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Woolly Hair Disorders: Acquired Progressive Kinking Of Hair

  • Acquired Progressive Kinking of Hair (APKH) includes a variety of acquired conditions characterized by acquired curly, frizzy, and lusterless hair that resembles secondary sexual hair. 
  • In 1932, Wise and Sulzberger were the first to describe the acquired progressive kinking of the Hair.  This acquired and rare kinking hair affects young adults and children, causing a change in texture and shape, primarily in the frontotemporal areas. 
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  • The hair shaft becomes coarse, curling, and lackluster. Color changes have also been noted.
  • In this article, we are going to explain the most frequent causes of woolly hair.


  • The cause is unknown; there is no indication that it is genetically determined, although it must have a hereditary component since it is linked to AGA. A biopsy revealed no abnormal findings.
  • Anagen's duration is shortened.
  • Hairs with normal cuticle may show half-twists and small changes in bore under the microscope.

Clinical Presentation

Whisker hair

  • Whisker hair are relatively rare conditions. This acquired disorder is over periauricular areas. Whisker hair is short and curly and resemble to beard and pubic hair. 
  • Norwood was the first to notice it in 1979. He described a patient who developed short, curly hair in the temporal and occipital areas, comparable to that of a beard. Mortimer et al. and Tosti et al. classified whisker hair as an APKH subtype.
  • It is strongly associated with severe androgenetic alopecia (abbreviation: AGA).

Acquired progressive kinking of the scalp hair associated with thinning

It represents a type of AGA.

In most cases, this type has a poor prognosis.

Hair kinking that has developed in a non-androgen dependent area of the scalp.

Rapidly progressive kinking of the scalp without associated hair thinning.

Rapidly progressive kinking of most or all the scalp hair without associated hair thinning has been reported, although rare. 


  • Acquired reversible hair kinking before or after puberty.
  • Trauma, ionizing radiation, and drugs (such as etretinate and isotretinoin) can also induce hair kinking,
  • Sometimes hair regrowth after alopecia areata or chemotherapy shows kinky hair. 

Differential Diagnosis

  • On the one hand, familial woolly hair syndromes, woolly hair nevus, and uncombable hair syndrome are congenital, whereas APKH is acquired. 
  • The kinking of the hair is mixed in with normal hair all over the head in the latter.


  • Treatment options include finasteride 1 mg to avoid AGA, and patients should be aware of this.
  • Minoxidil, on the other hand, isn't always effective.


  • Cases in males are related to rapidly progressive AGA. 
  • Patients may suffer not only from regular AGA but also from hair loss around their ears and occipital area, where curly hair was previously present. 


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