Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(1):e2023061 1

Plica Polonica Secondary to Chemotherapeutic 
Drugs Combination

Rashi Pangti1, Anukriti Yadav1, Vibhu Mendiratta1

1 Department of Dermatology & STD, Lady Hardinge Medical College, New Delhi, India

Citation: Pangti R, Yadav A, Mendiratta V. Plica Polonica Secondary to Chemotherapeutic Drugs Combination. Dermatol Pract Concept. 
2023;13(1):e2023061. DOI: https://doi.org/10.5826/dpc.1301a61

Accepted: July 6, 2022; Published: January 2023

Copyright: ©2023 Pangti et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Rashi Pangti, Assistant Professor, Department of Dermatology & STD, Lady Hardinge Medical College and 
associated hospitals, New Delhi-110001, India. Phone: +91-9990226358 E-mail: rashipangti457@gmail.com

Case Presentation

A 36-year-old female presented with sudden onset of matting 

of hair for the past three days along with non-cicatricial loss 

of hair from the frontal scalp and vertex (Figure 1, A and B). 

The patient had been on chemotherapy (cyclophosphamide 

and adriamycin) for the past one month for stage 4 breast 

cancer. The patient had proper hair care habits. There was no 

evidence of pediculosis capitis, psychiatric illness, or history 

of new shampoo use. A diagnosis of plica polonica was made 

based on history and examination.

Teaching Point

Plica polonica is characterized by an irreversible twisting, 

matting, and entanglement of hair. The exact causation and 

patho-mechanism of this condition are not known. Multiple 

factors like unkept hair, frequent combing, use of a new or 

harsh shampoo, psychiatric condition, and parasitic infes-

tation have been implicated [1,2]. Drug-induced matting of 

hair has been reported secondary to docetaxel, methotrexate, 

azathioprine, combination of paclitaxel, carboplatin, and 

combination of cisplatin, cyclophosphamide, doxorubicin 

[1,2]. Chemotherapeutic drugs disrupt the anagen phase of 

the hair cycle causing weakening of the partially keratinized 

proximal portion of the hair shaft, breakage, and shedding 

of anagen hair (anagen effluvium) [1,2]. The drugs can also 

cause cuticular damage to the proximal hair shaft predis-

posing to hair matting [2]. In our patient, cytotoxic agents 

(cyclophosphamide and adriamycin) lead to the matting of 

hair. The only suitable treatment for this condition is cutting 

matted hair or shaving [1,2].



2 Image Letter | Dermatol Pract Concept. 2023;13(1):e2023061

References

1. Gupta S, Kumar R, Vijay A, Jain SK. Plica polonica in a patient 

on chemotherapy: a case report with review of literature.  Int 

J Trichology.  2017;9(3):124–126. DOI: 10.4103/ijt.ijt_4_19. 

PMID: 31007476. PMCID: PMC5596649.

2. Kumar S, Brar BK, Kapoor P. Drug-associated plica polonica: 

an unusual presentation. Int J Trichology. 2019;11(2):80-81. 

DOI: 10.4103/ijt.ijt_96_16. PMID: 28932066. PMCID: 

PMC6463449.

Figure 1. (A) Matting of hair as seen from back. (B) Anagen effluvium over vertex of scalp.