Exam

Hair Pull Test

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Hair Pull Test

  • Indications
  1. Alopecia
  • Preparation
  1. Do not Shampoo hair 24 hours before test
  • Technique
  1. Performed at the vertex, both parietal regions and occiput
    1. Hairs should be at least 0.5 inches long
    2. Hair should not be pinned up
  2. Grasp small clump (40-60 hairs, 1-2 cm) in index, middle and thumb
  3. Pull hairs gently but with firm pressure
    1. Slide fingers distally along the Hair Shaft
  • Interpretation
  • Count hairs shed with maneuver
  1. Discard broken hairs (do not count)
  2. Normal shedding: <10% of hairs pulled (or 4-6 or fewer hairs shed
    1. May also be falsely negative due to inadequate force
  3. Active shedding: More than 10% of hairs pulled or 4-6 or more hairs shed (some guidelines use >2 hairs shed)
    1. Telogen Effluvium (positive in >1 region)
    2. Anagen Effluvium (positive in >1 region)
    3. Alopecia Areata (positive in ONLY 1 region)
  • References
  1. Shapiro (2000) Can Fam Physician 46:1469-77 [PubMed]