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Mudi-chood disease

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Mudi-chood disease
P Sugathan*
Dermatology Online Journal 5(2): 5

Baby Memorial Hospital, Calicut INDIA

Abstract

Mudi-chood disease is a distinct clinical entity seen nearly exclusively in young women in Kerala State, India. Traditional hair grooming methods that utilize various plant oils along with the natural environmental heat and humidity create the conditions necessary to produce a lichenoid dermatitis on the neck and upper back.


Review

Ethnic and geographically related differences in grooming habits contribute to the morphology and pattern of a variety of skin diseases. Some practices produce bizarre patterns of lesions that are sufficiently characteristic to warrant classification as a distinct clinical entity. Mudi-chood disease, described by Sugathan et al.[1] from Kerala State, India, is such a condition. The name, Mudi-chood, combines two words from Malayalee, one of the fourteen major languages of India, and means "heat of the hair."

Figure 1
Mudi-chood ("hair-heat") dermatitis occurs on the neck and back at the contact site of oiled hair. This patient wears the hair on the right, corresponding to the dermatosis.

In this exotic skin disease, the posterior neck and upper back show skin colored or slightly hyperpigmented, well-defined, coin-shaped, flat topped, mildly pruritic, follicular papules which are 2-4 mm in diameter. A typical papule has a very thin keratinous rim with a slightly depressed center. Manual removal of adherent scales leaves a hyperpigmented base reminiscent of lichen planus lesions (Fig 1, 2). Occasionally a Koebner effect is seen with lesions arrayed along a linear scratch (Fig.3). Usually, however, long-standing cases may show confluence of papules. Very rarely the lesions may also occur on the upper margins of the pinna of the ears.[2] This manifestation affects only young girls, particularly teenagers.

Figure 2
Closer view of the papules demonstrates a lichenoid appearance.

Although first described from Kerala State where this condition is common, one case was reported from Pune, Maharashtra State, India, in a non-Malayal woman. The geographical distribution of occurance of this entity is entirely related to the habits of women from Karala State as compared to other parts of the Indian subcontinent. Long black hair is considered a highly desirable asset by every woman of this area. To promote long hair, profuse application of plain or "medicated" coconut or sesame oil is recommended by Ayurvedic Practitioners and grandmothers. Leaves, flowers, seeds and roots of a variety of plants are used to prepare the medicated hair oils. The choice of plants is determined by family traditions and easy availability rather than any other consideration. Homemade shampoos are prepared by crushing the leaves of Hibiscus rosa-sinensis (Shoe flower, China Rose) or Hibiscus esculentus (Lady's finger) with water just before use. These are not very effective in removing oil from the hair. Application of these oils is ardently practiced by every young girl during their teens. For them it is customary to bathe in the morning prior to going to school. Hair dryers are frowned upon by many as they may result in breakage of long hairs. Braiding or putting up the moist hair readily induces piedra. Therefore, all of them leave their long hair loose, but knotted at the ends. Thus the oily wet hair rubs over the upper, exposed part of the back and neck. The daytime temperature may vary from 28 to 37 degrees Celsius during most of the day. This, combined with a relatively high humidity of 65 to 75% will induce profuse sweating. This combination of the oily wet hair, sweating, and friction results in a follicular vesico-pustule which soon crusts and starts slowly expanding peripherally to result in the final clinical picture (Fig.1). This condition is seldom seen in college aged or older women because by that age grooming methods have changed. They bathe only in the evenings, apply less oil, and use shampoos for washing the hair. However, middle aged women from rural backgrounds do still develop Mudi-chood disease and seek treatment.

Figure 3
Note the Koebnerization.

Histopathological examination shows only non-specific irregular acanthosis, hyperkeratosis with intervening layers of parakeratosis, edema of the dermal papillae, diminished melanin in the basal layers and mild infiltration with chronic inflammatory cells in the upper dermis. PAS stain does not show any fungal hyphae. Partially distinctive are the waves of 3-4 layers of parakeratosis with intervening normal zones of keratinization. This layered appearance implies recurrent episodes of insult are involved in production of the typical lesions. Microbiological studies failed to isolate any pathogenic bacteria or fungi.[4]

Treatment consists of the local application of 3-5alicylic acid ointment which is a simple and effective remedy for the malady. Steroid creams with or without salicylic acid are also good. Prevention can be achieved by simply keeping the hair relatively oil free and using a good, commercially available shampoo.

The mechanism by which the typical lesions are produced by the combination of oils, moisture, and heat are unclear. The earliest findings are reminiscent of miliaria crystallina. Later, hyperkeratosis caps the mouth of the follicular orifice. However, the hyperkeratotic plug does not extend down into the follicle as is seen in chloracne and other forms of acne and follicular occlusion conditions. The combination of physical and environmental factors as well as possible predisposing factors that produce Mudi-chood disease appear to be peculiar to Malayalee women. Since its description in 1972, only one case has been reported outside of this population.[3]

References

1. Sugathan P, Nair MB: Mudi-chood - A New Dermatosis. In Essays on Tropical Dermatology, Vol 2. Marshall J (Ed) Excerpta Medica Amsterdam 1972 Page 183 - 188

2. Sugathan P: Mudi-chood on the pinnae. Br.J.Dermatol 1976 95.197.

3. Gharpuray MB, et al. Mudi-chood: an unusual tropical dermatosis. Int J Dermatol. 1992 Jun;31(6):396-7.

4. Brede HD Dept of Microbiology, Stellenbosch University, South Africa (Personal communication) 1972



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