Abstract
Background:
Plica neuropathica (PN) is an acquired hair disorder characterized by sudden onset, irreversible hair matting, which seems to be a compact hair mass with irregular twists.
Aim and Objective:
This study aimed to evaluate the clinicodemographic features of PN.
Materials and Methods:
This study was a cross-sectional prospective clinical research that included patients with PN. All the included patients were subjected to a detailed history of clinicodemographic data and clinical with trichoscopic examinations of the affected hair and scalp.
Results:
This study included 18 female patients with PN, with a mean age of 23.94 ± 7.9 years. All the patients presented with PN had acute onset and progressive course, psychological stressful factors preceding PN, negligence of hair care, no history of hair care product use, no history of hair straightening, no previous treatment preceding PN, and no history of systemic diseases. Recurrence of PN was reported in 4 (22.2%) patients. On trichoscopic evaluation, all patients were presented with normal scalp and matting of hair shaft with honey-colored concretions mimicking the “wrangled mesh of wires” appearance. Sixteen (88.9%) patients were treated with cutting hair mass. Most of the included patients reported very large and extremely large effects on the quality of life.
Conclusion:
This study concluded that PN is an uncommon acquired hair matting disorder prevalent in young age females. It is associated with marked impairment of the patient’s quality of life. Psychological stressful factors and negligence of hair care are the main risk factors for PN. Regular hair care measures are essential to prevent hair matting.
Keywords: Clinicodemographic study, hair matting, plica neuropathica
Introduction
Plica neuropathica (PN) is an acquired hair disorder characterized by sudden onset, irreversible hair matting that seems to be a compact hair mass with irregular twists and normal scalp.[1,2] It is a relatively rare hair disorder with unknown incidence or prevalence.[3]
The exact etiopathogenesis of PN is not fully understood. Numerous factors have been suggested for the occurrence of PN, but none have been fully conclusive. These factors include electrostatic forces, hair care products, scalp infection or infestation, behavioral factors such as rubbing or neglecting hair, and psychological disorders.[4]
This study aimed to evaluate the clinicodemographic features of PN.
Materials and Methods
This study was a cross-sectional prospective clinical research. It was conducted at dermatology outpatient clinics, Sohag University Hospital. It included 18 patients with clinically evident PN.
Patients were subjected to detailed history taking, including age, sex, residence, marital status, occupation, educational level, and special habits. The onset, course, and duration of PN were assessed. Histories of psychological problems, use of any hair manipulation procedure, use of any hair cosmeceuticals, and past history of similar conditions or previous medications were evaluated. History of any systemic diseases or treatment was included. Patient quality of life was assessed by a 10-item dermatology life quality index (DLQI).[5]
A general examination was conducted to exclude any systemic disorders. A full dermatologic examination was conducted to assess any associated dermatological disorder. The affected hair and scalp were clinically evaluated to assess the type of hair, odor of the affected hair, and evidence of scalp infection or infestation. Trichoscopic examination of the affected hair and scalp was performed. Treatment options for PN were recorded.
Ethical considerations
The study was approved by the Ethical and Scientific Committee of the Faculty of Medicine at Sohag University. The approval number was (Soh-Med-22-12-33). Informed consent was obtained from all patients after a full explanation of the benefits of this study.
Statistical analysis
The data was analyzed using the Statistical Package for Social Sciences (IBM-SPSS/PC/VER. 24). Data was presented as mean ± standard deviation (SD), frequencies, and percentages.
Results
This study included 18 female patients with PN, with a mean age of 23.94 ± 7.9. Most of the included patients were from rural areas, were not working, and had moderate to high educational levels. All the patients presented with PN had acute onset and progressive course, with a mean duration (25.9 ± 11.5) days. Also, all the patients had the following characteristics: psychological stressful factors preceding PN, negligence of hair care, no history of hair care product use, no history of hair straightening, no previous treatment preceding PN, no family history of PN, and no history of systemic diseases. Recurrence of PN was reported in 4 (22.2%) patients. All the patients had normal general and cutaneous examinations [Table 1].
Table 1.
