Department of Dermatology, SRM Medical College Hospital & Research Centre, Kattankulathur – 603203, Kancheepuram District, Tamilnadu, India
(To be published in International Journal of Dermatology - Accepted in March 2006)
Plica polonica is an uncommon condition in which groups of hair shafts become irreversibly entangled forming a matted and sticky moist mass. The exact mechanism is not understood but multiple factors such as physical conditions, chemical agents and behavioral factors play a role. Fortunately cutting of the affected hair and avoidance of all possible triggering factors are effective treatments.
We report a child with plica polonica associated with pediculosis capitis and scabies
Keywords: Plica polonica, pediculosis capitis, matted hair, Polish plait
Plica polonica is a rare disorder of hair in which groups of hair shafts become irreversibly entangled forming a matted, malodorous and encrusted, sticky moist mass. Various predisposing factors are known to cause this condition. We report one such case associated with pediculosis capitis and scabies.
A one-year-old female child was brought to our outpatient services by her mother with complaints of itching all over the body including the scalp for two months. The itching was more severe in the nights leading to irritability and lack of sleep. The mother also gave history of itching of her own body and scalp.
On physical examination, we found that the child was irritable, listless and malnourished. The scalp hair was matted together, entangled and unkempt. There were multiple pediculi and nits in the scalp hair. Pyoderma of the scalp was present with oozing and crusting. She had tender cervical lymphadenopathy. Multiple excoriated papules were present over the entire body with burrows in her finger web spaces.
Scrapings from the burrows revealed sarcoptes scabei. The patient was diagnosed to have scabies, pediculosis capitis with secondary pyoderma and plica polonica.
The child was treated with topical antiscabetics and oral antibiotics. The entire family was also treated for scabies and pediculosis capitis. The matted locks of hair were cut close to the scalp after which she recovered dramatically.
Plica polonica is a rare acquired disorder of the hair shafts in which groups of hair are matted together forming a malodorous, encrusted and sticky, moist mass.1 First records of dreadlocks go back to 2500 BC with the dreadlocked Hindu deity Shiva and his followers reported in the Vedic scriptures of India as “JaTaa”, meaning twisted locks of hair. The term is probably derived from the Dravidian word “CaTai”, which means ‘to twist or to wrap’. Later, it was also described in Poland in the eighteenth century.2 It is also known as ‘plica neuropathica’3 or ‘dread locks’.2 Le Page coined the term ‘plica polonica’ in 1884 when he described a 17-year-old girl with a sudden onset of tangled scalp hair.1 Le Page attributed this strange phenomenon to “nerve force” while the parents of the child considered it a “visitation from God”.
Plica polonica was quite common in Poland as early as the 16th century AD and hence the synonym ‘Polish Plait’. A growing plait was believed to take illnesses out of the body and therefore it was rarely cut off. In addition, the Polish custom of wearing tight fur caps and the superstition that a lousy scalp was healthy contributed to deficient hair care and eventually plica polonica.4
Various predisposing factors have been identified. They include pediculosis capitis5 with pyoderma, poor hygiene and deficient hair care, which is commonly seen in vagabonds, mentally retarded or ill patients.1 Other factors that play a role are hair with natural kinks6 and certain shampoos used7. Religious ‘sadhus’ of certain religions who have chronic unkempt hair are also prone to develop plica polonica. Members of a Jamaician religious movement called ‘Rastafarian’ are said to have had plica polonica and hence the term ‘Rastafarian hair style’.
The exact mechanism of hair matting is poorly understood but it is thought to be due to damage to the sections of cuticle thereby exposing sticky cortex to which similar other hairs adhere.
Treatment includes cutting of the affected hair and treatment of the underlying predisposing factors.8 Plica polonica can be prevented by early and prompt treatment of predisposing factors like pediculosis capitis and maintenance of hair hygiene.
In our patient, poor hygiene is probably the factor that contributed to plica polonica as evidenced by the association of pediculosis capitis and scabies. We report this case for its rarity of occurrence.