Bird's Nest View from a Dermatologist's Eye

Area of Science:

• Dermatology
• Trichology

Background:

• Plica neuropathica, or "birds nest" hair, is characterized by irreversible hair matting.
• It is typically associated with factors like herbal soaps, parasitic infections, psychiatric conditions, or neglect.
• Hair matting is also a known side effect of immunosuppressive drugs, with rare reports linked to azathioprine.

Purpose of the Study:

• To report two cases of plica neuropathica in chronically ill patients using immunosuppressive therapy.
• To review the existing literature on the etiological factors and pathogenesis of plica neuropathica.

Main Methods:

• Case report of two patients diagnosed with plica neuropathica.
• Literature review focusing on etiological factors and pathogenesis of hair matting.

Main Results:

• Plica neuropathica was observed in two patients undergoing treatment with azathioprine and methotrexate.
• The findings suggest a potential association between immunosuppressive drug use and the development of plica neuropathica.

Conclusions:

• Immunosuppressive drugs, specifically azathioprine and methotrexate, may be an underrecognized cause of plica neuropathica.
• Further investigation into the pathogenesis of drug-induced hair matting is warranted.