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| CASE REPORT |
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| Year : 2022 | Volume
: 14
| Issue : 6 | Page : 210-212 |
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Sudden hair “felting” during styling procedure: The puzzle is solved
Enas A. S. Attia
Department of Dermatology and Venereology, AIN Shams University, Cairo, Egypt; Department of Dermatology, Queen Hospital, Doha, Qatar
| Date of Submission | 28-Nov-2021 |
| Date of Acceptance | 14-Jun-2022 |
| Date of Web Publication | 31-Jan-2023 |
Correspondence Address:
Enas A. S. Attia
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, AIN Shams University, P. O. 11566, Cairo
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijt.ijt_113_21
 Abstract | | |
Acute scalp hair “felting” is a rare acquired condition that presents with sudden severe twisting, entangling, and matting of scalp hair into a stiff tightly packed mass, in otherwise healthy individuals. In such conditions, the mechanism of hair matting is almost like the process of “felting” in wool and textile industry, where adjacent fibers are compacted together in a warm liquid medium. Herein, a case of acute hair “felting” during styling practice is discussed with the possible predisposing factors, prophylaxis, and treatment.
Keywords: Acute, hair, matting, styling
How to cite this article:
Attia EA. Sudden hair “felting” during styling procedure: The puzzle is solved. Int J Trichol 2022;14:210-2 |
| Introduction | |  |
Acute scalp hair “felting” in otherwise healthy individuals is a rare disorder of scalp hair. Herein, a case is presented where acute hair “felting” occurred following the usage of a coconut hair mask for the first time in an otherwise healthy woman.
| Case Report | | |
A 30-year-old woman presented with sudden hair matting during a styling procedure. She visited the beauty salon to have a “nourishing hair mask,” where the beautician divided the hair into tufts and applied coconut cream mask on each tuft. Each tuft was then bent in a circular pattern and left for 30 min. Once the beautician attempted to shampoo the hair, sudden hair matting occurred. Further attempts of using hot water and blow drier just worsened the condition. The patient attempts to detangle the matted hair over the following days failed. Finally, she cut the matted mass and the rest of her hair short. There was no previous history of comorbid scalp condition or any recent styling procedure, and this was the first time for the patient to have coconut hair mask. The patient presented a mass of cut matted hair together with apparently normal cut tufts of her hair. On examination, a hair “felt” appeared as a compact dry lustreless bleached hair mass resembling a bird's nest, compared to the more or less normal cut tufts of hair [Figure 1]. The scalp was normal with no evidence of parasitic infestation or pyoderma, and with adequate hygiene. After the patient's consent, the matted hair mass was embedded in acetone as an organic solvent overnight, and resulted in partial detangling [Figure 2]. The patient and her family were reassured that the hair will grow normally and were counseled to overcome the emotional stress following the incident with recommended psychiatric support. | Figure 1: (a) Gross and dermoscopic appearance of a compact dry lustreless partially bleached hair mass resembling a bird's nest. (b) Gross and dermoscopic appearance of apparently normal cut tufts of hair
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 | Figure 2: Partial detangling of the hair mass after overnight application of acetone (organic solvent)
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| Discussion | | |
Acute scalp hair “felting” in otherwise normal individuals, with no local or systemic comorbidities, is a rare condition, previously reported in women with long hair, enhanced by longitudinal splitting and weathering of the hair, on vigorous use of soap or shampoo,[1],[2] and after the application of coconut and castor oil.[3] This condition differs from cases of neglected hair hygiene, parasitic hair infestations and pyoderma of long dense hair, or deliberate forms of hair matting known as dreadlocks or jata in some cultures.[4] It also differs from cases of plica polonica described in Schizophrenia,[5] and cases of acute hair matting associated with shaft cuticular damage, described with immunosuppressive drugs.[6]
The presented case is sudden hair “felting” following the application of coconut cream hair mask, containing Cocos nucifera (coconut) oil, known to be safe as cosmetic ingredients.[7] However, the styling procedure followed the exact steps done in “felting.”
”Felting” is the term commonly used in wool and textile industry. Felt is a structure build up from interlocking of wool fibers or animal hairs by a suitable combination of mechanical work, chemical action, moisture and heat without spinning, weaving or knitting. The handmade felt is prepared after thorough blending, mixing, and opening of the fibers by Dhunak (grease or glue in Urdu). The opened fibers in the form of web are wetted by warm alkali solution and 3% soap solution. Thereafter, pressure is applied by hands/rollers to facilitate their permanent felting, i.e., interlocking into one piece. If the mats are randomly extended, they are manufactured on special machines that supply the filaments with an air current on a heavy, hot, back- and-forth moving plate or between heated rollers, with steam shedding through the bristles, and exposed to saponified, or emulsified solutions to increase the cohesion of the bristles. Thus, the bristles are exposed to heat, moisture, saponification, and friction for felting.[8],[9],[10]
Similarly, in the presented case, coconut cream mask was applied on long hair with intense oscillatory rubbing in a warm saponified liquid medium when shampooed, then exposed to hot air blow drier, resulted in the cohesion of contiguous hair fibers into felted bunch, ending up in bird's nest hair.
The avoidance of vigorous rubbing of greasy hair in hot saponified water is the cornerstone of prophylaxis. It is recommended to detangle the greased hair and deeply condition to reduce static electricity before washing with a mild shampoo. People with long hair are advised to periodically trim their hair and avoid piling their hair over the crown while washing and backcombing, as well as avoid rotatory rubbing of hair.
The treatment involves the manual separation of the twisted hairs aided using an organic solvent in the early stages or cutting out the matted hair with appropriate psychological support.
| Conclusion | | |
Acute hair “felting” following coconut hair mask application is reported for the first time. The avoidance of vigorous rubbing of the greasy hair in hot saponified water is the corner stone of prophylaxis. Beautician and people with long hair have to be taught how to avoid such incidents. Treatment of felted hair with organic solvent ensures a good prognosis especially if done early. Otherwise, cutting off the affected hair can be done with appropriate psychological support.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ramanan C, Ghorpade A. Plica neuropathica after using herbal soap. Int J Dermatol 1993;32:200-1.  |
| 2. | Kaur T, Singh D, Malhotra SK, Singh J. Plica polonica after use of shampoo. Int J Trichology 2016;8:46-7. |
| 3. | Maduri VR, Vedachalam A, Kiruthika S. “Castor Oil” – The culprit of acute hair felting. Int J Trichology 2017;9:116-8. |
| 4. | Bhatia A, Kanish B. Plica neuropathica (Polonica) – A matter of faith. Int J Sci Study 2014;2:91-2. |
| 5. | Singla M, Williams A. Paranoid schizophrenia with plica polonica. Delhi Psychiatry J 2014;17:201-3. |
| 6. | Joshi R, Singh S. Plica neuropathica (Plica polonica) following azathioprine-induced pancytopenia. Int J Trichology 2010;2:110-2. |
| 7. | Burnett CL, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG Jr., Shank RC, et al. Final report on the safety assessment of Cocos nucifera (coconut) oil and related ingredients. Int J Toxicol 2011;30:5S-16S. |
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| 9. | Anisha S, Sukhjot K, Sunil GK, Sandeep P. Bird's nest view from a dermatologist's eye. Int J Trichology 2016;8:1-4. |
| 10. | Jorie J. Felt Making and Wool Magic: Contemporary Techniques and Beautiful Projects. Gloucester, MA: Quarry; 2006. |
[Figure 1], [Figure 2]
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