Indian Journal of Psychiatry, 2001, 43 (3),281-283 PLICA NEUROPATHICA (POLONICA) IN SCHIZOPHRENIA - A CASE REPORT AND REVIEW OF LITERATURE P.N. SURESH KUMAR, BEENA ANTONY, ASHISH CHAKRAVARTHY & A.M. KUNHI KOYAMU ABSTRACT Plica neuropathica also known as plica polonica is an uncommon condition in which the hairs of the scalp in a localised area is compacted into irregularly twisted, irreversibly entangled plaits. A review of literature shows several predisposing factors figuring in plica neuropathica like kinky hair, use of shampoos, febrile illness and psychological disturbances. The authors describe a case of plica neuropathica in a paranoid schizophrenic patient who developed irreversible tangling of scalp hair. Key words: Plica neuropathica, plica polonica, schizophrnia Plica neuropathica also known as plica polonica is an uncommon condition in which the hairs of the scalp in a localised area are compacted into irregularly twisted, irreversibly entangled plaits. This term was coined by Le Page in 1884, when he described a 17-year-old girl with a sudden onset of tangled scalp hair. Le Page attributed this strange occurrence to "nerve force" while the parents of the child considered it a "visitation from god". A few cases have since been reported (Dubreuilh, 1902; De Amis, 1923; Ohman and Dumesnil, 1923; Grahm, 1952; Mozer, 1995 and Friedlietal, 2000). In 1969, Simpson etal reported a case of plica neuropathica is a psychiatric patient with anxiety and depression. According to him predisposing factors figuring in plica-neuropathica were kinky hair, use of shampoos, febrile illness and psychological disturbance. In 1985, Khare reported plica neuropathica in a 20- years old female, with continuous mental illness. She developed plica neuropathica after having undergone such a stress for six months. Since matting of hair could not be produced by rubbing together of uninvolved hair, the mechanical effect is not likely cause in this case. On referring the latest textbooks of dermatology, it was found that plica polonica is an older term of plica neuropathica for irreversibly entangled and matted hair. Plica neuropathica was a common condition of the scalp hair in Poland during the 19th century. It was characterized by a filthy, malodorous, inflamed scalp usually heavily infested by lice. The hair was matted into a sticky, moist mass probably due to deficient care of the hair. The Polish custom of wearing tight fur caps and the superstitious belief that a lousy scalp was healthy no doubt contributed to the frequency of plica polonica in Poland (Agnes,-1952). As described in reported cases, plica neuropathica is characterized by a sudden onset and a scalp healthy in appearance and free of offensive colour and parasites. Hysteria was described as a prominent feature in five of seven women previously reported with plica neuropathica (Simpson, 1969). The scalp hair has been a prime target of superstitious beliefs. Plaited hair has been regarded as a safety valve in severe illnesses and, if a patient could "raise" a plica, he/she would supposedly recover from his disease. A plica was produced by tar, pitch, or wax by those people 281