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Year : 2022  |  Volume : 14  |  Issue : 5  |  Page : 183-185  

Alopecia areata complicated by plica neuropathica: A rare case report

1 Department of Dermatology, Jhalawar Medical College, Jhalawar, Rajasthan, India
2 Deparment of Dermatology, SNMC, Jodhpur, Rajasthan, India

Date of Submission15-Jan-2022
Date of Decision19-Jun-2022
Date of Acceptance22-Jun-2022
Date of Web Publication07-Oct-2022

Correspondence Address:
Akshay Kumar Jain
House Number 415, New Rajiv Gandhi Nagar, Kota, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijt.ijt_10_22

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Plica neuropathica is a rare scalp condition, which is manifested as a compact mass of scalp hair. Previously, it has been found to be associated with a variety of dermatological disorders. We report a case of 15-year-old female presenting with alopecia areata associated with plica neuropathica.

Keywords: Alopecia areata, neurodermatology, plica polonica

How to cite this article:
Agarwal S, Vijay A, Sharma MK, Jain AK. Alopecia areata complicated by plica neuropathica: A rare case report. Int J Trichol 2022;14:183-5

How to cite this URL:
Agarwal S, Vijay A, Sharma MK, Jain AK. Alopecia areata complicated by plica neuropathica: A rare case report. Int J Trichol [serial online] 2022 [cited 2023 Feb 4];14:183-5. Available from: https://www.ijtrichology.com/text.asp?2022/14/5/183/358097

   Introduction Top

Plica neuropathica also known as plica polonica, felting, or bird's nest hair is an uncommon acquired disorder of the scalp clinically seen as irreversible entanglement of matted scalp hair associated with gross self-neglect.[1],[2] The condition has been reported in association with psychiatric disorders, ectoparasitoses, vesiculobullous disorders, and the use of hair shampoos with cationic surfactants. Herein, we report a case of alopecia areata associated with prurigo nodularis (PN) arising due to poor hair hygiene due to fear of losing more hairs.

   Case Report Top

A 15-year-old female presented with a 3-month history of alopecia involving 70% of the scalp and patchy nonscarring alopecia involving left eyebrows and increasingly matted hairs involving remaining hairs. Due to rapid hair fall, she was restricted by her family members to cut or wash her hair using shampoos or to use comb to detangle hair. She used a scarf to cover her hair all the time to avoid social stigmatization arising from hair loss. There was no history of itching, pain, or malodor in the lesions. She was otherwise healthy, and there was no history of any concomitant psychiatric disorder. No history of pediculosis capitis mites or any other ectoparasite or scalp could be elicited.

On local cutaneous examination, multiple patches of nonscarring alopecia involving frontal, bilateral parietal, and occipital scalp (covering almost 70% scalp) and 40% of the left eyebrow. There were masses of matted hairs covering the rest of 30% of the scalp. There were no signs of infestation or inflammation over the scalp [Figure 1]. Examination of nails, skin, and oral mucosa was unremarkable. Systemic examination did not reveal any significant abnormality. There was no history of any drug intake before the onset of lesions.
Figure 1: Alopecia areata involving 60% of the scalp and 40% of the left eyebrow associated with matted mass of remaining hairs of the scalp

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Her routine blood reports were within normal limits including complete blood count, liver function tests, and renal function tests. Potassium hydroxide mount of hairs was negative for fungal elements.

On the basis of history and clinical examination, a diagnosis of alopecia areata associated with plica neuropathica was made. The patient was advised to start treatment of alopecia areata, cut her hair short, and practice standard hair hygiene measures. For the treatment of plica neuropathica, the patient was advised to shave her head clear, because due to extensive alopecia areata involving the scalp and remaining hairs forming a ball of matted hairs, it was difficult to salvage remaining hair, maintain hair hygiene, and apply topical medicines.

   Discussion Top

PN is a rare scalp condition clinically characterized by irreversible twisting, matting, and entanglement of hairs resulting from gross hair care neglect. The pathogenesis of PN is largely unknown, and multifactorial causes have been implicated in the causation of this entity.[3],[4] It is often simulated to felting in the textile industry which is a compaction of fabric fibers subjected to simultaneous friction and compaction in a liquid medium.[5] Over rigorous manipulation of curly and long hairs combined with viscous fluid welding also contributes to felting.[6] Electrostatic attraction triggered by ionic surfactants and increased by rubbing can also trigger felting.[7] Other causation factors include excessive weathering and fraying in hairs which are not cut timely. It has been associated with psychiatric disorders, ectoparasitoses, infections, psoriasis, seborrheic dermatitis, shampoos with cationic surfactants, drugs, and chronic scalp hair care neglect. [Table 1] describes various etiopathogenetic factors associated with plica neuropathica.
Table 1: Etiopathogensis of pilca neuropathica

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Here, the case presented is unique because as plica neuropathica is caused by three factors – acute shedding of hairs due to alopecia areata, fear to comb or shampoo hair to keep remaining hairs intact, and continuous covering of the head to avoid social stigma associated with a girl having alopecia.

To the best of our knowledge, this is the first case report of plica neuropathica associated with alopecia areata.

Declaration of patient consent

We have obtained informed written consent from the patient's guardian to publish clinical details and photos of the patient. The patient and her guardians understand that efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Marshall J, Parker C. Felted hair untangled. J Am Acad Dermatol 1989;20:688-90.  Back to cited text no. 1
Kwinter J, Weinstein M. Plica neuropathica: Novel presentation of a rare disease. Clin Exp Dermatol 2006;31:790-2.  Back to cited text no. 2
Brar BK, Mahajan B, Kamra N. Felted hair in rupoid psoriasis: A rare association. Int J Trichology 2014;6:69-70.  Back to cited text no. 3
Osorio C, Fernandes K, Guedes J, Aguiar F, Silva Filho N, Lima RB, et al. Plica polonica secondary to seborrheic dermatitis. J Eur Acad Dermatol Venereol 2016;30:e134-5.  Back to cited text no. 4
Bogaty H, Dunlap FE. Matting of hair. Arch Dermatol 1970;101:348-51.  Back to cited text no. 5
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
Anisha S, Sukhjot K, Sunil GK, Sandeep P. Bird's nest view from a dermatologist's eye. Int J Trichology 2016;6:69-70.  Back to cited text no. 7


  [Figure 1]

  [Table 1]


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