Hair Development, Growth, and Loss 62 diagnosis is confirmed. Events that may elicit telogen effluvium include childbirth, febrile diseases, severe psychological stress, major surgery, thyroid diseases, crash diets, iron-deficiency, and medications (Table 1). A chronic variant of telogen effluvium usually affects middle- aged women.83 Abnormal hair shedding lasts more than six months and often follows a fluctuating course. There is no widening over the central parting line or miniaturization of the hair follicles, which are the two typical features of FPHL. Usually no specific triggering is evident. There is no progressive reduction in hair density although hair-shedding may persist for years. Later development of FPHL associated with chronic telogen effluvium has been reported.84 Anagen effluvium: Anagen effluvium is best exemplified by chemotherapy-induced alopecia and is regarded as the Table 1. Common causes responsible for telogen effluvium Postpartum Severe emotional stress Febrile diseases Crash diet Hypothyroidism or hyperthyroidism Severe trauma Severe infection Iron deficiency Severe chronic illness (autoimmune diseases and malignancies) Medications Anticoagulants Interferons Anticonvulsants Retinoids Hormones Heavy metals