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. 2009 Jul;1(2):108-19.
doi: 10.4103/0974-7753.58553.

Hair evaluation methods: merits and demerits

Rachita Dhurat  1 , Punit Saraogi
Affiliations

Hair evaluation methods: merits and demerits

Rachita Dhurat et al. Int J Trichology. 2009 Jul.

Abstract

Various methods are available for evaluation (for diagnosis and/or quantification) of a patient presenting with hair loss. Hair evaluation methods are grouped into three main categories: Non-invasive methods (e.g., questionnaire, daily hair counts, standardized wash test, 60-s hair count, global photographs, dermoscopy, hair weight, contrasting felt examination, phototrichogram, TrichoScan and polarizing and surface electron microscopy), semi-invasive methods (e.g., trichogram and unit area trichogram) and invasive methods (e.g., scalp biopsy). Any single method is neither 'ideal' nor feasible. However, when interpreted with caution, these are valuable tools for patient diagnosis and monitoring. Daily hair counts, wash test, etc. are good methods for primary evaluation of the patient and to get an approximate assessment of the amount of shedding. Some methods like global photography form an important part of any hair clinic. Analytical methods like phototrichogram are usually possible only in the setting of a clinical trial. Many of these methods (like the scalp biopsy) require expertise for both processing and interpreting. We reviewed the available literature in detail in light of merits and demerits of each method. A plethora of newer methods is being introduced, which are relevant to the cosmetic industry/research. Such methods as well as metabolic/hormonal evaluation are not included in this review.

Keywords: Alopecia; diagnostic methods for hair loss; evaluating hair loss; hair loss; quantifying hair loss.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Daily hair count - collected hairs for 7 days
Figure 2
Figure 2
Pull test-approximately 60 hairs are grasped from the proximal portion of the scalp and tugged from the proximal to the distal end
Figure 3
Figure 3
(a) Stereotactic device, (b) Stereotactic device-local modification
Figure 4
Figure 4
Dermoscope picture of cicatricial alopecia - features seen are hyperpigmentation, follicular plugging and scale crust
Figure 5
Figure 5
Dermoscope picture of FPHL - small bald areas representing exogen hair follicle
Figure 6
Figure 6
Dermoscope picture showing white dots
Figure 7
Figure 7
Contrasting felt examination-showing frontal fringe of vellus hairs
Figure 8
Figure 8
Trichogram - 60-80 hairs are grasped with a hemostat covered with rubber and are plucked, twisting and lifting the hair shafts rapidly in the direction of emergence from the scalp
Figure 9
Figure 9
Preparing the trichogram slide - the plucked hairs are arranged side by side on a glass slide and taped
Figure 10
Figure 10
Anagen hair - forcibly plucked terminal anagen hair showing the pigmented bulb with 'hockey-stick' appearance (IRS: inner root sheath; ORS: outer root sheath)
Figure 11
Figure 11
Telogen hair - forcibly plucked early telogen hair showing the hypopigmented, club-shaped cornified bulb with remanents of the cornified epithelial sac
Figure 12
Figure 12
Phototrichogram - image analyser comparing day 0 and day 2 pictures from the same site
Figure 13
Figure 13
Terminal anagen hair-showing the inner root sheath and the outer root sheath (IRS, inner root sheath; ORS, outer root sheath)
Figure 14
Figure 14
Vellus hair - inner root sheath thicker than the hair shaft
Figure 15
Figure 15
Androgenetic alopecia-scalp biopsy from the involved area from a male showing a follicular unit with three vellus hairs (V); one terminal (T) and one secondary hair germ (SHG)
Figure 16
Figure 16
Scalp biopsy-showing telogen hairs, secondary hair germ (SHG) and terminal hairs (T)
Figure 17
Figure 17
Trichoscan software interface
See this image and copyright information in PMC

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