Trichotillometry: the quantitation of hair pluckability as a method of nutritional assessment

In protein-calorie malnutrition, particularly kwashiorkor, ease of hair pluckability is frequently observed. In an attempt to quantitate this manifestation of the disease a calibrated mechanical instrument, referred to as a trichotillometer, was devised and used to determine the force required to epilate individual hairs in 17 adult hospitalized patients with evidence of protein calorie malnutrition and in 16 well-nourished patients. Nutritional status was examined by measuring body weight, triceps skinfold thickness, arm muscle circumference, serum albumin, lymphocyte count, hematocrit, beta-carotene, vitamin nutriture, and hair shaft diameter. Average epilation force was significantly lower in the malnourished patients than in the well nourished group (17.0 g +/- 11.8 versus 38.2 g +/- 11.4, p less than 0.001), with the lowest mean value found in patients categorized as having kwashiorkor (14.8 g). Plucking force correlated significantly and positively with serum albumin, hair shaft diameter, triceps skinfold, arm muscle circumference, weight, hematocrit, beta-carotene; it did not correlate with vitamin status. In order to determine the effect of acute stress on epilation force a subgroup of 18 patients was evaluated before and 1 and 4 days after surgery. Within this time interval epilation force was not significantly altered by the stress of surgery.