Plica Neuropathica: Bird's Nest under Dermatoscope

Plica polonica is a rare condition presenting as a mass of scalp hair with irregular twists and irreversibly entangled plaits, which are firm to hard impenetrable mass of keratin cemented together with dirt and exudates. The exact etiopathogenesis of plica neuropathica is not known, but it can be due to longitudinal splitting or weathering of hair shaft due to vigorous friction and frequent use of harsh shampoos and cleansers or long hair with poor hair care Drug-induced hair matting due to chemotherapeutic drugs and due to neurotic illness like hysteria, anxiety, to psychotic illness have also been reported. Dermatoscopy showed interwining of hair shaft with matting and honey-colored concretions mimicking “wrangled mesh of wires” appearance. The treatment of plica neuropathica involves cutting the matted hair and evaluating underlying psychiatric illness to prevent recurrence.