Original article
Hair pull test: Evidence-based update and revision of guidelines

https://doi.org/10.1016/j.jaad.2016.10.002Get rights and content

Background

The hair pull test lacks validation and has unclear pretest guidelines.

Objective

We sought to quantify normal hair pull test values and elucidate the effect of pretest hair washing and brushing. The impact of hair texture and lifestyle was also examined.

Methods

Participants (n = 181) completed a questionnaire recording demographics, medications, and hair health/history. A single hair pull test (scalp vertex) was performed.

Results

The mean number of hairs removed per pull was 0.44 (SD 0.75). There was no significant difference in the mean number of hairs removed regardless of when participants washed (P = .20) or brushed (P = .25) their hair. Hair pull test values were similar between Caucasian-, Asian-, and Afro-textured hair. There was no significant difference in hair pull values between participants taking medications affecting hair loss and participants not taking these medications (P = .33). Tight hairstyles did not influence hair pull test values.

Limitations

Participant hair washing and brushing could not be controlled during the study, but this information was documented and analyzed.

Conclusion

Normal values for the hair pull test should be reduced to 2 hairs or fewer (97.2% of participants). The current 5-day restriction on pretest hair washing can be reduced and brushing be made permissible.

Key words

acute telogen effluvium
alopecia
alopecia areata
anagen effluvium
clinical examination
clinical guidelines
diagnosis
ethnicity
hair
hair loss
hair pull guidelines
hair pull test
hair texture
loose anagen syndrome
traction test
trichology

Cited by (0)

Funding sources: None.

Conflicts of interest: None declared.

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