Introduction Top


Plica polonica/plica neuropathica is a rare acquired condition of sudden onset characterized by irreversible entanglement of hair. [1] The term was coined by Le page in 1884, when he described a 17-year-old girl with a sudden onset of tangled scalp hair. [2] Simpson and Mullins subsequently reported instances of this disorder in association with various psychiatric disorders. [3] The condition is not uncommon and has been reported in various psychiatric disorders, parasitic infestations, vesico-bullous disorders, neglect of scalp hair and with the use of shampoos and hair lotions with cationic surfactants. To the best of our knowledge, it has not been described previously in association with rupoid psoriasis.


   Case report Top


A 13-year-old female patient presented to our outpatient department with thick, scaly, cone-shaped lesions present over the trunk, back, upper, and lower extremities since 1 month. There was no history suggestive of any systemic or psychiatric illness. On examination multiple, discrete to confluent limpet-like, cone-shaped lesions were present on the above mentioned sites with erythema and slight scaling present over the face [Figure 1]. On the scalp, multiple plaques with asbestos like scaling were firmly adherent to the scalp and associated hairs [Figure 1]. All the finger and toe nails showed psoriatic nail changes. On clinico-pathological basis [Figure 2] diagnosis of rupoid psoriasis was made. All routine investigations were within the normal limits. She was started on 10 mg of methotrexate weekly and potent topical corticosteroid preparation over the affected sites, with significant clinical improvement of the cutaneous and scalp lesions, but with matting of hairs over the vertex of the scalp after 1 month, while patient was on the same treatment. History of vigorous rubbing of hairs was present. On examination, scalp had a matted, intertwined hair mass over the vertex and occipital region [Figure 1]. The hairs were strongly felted and could not be separated. The underlying scalp skin over the vertex and occipital region was normal, and there was no evidence of pediculosis or psoriatic lesions. Slight scaling was present on the frontal region of the scalp. Light microscopic examination of the involved hair revealed bending and twisting, but no hair shaft abnormality was present.
Figure 1: (a) Limpet-like scales of rupoid psoriasis present over the back. (b) Slight scaling and erythema over the face. (c) Thick psoriatic plaques over the scalp. (d) Felted hairs over the vertex and occiput

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Figure 2: Histopathology showed psoriasiform epidermal hyperplasia, remarkable microabsesses in the horny layer with dense dermal edema and inflammatory infiltrate

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   Discussion Top


Irreversible matting of scalp hair is rare but well described condition. In situations of gross neglect, it has been called plica polonica. In cases with hysterical illness it has been described as plica neuropathica. [4] Bogaty and Dunlap first used the term "matting of hair" in 1970 and compared the condition with "felting." [5] Various physical factors have been attributed to the pathogenesis of plica [Table 1]. In our case, vigorous rubbing of hairs may have resulted in matting. Though various immunosupressants like azathioprine have been postulated as a cause for plica polonica, they caused hair shaft cuticle damage which was not seen in our case, ruling out methotrexate as a cause. [9]
Table 1: Physical factors attributed in pathogenesis of plica


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Treatment of plica is difficult except for cutting the affected hairs. On one occasion, a patient separated the tangled hair using a knitting needle and olive oil as a lubricating agent. [10]

 
   References Top

1.Kumar PN, Antony B, Chakravarthy A, Koyamu AM. Plica neuropathica (polonica) in schizophrenia - A case report and review of literature. Indian J Psychiatry 2001;43:281-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Le Page JF. On Neuropathic Plica. Br Med J 1884;1:160.  Back to cited text no. 2
[PUBMED]    
3.Simpson MH, Mullins JF. Plica neuropathica. Report of a case. Arch Dermatol 1969;100:457-8.  Back to cited text no. 3
[PUBMED]    
4.Khare AK. Plica neuropathica. Indian J Dermatol Venereol Leprol 1985;51:178-9.  Back to cited text no. 4
    
5.Bogaty H, Dunlap FE. Matting of hair. Arch Dermatol 1970;101:348-51.  Back to cited text no. 5
[PUBMED]    
6.Dawber R. Matting of scalp hair due to shampooing: A hypothesis as to the cause. Clin Exp Dermatol 1984;9:209-11.  Back to cited text no. 6
[PUBMED]    
7.Wilson CL, Ferguson DJ, Dawber RP. Matting of scalp hair during shampooing - A new look. Clin Exp Dermatol 1990;15:139-42.  Back to cited text no. 7
    
8.Marshall J, Parker C. Felted hair untangled. J Am Acad Dermatol 1989;20:688-90.  Back to cited text no. 8
    
9.Joshi R, Singh S. Plica neuropathica (Plica polonica) following azathioprine-induced pancytopenia. Int J Trichology 2010;2:110-2.  Back to cited text no. 9
    
10.Al Ghani MA, Geilen CC, Blume-Peytavi U, Orfanos CE. Matting of hair: A multifactorial enigma. Dermatology 2000;201:101-4.  Back to cited text no. 10
    


    Figures

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    Tables

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