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Year : 1990  |  Volume : 56  |  Issue : 2  |  Page : 141-142

Plica neuropathica causing traction alopecia

Correspondence Address:
K Pavithran

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A middle aged woman developed matting of the hairs of the scalp following use of a home made shampoo that contained leaves of Hibiscus rosasiensis. The entangled and matted hair mass in the occipital region pulled hairs of the vertex region of the scalp, resulting in a patch of traction alopecia. Release of tension on the hairs by cutting them with scissors prevented further extension of alopecia.

Keywords: Plica neuropathica, Plica polonica, Hair matting, Traction alopecia

How to cite this article:
Pavithran K. Plica neuropathica causing traction alopecia. Indian J Dermatol Venereol Leprol 1990;56:141-2

How to cite this URL:
Pavithran K. Plica neuropathica causing traction alopecia. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2021 Jan 17];56:141-2. Available from:

Plica neuropathica, also known as plica, polonica is an uncommon state in which the hairs of the scalp in a localised area is compacted into irregularly twisted, irreversibly entangled plaits. Only a few cases of plica neuropathica have been reported from India.[1],[2],[3],[4] The condition is usually induced by the repeated manipulation of the hairs by psychologically disturbed women.[5] It may also occur due to infection or infestation of the scalp or may follow use of shampoos containing cationic detergents.[4] sub According to Bogaty and Dunlap,[6] the process of matting is essentially similar to the `felting' of fibies familiar in the wool and textile industries. We report a case of plica polonica in a middle aged woman. The constant pull on the hairs resulted in a patch of alopecia on the vertex region and caused constant pain in the scalp.

  Case Report Top

A 45-year-old female developed irreversible tangling of the scalp hairs since one month. It developed following use of a home-made shampoo containing crushed leaves of Hibiscus rosasienensis (shoe flower plant) mixed with water. There was no history of application of detergents on the scalp or associated fever. The number of hairs affected by matting gradually increased and finally resulted in a firm hair mass of 12 x 6 cm on the occipital region[Figure - 1]. More and more hairs were pulled by the hair mass. The constant traction caused by this pull on the hairs resulted in a patch of alopecia of 8 X 5 cm on the vertex region and caused constant pain on the scalp. The patch was devoid of hairs, though a few vellus hairs persisted anteriorly [Figure - 2]. At the base of the hair mass, the hairs were seen under tension with one end attached to the skin and the other end to the matted hair mass. On the border of the patch of alopecia, many hairs under traction were seen detached from their follicles. There was no evidence of infection or infestation of the scalp. Attempts to remove the hairs forcibly front the hair mass resulted in their breakage. Examination of the hairs thus removed did not reveal any abnormality macro­scopically or microscopically. A detailed psy­chiatric evaluation of the patient revealed no abnormality. All other systems were clinically normal. Since she denied consent for complete removal of the hair mass, only the hairs that were under high tension due to traction were cut with scissors at sites where they just joined the entangled hair mass. This caused dramatic relief of her headache. She was advised to cut the hairs under tension at home and when seen after one month there was no further extension of alopecia though the entangled hair mass per­sisted. After this, she was lost to follow-up.

  Comments Top

The exact cause of development of plica neuropathica in our patient is not known, though she attributed it to use of a home-made shampoo. Such a shampoo is commonly used by women in this part of the country but none of them has been seen developing plica neuropathica. Usually plica neuropathica develops in patients with some psychological disturbance but our patient was mentally normal. Though curling, looping, intertwisting and matting of the hairs can occur in plica neuropathica, development of associated alopecia is quite unusual. Constant traction on the hairs of the vertex region in our case resulted in traction alopecia. Release of tension on these hairs by cutting them with scissors prevented further progression of alopecia and caused relief from her constant headache. Traction alopecia from prolonged tension on hairs usually results from wearing the hair tightly braided, pulling the hairs to straighten them or twisting the hairs with fingers. Traction alopecia developing secondary to constant pull on hairs by the entangled hair mass of plica neuropathica is quite unusual.

  References Top

1.Hajini GH, Ahmed QM and Ahmed M : Plica neuropathica, Ind J Dermatol Venereol Leprol, 1982; 48 :221-222.  Back to cited text no. 1    
2.Mani MZ and Sahni PS : Matting of hair due to `halo egg' shampoo, Ind J Dermatol Venereol Leprol, 1983; 49 : 138-140.  Back to cited text no. 2    
3.Khare AK : Plica neuropathica, Ind J Dermatol Venereol Leprol, 1985; 51 : 178-179.  Back to cited text no. 3    
4.Sharma PK, Saxena AK, Jain RK et al : Matting of the hair due to cationic detergent, Ind J Derma­tol Venereol Leprol, 1987; 53 : 179-180.  Back to cited text no. 4    
5.Simpson MH and Mullins JF : Plica neuropathica, Arch Dermatol, 1969; 100 : 457-458.  Back to cited text no. 5    
6.Bogaty H and Dunlap FE : Matting of hairs, Arch Dermatol, 1970; 101 : 348-351.  Back to cited text no. 6    


[Figure - 1], [Figure - 2]

This article has been cited by
1 Plica neuropathica: A mystery
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Pediatric Dermatology. 2004; 21(4): 477-478


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