Mudi-chood dermatitis: a cultural dermatoses

Mudi-chood dermatitis is a peculiar dermatosis seen almost exclusively in young women from Kerala, India. The condition was first described in 1972 and literally translates to ‘heat of the hair´ in Malayalam, the native language of the state. The condition arises on the posterior neck and back due to skin contact with residual hair oils applied as a part of traditional hair grooming practices which include the application of coconut oil infused with plant leaves, flowers and roots to promote hair growth and the use of homemade plant-based shampoos that do not effectively remove the oil, thereby causing constant exposure of oily hair with skin. It is presumed to be a nonspecific follicular reaction to wet and oily hair in a hot and humid environment due to the friction between hair and skin, typically reported in females, predominantly seen over nape of neck, upper back or over the pinna. It is characterized by itchy, pigmented, follicular, flat-topped papules 2-4 mm in diameter. Treatment options include local application of salicylic acid ointment, steroid creams and can be prevented by simply keeping the hair relatively oil free using commercially available shampoos. A 32-year-old female patient presented with lesions over the upper back since 1 year associated with minimal itching which aggravated after hair oil application. On examination multiple flat-topped, papular to lichenoid lesions, 2-4 mm in diameter were noted over the right upper side of upper back. The diagnosis was made based on history and clinical findings. The patient was treated with clobetasol topical application and was asked to avoid oiling of hair, resulting in significant improvement within a week.