Background: The hair pull test lacks validation and has unclear pre–test guidelines. The test is a very approximate method which is difficult to standardize and it has low specificity and sensitivity, but it might be supportive as a secondary procedure to assess activity of hair loss.

Objective: We sought to quantify normal hair pull test values between various types of hair and hair styling methods and elucidate the effect of pre–test and post–test hair washing and brushing. The impact of hair texture and lifestyle was also examined.

Methods: Participants ([female=42, male=18] [test 30, control 30]) were subjected to a questionnaire recording demographics, medications, and hair health/history. Hair pull test was performed over 4 sites, namely, vertex, occiput, right and left parietal region of scalp.

Results and conclusion:

Hair pull test was positive in 21 patients. On comparing hair pull test with hair texture and scalp diseases, it was significantly more positive in those with curly hair and was also significantly more positive in patients with telogen effluvium. There was no significant difference in the positivity of the test between different hairstyles and with recent illness and comorbidities.