Plica polonica: Bird’s nest under dermatoscope

A 48-years-old excessively religious female presented with matted scalp hair for 6 years. She had no history of using soap, shampoo, or other chemical products over the scalp. On account of his religious and spiritual beliefs, she feels that it is given by god to her. Physical examination revealed a bulk oval mass of matted hair over the vertex and occipital area, mimicking a bird’s nest. The color of the hair ranges from black to golden brown hair predominantly over the surface of the matted hairs [Figure 1]. There was no evidence of nits or scalp infection. On potassium hydroxide examination, no fungal hyphae were seen. The patient did not have any psychiatric disturbances. Dermatoscopy examination with Dermlite 4 having polarized light illumination having ×10 magnification showed matting of hair shaft with honey-colored concretions mimicking a “wrangled mesh of wires” appearance [Figure 2]. With above findings, a diagnosis of plica polonica (matted hair) was made.

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Figure 1:

Mass of dense matted hair over the vertex and occipital area mimicking a “bird’s nest.”

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Figure 2:

Dermatoscopy showed matting of the hair shaft with honey-colored concretions mimicking “wrangled mesh of wires” appearance.

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Plica polonica is characterized by a mass of scalp hair with bizarre twists and irreversibly entangled plaits, which are hard, impenetrable masses of keratin cemented with dirt and exudates. It is seen in religious persons (Sadhus) in India who raise a plica for wish fulfillment, similar to our case. The exact etiopathogenesis of plica polonica is not understood. Still, it can be due to longitudinal splitting or weathering of the hair shaft due to vigorous friction and frequent use of harsh shampoos and cleansers and/or to keeping long hair with poor hair care or neglect. Diagnosis is based on clinical examination, but dermatoscopy can be used to confirm its diagnosis.^[1] We report a case of plica polonica which was due to her religious and spiritual beliefs and therefore any treatment for the same was refused.