Pediatric Dermatology Photoquiz: A 14-Year-Old Boy with Abrupt-Onset Hair Changes

A 14-year-old boy presented with sudden changes in his hair texture, specifically frizzy and unmanageable hair in the bilateral frontotemporal scalp without hair loss or breakage. His medical history included depression, irregular sleep patterns, and facial acne, and he was on escitalopram, melatonin, and vitamin D. The diagnosis was Acquired Progressive Kinking of the Hair (APKH), a rare condition characterized by kinked hair not present at birth, typically developing in androgen-dependent areas of the scalp in postpubertal boys and men aged 14 to 22. APKH is associated with hair thinning and often progresses to androgenetic alopecia. Histologic and hormonal studies suggest APKH is a precursor to androgenetic alopecia, with higher levels of dihydrotestosterone (DHT) in affected scalp skin and hair follicle miniaturization similar to androgenetic alopecia. There are no known effective treatments for APKH, and while minoxidil did not prevent progression to alopecia in one series, oral finasteride has been proposed as a potential treatment. The patient's condition was consistent with the most commonly reported type of APKH, and treatment with minoxidil 5% topical foam was recommended despite the lack of well-studied treatments and uncertain prognosis.