There are several non-invasive, very easy to perform diagnostic tests for male and female hair loss.
Daily hair count is an easy test that every patient can perform at home which can help the doctor determine the severity of hair loss. It defines how much hair a patient is losing and makes sure that this is not more than physiologic hair loss. It is quoted as normal to lose up to 100 hairs per day.
Patients are instructed to collect and count all the hairs shed in one day, and place them in plastic bags. All hairs shed in the shower or sink or hairbrush, and on the pillow, are collected. Daily hair counts for 7 days are maintained. More hairs are expected to be lost on shampoo days.
Although this is not standardized test, it is a useful tool to monitor one’s hair loss.
Pull test (traction test, Sabouraud’s sign) is a simple test that comprises of lightly pulling a small amount of hair (about 100 strands) from proximal to distal in a few different areas of the scalp to determine if there is excessive loss, and in what areas of the scalp are experiencing the hair loss. If more that 10 % of hairs come out, it constitutes as a positive pull test and implies active shedding. Hair should not be washed 24-48 hours prior to the pull test.
The test is positive, indicating greater severity of hair loss, in cases of:
- telogen effluvium
- anagen effluvium
- loose anagen syndrome
- early cases of patterned alopecia and at the advancing edge of alopecia areata.
In cases of acute telogen effluvium, the pull test is positive over the entire scalp whereas in cases of AGA, it is usually positive over the area(s) of thinning.
If anagen hairs with thickened root sheaths are present, the test suggests cicatricial alopecia.
Hair pull tests vary from person to person. It is a very rough method and difficult to standardize. Moreover, negative tests do not exclude the diagnosis.
Pluck test (trichogram) is a semi-invasive test to determine the rate of hair loss progression by establishing how much of hair is in each of the three stages of the hair growth cycle: anagen (growth), catagen (transitional) and telogen (resting). Roughly 10% of the hairs should be in the resting phase, any more indicating active shedding. It is performed by pulling out about 50 individual hairs from one spot, then examining the roots microscopically. Pluck test should be done on the 5th day after the last shampoo and cosmetic hair treatments should not be done 8 weeks prior to an evaluation. Anagen hairs are distinguished from telogen hairs, and anagen-to-telogen ratios are calculated.
FPHL is usually associated with a lower anagen-to-telogen ratio than normal. Moreover, more telogen hair in the frontal scalp as compared to the occipital scalp is usually found in the patterned hair loss. The trichogram needs to be repeated over a period of time to follow the pattern of hair loss or thinning.
Phototrichogram is a non-invasive method which provides an accurate qualitative and quantitative assessment of the hair.
One small area of the scalp is shaved then a close-up photo is taken. Parameters that are analyzed for include: hair density, percentage of vellus hairs, hair shaft thickness, and telogen and anagen rate. Trichoscan® and Folliscope® are the two main automated phototrichogram systems available. Phototrichogram is a useful tool to differentiate between androgenetic alopecia and diffuse effluvium, and to evaluate the efficacy of certain treatments.
Wash test is a technique to differentiate telogen effluvium to FPHL by comparing the number of vellus hairs. After refraining from shampooing for 5 days, the individual then shampoos and rinses the hair and collects the hair that are then examined.
60 second test is practical and objective tool for monitoring conditions associated with hair shedding. Although not yet standardized for women, this tests shows how much hair patients shed on average. Everything above this level represents abnormal hair shedding. After washing her hair for three consecutive days, on the fourth day, the patient is instructed to comb her hair for 60 seconds starting from the vertex and combing forward. The shed hairs are then collected and their number is recorded. Broken hairs are discarded. Patients shed on average 10.2 hairs during the 60 seconds.
This test requires further study so it becomes applicable in women. It is a tool though to diagnose excessive shedding as well as to monitor the effects of certain treatments for hair loss.
HairCheck® is a relatively new device on the market that is being used more frequently by doctors in order to assess hair loss and hair regrowth. HairCheck® or Cross-section trichometry (CST) is a non-invasive method in which one small area of cross sectional diameter of 4 cm2 of hair is isolated and gathered which is measured with the device. It is suggested that more than one area is measured, so it is used in the frontal scalp, mid-scalp, vertex and occipital areas. The hair must be at least 2 to 3 inches long in order to measure the TI WHAT IS THIS????. The measurement reflects the total number of hairs in a given area and the hair shaft diameter.
HairCheck® is used to identify hair loss before it is visible to naked eye, measure the effectiveness of certain treatments, and define good donor areas for hair restoration.