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Clinicians recommend hair pull test of up to two hairs for all textures

Journal of the American Academy of Dermatology
Reuters Health - 14/01/2021 - A hair pull test with up to two hairs pulled, indicated in 2017 clinical practice guidelines, may be effective for evaluating hair loss disorders in individuals with Afro- or Asian-textured hair, a recent study suggests.

Researchers conducted a study of the hair pull test in 198 hair salon clients with either Afro (n=104) or Asian (n=94) textured hair to see if clinical practice guidelines established based on studies of Caucasians were also appropriate for people from other racial and ethnic groups with different hair textures.

In the study, the normal range of hairs pulled was no more than two hairs for both Asian and afro textured hair, comparable to results from previous research in Caucasians, researchers report in the Journal of the American Academy of Dermatology.

"Pull tests are one of the most important ways to diagnose a form of hair loss called telogen effluvium and also helps to give an indication of active alopecia areata," said Dr. Amy McMichael, chair of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina.

"If a different standard were needed for people of different ethnicity, it would make diagnoses difficult if not impossible, and this would lead to missed diagnoses or over-diagnoses, either of which causing treatment delays or incorrect treatment," Dr. McMichael, who wasn't involved in the study, said by email.

There was no significant difference in hair pull test outcomes for people with Asian- or Afro-textured hair based when participants brushed or washed their hair prior to the salon visit.

Chemically treated Afro-textured hair, which can be prone to breakage due to chemical relaxers, did have more broken hairs (mean 0.69) than untreated Afro-textured hair (mean 0.25).

One limitation of the study is that researchers didn't assess the variability of results based on individual raters. Lead study author Dr. Katherine Ann McDonald of the University of Toronto didn't respond to requests for comment.

The study results suggest that it's possible to get consistent results from a hair pull test, said Dr. Susan Taylor, vice chair of Diversity Equity and Inclusion in the Department of Dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

"This study confirms that all patient groups have a consistent interpretation of hair pull tests," Dr. Taylor, who wasn't involved in the study, said by email.

SOURCE: https://bit.ly/3oHoL4n Journal of the American Academy of Dermatology, online December 14, 2020.

By Lisa Rapaport

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