Demographic and clinical presentations of 18 patients with PN
| Variable | Data |
|---|---|
| Demographic and clinical features | |
| No. of the included patients | 18 |
| Age (year) | |
| Mean±SD | 23.94±7.90 |
| Range | (14-45) |
| Sex | Female, 18 (100%) |
| Residence | Rural, 13 (72.2%) |
| Urban, 5 (27.8%) | |
| Occupation | No working, 11 (61.1%) |
| Student, 4 (22.2%) | |
| Teacher, 2 (11.1%) | |
| Marital status | Single, 9 (50%) |
| Married, 9 (50%) | |
| Education level | Low, 4 (22.2%) |
| Moderate, 10 (55.6%) | |
| High, 4 (22.2%) | |
| Special habits | No special habits, 18 (100%), |
| Onset of PN | Sudden, 18 (100%) |
| Course of PN | Progressive, 18 (100%) |
| Duration of PN (mean±SD (day)) | 25.9±11.5 |
| Psychological stressful factors preceding PN | Yes, 18 (100%) |
| History of hair care products use | No, 18 (100%) |
| History of hair straightening | No, 18 (100%) |
| Negligence of hair care | Yes, 18 (100%) |
| Previous treatment preceding PN | No, 18 (100%) |
| Past history of PN (recurrence) | No, 14 (77.8%) |
| Yes, 4 (22.2%) | |
| Family history of PN | No, 18 (100%) |
| History of systemic diseases | No, 18 (100%) |
| Examination | |
| General examination | Normal, 18 (100%) |
| Cutaneous examination | Normal, 18 (100%) |
| Scalp and hair examination | |
| Hair type | Wavy, 10 (55.6%) |
| Curly, 8 (44.4%) | |
| Offensive odor | Yes, 11 (61.1%) |
| No, 7 (38.9%) | |
| Evidence of scalp infection or infestation | No, 16 (88.9%) |
| Yes (pediculosis), 2 (11.1%) | |
| Trichoscopic findings | Normal, 18 (100%), normal scalp. |
| Matting of hair shaft with honey-colored concretions mimicking “wrangled mesh of wires” appearance, 18 (100%). | |
| Pediculosis, 2 (11.1%) | |
| Treatment | |
| Treatment options of PN | Cutting hair mass, 16 (88.9%) |
| Cutting only hair knobs combing with serum, 2 (11.1%) |
PN: plica neuropathica. Data were presented as mean±standard deviation (SD), frequencies, and percentages
During the clinical examination of the scalp and hair examination, all the patients were presented with hair matting. Ten (55.6%) patients presented with wavy hair, 11 (61.1%) patients had an offensive odor of the hair and scalp, and evidence of pediculosis was presented in 2 (11.1%) patients. On trichoscopic evaluation, all patients were presented with normal scalp and matting of hair shaft with honey-colored concretions mimicking “a wrangled mesh of wires” appearance. 2 (11.1%) patients were presented with pediculosis. 16 (88.9%) patients were treated with cutting hair mass [Table 1 and Figures 1-3].
Figure 1.
A 17-year-old female patient presented with PN
Figure 3.
Matting of hair shaft with honey-colored concretions mimicking “a wrangled mesh of wires” appearance
Figure 2.
A 25-year-old female patient presented with PN
Most of the included patients reported extremely large effects on the quality of life [Table 2].
Table 2.
Dermatology life quality index score of 18 patients with PN
| No. of questions | Questions | Scores |
|---|---|---|
| 1 | Itch/pain | 0: 7 (38.9%) |
| 1: 8 (44.4%) | ||
| 2: 3 (16.7%) | ||
| 3: 0 | ||
| 2 | Embarrassment | 0: 0 |
| 1: 0 | ||
| 2: 4 (22.2%) | ||
| 3: 14 (77.8%) | ||
| 3 | Shopping/looking after home or garden | 0: 4 (22.2%) |
| 1: 1 (5.6%) | ||
| 2: 6 (33.3%) | ||
| 3: 7 (38.9%) | ||
| 4 | Clothing | 0: 1 (5.6%) |
| 1: 0 | ||
| 2: 1 (5.6%) | ||
| 3: 16 (88.9%) | ||
| 5 | Social or leisure activities | 0: 7 (38.9%) |
| 1: 4 (22.2%) | ||
| 2: 3 (16.7%) | ||
| 3: 4 (22.2%) | ||
| 6 | Sports | 0: 88 (44.4%) |
| 1: 1 (5.6%) | ||
| 2: 1 (5.6%) | ||
| 3: 8 (44.4%) | ||
| 7 | Work/study | 0: 8 (44.4%) |
| 1: 4 (22.2%) | ||
| 2: 3 (16.7%) | ||
| 3: 3 (16.7%) | ||
| 8 | Problems with partners/close friends/relatives | 0: 1 (5.6%) |
| 1: : 5 (27.8%) | ||
| 2: 3 (16.7%) | ||
| 3: 9 (50%) | ||
| 9 | Sexual difficulties | 0: 11 (61.1%) |
| 1: 0 | ||
| 2: 1 (5.6%) | ||
| 3: 6 (33.3%) | ||
| 10 | Treatment | 0: 0 |
| 1: 5 (27.8%) | ||
| 2: 7 (38.9%) | ||
| 3: 6 (33.3%) | ||
| Total | Interpretation meaning of DLQI Scores | |
| No effect at all on patient’s life | 0 | |
| Small effect on patient’s life | 0 | |
| Moderate effect on patient’s life | 2 (11.1%) | |
| Very large effect on patient’s life | 9 (50%) | |
| Extremely large effect on patient’s life | 7 (38.9%) |
