Examining Hair Samples: 4 Quick Things to Evaluate

4 Quick Things to Evaluate

Many patients bring in hairs in bags. These have been collected in a variety of ways including when combing, after shampooing (while blow drying) and sometimes in the shower or from a drain. I don’t typically need hair collection performed as a starting point in any evaluation but when hairs are brought in, I always look at them.

There are several things I want to know when I examine the bag of hair. Typically, I am less interested in the number of hairs when the “hair collection” is performed in a non-standard manner (ie not done via a five day modifed hair wash test protocol or not a 60 second comb test). However, the key information I do seek to gather includes:

1. How was the sample collected? (...was it pulled from the drain or from a brush)
2. When was the last shampoo or hair wash? (...does the hair in the bag represent 1 day of not washing or 1 week?)
3. Do I see any anagen hairs in the sample? (... anagen hairs are suggestive of a scarring hair loss condition and are extremely rare to be seen to see but easily confused by patients).
4. Do I see many broken hairs ? (... broken hairs can suggest damage from heat or chemicals, traumatic brushing, alopecia areata and rarely scarring alopecias). With these 4 questions, I can sometimes get a sense of whether something unusual might be happening in the scalp. If it is necessary to get a more quantitative evaluation of the numbers and types of hairs shed, I may ask patients to perform a “five day” modified hair wash test. This involves not shampooing for five days and then collecting all hairs on a gauze during a shampooing and rinse.