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 Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 31  |  Issue : 2  |  Page : 161-162

Plica neuropathica: Looking at the sociocultural mirror


Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Sonitpur, Assam, India

Date of Web Publication6-Jan-2016

Correspondence Address:
Soumik Sengupta
Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Sonitpur, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.173287

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How to cite this article:
Dutta H, Sengupta S, Nath S, Tamuli K. Plica neuropathica: Looking at the sociocultural mirror. Indian J Soc Psychiatry 2015;31:161-2

How to cite this URL:
Dutta H, Sengupta S, Nath S, Tamuli K. Plica neuropathica: Looking at the sociocultural mirror. Indian J Soc Psychiatry [serial online] 2015 [cited 2019 Nov 12];31:161-2. Available from: http://www.indjsp.org/text.asp?2015/31/2/161/173287

Sir,

Plica neuropathica is a condition of abnormal development of hair characterized by curling, matting, looping, intertwisting, and felting over the scalp.[1] This term was coined by LePage in 1884 while describing a 17-year-old young woman with a sudden onset of tangled scalp hair.[2] LePage (1984) attributed this strange occurrence to “nerve force.” The condition is sparsely reported in literature but is very common in Hindu religious persons in our country.[2],[3] The Hindu deity Shiva and his followers were described in the scriptures as wearing “Jataa,” meaning “twisted locks of hair.”[4] Here, we have reported a case of plica neuropathica with undifferentiated schizophrenia in which cultural belief acted as a protective factor against the hostile attitude toward the patient.

Miss X, 33 years, Hindu, educated up to 8th standard, and from rural background, presented to our outpatient department with chief complaints of poor self-care, muttering, disorganized behavior, self-smiling, aggressiveness, and irrelevant talk for the last 5 months. Attendant reported that along with above symptomatologies, she developed curling, twisting, and tangling of her hair for the last 5 months. These abnormalities started appearing over the occipital area and became more prominent as her hair began to grow. After that, they did not touch or request to dress her hair as according to them, it has spiritual value. She used to wash her scalp in a 30 days interval but did not comb her hair regularly. On inquiry, she revealed that this abnormality of hair gave her protection against the physical abuse by her household members as they also commenced to believe religious influence on it.

The history revealed that she had suffered 2-3 episodes for the last 5 years. Her biological functions were normal.

Mental status examination revealed intact consciousness and orientation, decreased psychomotor activity, poor eye contact and rapport, poor personal hygiene and grooming, restricted affect, poverty of content of the speech, impaired judgment, and insight.

Physical examination, hematological, and biochemical parameters were within normal bounds. She was admitted to our hospital for detailed evaluation and was diagnosed to have undifferentiated schizophrenia as per International Classification of Diseases-10. Because of her poor hair condition, dermatological consultation was sought and was diagnosed as Plica neuropathica. Possibilities of other factors had been ruled out by a thorough history taking and physical examination. During hospital admission, her hair was cut with the due consent and olanzapine 20 mg in two divided dosages along with trihexyphenidyl 2 mg was started. She showed improvement with these medications, and no further abnormal growth of hair was noted at the time of discharge. Psycho-education to the patient as well as the family was provided regarding the connection between the mental illness and abnormal hair growth. The patient had been maintaining well on subsequent visits.

Plica neuropathica is seen very frequently, but its connection with schizophrenia has been less reported. Several risk factors for plica have been reported are mainly psychological disturbances, lice infection, use of shampoos, poor hair care, hair with natural twists, the electrostatic attraction between the hairs, vigorous rubbing of hair in a rotating manner, improper care resulting in severe infestations with resultant exudates causing matting of hair, and chemical exposure.[1],[5] As our patient was suffering from undifferentiated schizophrenia, she was not maintaining her self-care, which may be a predisposing factor for the unconventional growth of her hair. Aside from this, religious belief associated with plica neuropathica played an important perpetuating factor in maintaining this peculiar hair growth. In our patient, as there were no other factors, lack of hygiene due to disturbed psychological state can be considered as a chief predisposing factor. In our case, we also noticed that plica neuropathica had played a protective role against the ravishment of the family members. The role of culture and superstitious belief of the society on plica neuropathica has also been thought over by previous works.[1],[6] In our society, the religious belief associated with plica often act as a hindrance in the detection of underlying mental illness in many of them. More awareness needs to be created in the society regarding conditions such as plica and their association with mental illness in the greater benefit of the patients, their families, and the society as a whole.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kumar PN, Antony B, Chakravarthy A, Koyamu AM. Plica neuropathica (polonica) in schizophrenia – A case report and review of literature. Indian J Psychiatry 2001;43:281-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Le Page JF. On neuropathic plica. Br Med J 1884;1:160.  Back to cited text no. 2
    
3.
Kanwar AJ, De D. Plica neuropathica in a 2-year-old boy. Int J Dermatol 2007;46:410-1.  Back to cited text no. 3
    
4.
Glazier SD. Encyclopedia of African and African-American Religions. 1st ed. London: Routledge; 2001.  Back to cited text no. 4
    
5.
The Trichological Society. Plica Polonica; 2004. Available from: . [Last accessed on 2015 Aug 15].  Back to cited text no. 5
    
6.
Kanwar AJ, De D. Plica neuropathica in a 2-year-old boy. Int J Dermatol 2007;46:288-9.  Back to cited text no. 6
    




 

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