Scoring: 0: or Not relevant scored, 0: Not at all scored, 1: A little scored, 2: A lot scored, 3: Very much scored. Interpretation meaning of dermatology life quality index scores: 0–1: no effect at all on patient’s life, 2–5: small effect on patient’s life, 6-10: moderate effect on patient’s life, 11–20: very large effect on patient’s life, 21–30: extremely large effect on patient’s life.[5]. PN: plica neuropathica. Data were presented as frequencies and percentages
Discussion
This study was cross-sectional prospective research aimed at evaluating the clinicodemographic characteristics of PN. This study included 18 female patients with PN, with a mean age of 23.94 ± 7.9. However, the prevalence of PN is unknown; female predilection has been reported, possibly because women tend to have longer hair and an increased risk of developing psychological disorders.[1,2,3] In addition, PN was first reported by Le Page in 1884, who presented a 17-year-old female patient suffering from hysteria, whose hair was tangled into a solid hair mass that she could not untangle.[6]
In this study, all patients were clinically presented with sudden onset of hair matting as compact mass with irregular hair twists, progressive course, with a mean duration (25.9 ± 11.5) days. These findings were in agreement with several studies.[1,2,3,4]
This study reported that most of the patients were from rural areas, were not working, and had moderate to high educational levels. All the patients had psychological stressful factors preceding PN, and this finding was in agreement with several studies; PN was more prevalent among patients with psychological disturbances that included schizophrenia, severe depression, obsessive-compulsive disorder, and mixed anxiety-depressive disorder.[3,6,7,8,9,10] Also, the current study reported that most of the included patients reported very large impairments in the quality of life.
The negligence of hair care was reported in all the patients with PN, and this finding was in agreement with several studies.[3,10] In addition, most of the patients had an offensive odor of the hair and scalp, and evidence of pediculosis was presented in 2 (11.1%) patients. This inappropriate self-hair care and negligence could be related to the psychologically stressful factors preceding PN that may increase the risk of PN.
The recurrence of PN was reported in 4 (22.2%) of the patients, and this could be partially due to the persistence of psychological stressful factors with negligence of hair care. It has been reported that the appropriate hair care measures, such as regular and continuous cleaning of hair with shampoos, hair conditioners, gentle oiling, and combing with proper hair trimming, were essential to prevent hair matting.[11]
This study reported that there was no history of any systemic disease or drug use preceding PN. However, it has been reported that drug-induced hair matting, e.g. azathioprine, methotrexate, doxorubicin, paclitaxel, carboplatin, cyclophosphamide, and cisplatin, was recorded. The chemotherapeutic drugs could impair or disrupt the anagen hair phase, causing hair follicle dystrophy and damage of hair cuticles, which may predispose to PN.[12,13]
On trichoscopic evaluations, all patients with PN were presented with normal scalp and matting of hair shaft with honey-colored concretions mimicking “wrangled mesh of wires.” This finding was consistent with numerous studies.[1,10,14]
The treatment of PN is still challenging because simple modalities such as manual hair separation and hair soaking with organic solvents are usually ineffective. In this study, most of the patients were treated with cutting hair mass. These findings were in agreement with numerous studies.[1,10,11]
Conclusion
This study concluded that PN is an uncommon acquired hair matting disorder prevalent in young age females. It is associated with marked impairment of the patient’s quality of life. Psychological stressful factors and negligence of hair care are the main risk factors for PN. Regular hair care measures with shampoos, hair conditioners, gentle oiling, and combing with proper hair trimming were essential to prevent hair matting.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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