Hair pull test
The hair pull test is a simple test for the clinician to determine the ongoing activity and severity of any kind of hair loss.
Its range of application in the diagnostic process reaches from androgenetic alopecia and alopecia areata, to diffuse effluvium, to scarring alopecia.
A bundle of about 50–60 hairs is grasped between the thumb, index finger, and middle finger from the base near the scalp. The hair is firmly, but not forcibly, tugged away from the scalp as fingers slide along the hair shaft. Another procedure is to use both hands, and grasp a tuft of hair between two fingers of one hand and pull at it with the other.
Afterwards the number of extracted hairs is counted and, depending on the diagnosis, sometimes examined under the microscope, e.g., in loose anagen hair.
If more than 10% of grasped hairs, or six hairs, are pulled away from the scalp, this constitutes a positive pull test and implies active hair shedding. If fewer than six hairs can be easily pulled out, this is considered normal physiologic shedding.
The same procedure is repeated in four scalp areas (right + left parietal and frontal + occipital areas). To standardize the test and to obtain comparable results,patients are asked to refrain from washing their hair in
the 5 days before the examination; however, some clinicians have a standard 2-day period between shampooing and the pull test, although it is important that they make this clear when reporting the results. The pull test
is normally negative on the day of shampooing as all telogen hairs have been rinsed away.
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