Localized and Diffuse Forms of Hair Tangling

Localized and Diffuse Forms of Matting

Hair matting can either be diffuse or localized and either acute or chronic. Bogaty and Dunlap first used the term “matting of hair” in 1970 and compared the condition with “felting.”

Acute hair felting is a very rare disorder of scalp hair. Affected patients notice that their hair becomes twisted and tangled and essentially becomes a hard stony mass not too different from a 'bird's nest.' The sudden matting of hair has been reported after several types of exposures, including the use of various chemical and herbal shampoos in a vigorous manner.   Cationic surfactants may have a particular role. In 2017, Maduri reported the sudden (acute) matting of hair after use of coconut oil and castor oil following washing. The patient's long hair coupled with the high viscosity of the castor oil was believed to contribute to the sudden felting of hair.

In contrast to diffuse forms of matting, localized matting and tangling of hair also has many causes. "Plica polonica" is a localized area of hair matting that can occur either from the simple neglecting of hair or from underlying psychiatric illness. Other risk factors are summarized below.

The matting of hair has been described for over 4000 years and the Vedic scriptures of India document the wearing of dreadlocks.  More recently in history, a similar dreadlock-type appears of hair was well known in Poland in the eighteenth century. The hairstyle itself became known as ‘plica neuropathica’ or ‘dread locks’.  In 1884, Le Page first coined the term ‘plica polonica’  when he described a 17-year-old girl with a sudden onset of tangled scalp hair. He actually attributed this strange phenomenon to “nerve force” while the parents of the child considered it a ”visitation from God”.  In the 19th century, the wearing of matted thick moist hair was rather common and very much in vogue.  Due to lack of hair care, the hair became malodorous and the scalp became inflamed and often heavily infested with lice.  The Polish custom of wearing tight fur caps did not help the issue nor did the superstitious belief that a lice -infested scalp was healthy. Plica Polonica was common in Poland. To date, the term continues to be used. 


Risk factors for Matting (Plica Polonica)

To date, Plica polonica are frequently associated with neglected personal hygiene. In addition to underlying psychiatric illness, a variety of risk factors have also been suggested including chemotherapy, seborrehec dermatitis, psoriasis and use of immunosuppressants like azathioprine.

The terms Plica Neuropatica and Plica Polonica are frequently used interchangeably. However, some reserve the term plica neuropathica for situations where there is particular underlying psychological issues. 


Treatment of Hair Matting

Regardless of whether matting is localized or diffuse, there is only one consistently helpful treatment - and that is to cut off the hair.  If matting is in the earliest of stages, a knitting needle together with use of olive oil has been described as helpful. However, usually cutting the hair is the only good option.



Plica neuropathica (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”.[4] This phenomenon was historically linked to a common condition of scalp hair in Poland during the 19thcentury. It was characterized by fitting malodorous inflamed scalp usually heavily infested with lice.[5] The hair was matted into a thick, moist mass, due to deficit hair care. The Polish custom of wearing tight fur caps and the superstitious belief that a lousy scalp was healthy contributed to the frequency of plica polonica in Poland.

Some of the risk factors reported for this condition are psychological disturbances, secondary scalp infection or infestation of scalp or use of shampoos containing cationic detergents.[6] There are sporadic reports of this condition in various dermatology journals from India[1,710] and abroad.[6,11] Surprisingly despite the role of psychological disturbance as risk factors for this condition only few cases are reported in psychiatry journals.[1] This is perhaps the second case report from psychiatric point of view.



Maduri VR, et al. "Castor Oil" - The Culprit of Acute Hair Felting. Int J Trichology. 2017 Jul-Sep.

Suresh Kumar PN and Rammohan V.  Plica neuropathica (polonica) in schizophrenia Indian J Psychiatry. 2012 Jul-Sep; 54(3): 288–289. 




Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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