Scrub typhus

Disease Description (Causes and Symptoms)

• Summary of definition
  • Excessive hair growth is broadly divided into hypertrichosis, which is generalized or localized and unrelated to androgens (common term: hypertrichosis), and androgen-dependent male-pattern excessive hair growth (hirsutism).
• Main causes and pathophysiology
  • Hypertrichosis (increased vellus hair, generalized increase, etc.): congenital (genetic abnormalities) or acquired (medications, toxins, systemic diseases, etc.). Localized causes include dermal tumors such as melanocytic nevi, repeated irritation, and prolonged occlusion (casts), among others.
  • Hirsutism (androgen-dependent): ovarian causes (polycystic ovary syndrome, ovarian tumors), adrenal causes (congenital adrenal hyperplasia, adrenal tumors), Cushing syndrome, abnormalities in prolactin secretion, or exogenous androgen/medication use.
• Main symptoms
  • Excessive hair density or length (generalized or localized), with a male-pattern distribution in women (chin, around the upper lip, chest, back and upper pubic area, thighs, etc.).
  • In hirsutism, vellus hair changes into thick, dark terminal hair. Associated androgen-related symptoms include acne, male-pattern hair loss, menstrual disorders, infertility, and metabolic abnormalities such as obesity and insulin resistance (especially with PCOS).
• Signs requiring suspicion (assessment of urgency/severity)
  • Rapidly progressing virilization symptoms (within several months), such as a deepening voice or clitoral enlargement, require exclusion of possible malignant ovarian or adrenal tumors.

Treatment Methods and Precautions

• Treatment principles
  • When possible, correct the underlying cause first. When the cause is unknown or the concern is cosmetic, combine symptom relief with hair-removal treatment.
• Medication treatment (primarily used for hirsutism)
  • Oral contraceptives (combined oral contraceptives): the first-line option for suppressing androgens and improving symptoms.
  • Antiandrogens: spironolactone (blood pressure and potassium monitoring required), flutamide (caution for hepatotoxicity), finasteride (teratogenic; pregnancy prohibited), and cyproterone acetate (approval varies by country).
  • Topical medication: eflornithine (suppresses growth in localized areas such as the chin).
  • When PCOS is present: consider combination treatment with metformin (for the purpose of improving metabolic abnormalities).
• Procedures and cosmetic treatments
  • Immediate and short-term: hair removal, shaving, depilatory creams, waxing, and electrolysis (electrolysis for permanent hair removal)
  • Permanent or semi-permanent: laser hair removal (currently the most common; effectiveness varies according to skin and hair color), permanent electrolysis (electrolysis)
  • For tumor-related causes: surgical resection (such as ovarian or adrenal tumors)
• Lifestyle management
  • Weight loss (particularly in PCOS, to reduce androgens and improve symptoms), regular exercise, and management of blood glucose and lipids.
• Precautions and side effects
  • Use of antiandrogens carries a risk of fetal abnormalities during pregnancy — reliable contraception is required during use.
  • Spironolactone: risk of hyperkalemia (caution in people with kidney disease or a history of hyperkalemia), gastrointestinal disorders, etc.
  • Flutamide and similar medications: possible hepatotoxicity (liver function tests required).
  • Laser hair removal: effectiveness varies according to skin and hair color; hyperpigmentation and burns may occur.
  • The choice of medication or procedure should take age, pregnancy plans, comorbidities, cost, and time required into consideration.

Outpatient Visit Checklist (Preparation and Example Questions)

• Items to bring (recommended)
  • A list of all medications and supplements currently being taken (including dosage and duration of use)
  • Results or records of previous tests (hormone tests, blood tests)
  • Photos showing when the condition began and how it has progressed (in chronological order)
  • Records of menstrual history (menstrual cycle and whether it is irregular), pregnancy and childbirth history, and family history (similar symptoms)
  • Records of systemic symptoms such as weight changes, skin changes, tendon changes, and voice changes
• Main questions to answer at the outpatient visit (what the doctor may ask)
  • When and how did the symptoms begin (acute vs. gradual)?
  • How quickly are they progressing (rapidly or slowly)?
  • Are there accompanying signs of virilization (voice changes, increased muscle mass, menstrual abnormalities)?
  • What is your contraceptive status, and do you have plans for pregnancy?
  • Have you previously undergone hormone tests or imaging tests?

Examples of General Questions to Ask the Doctor

• "What are the possible causes of these symptoms? What additional tests should I have?"
• "What treatment options do you recommend and what effects can I expect? What are the side effects of each?"
• "Between laser hair removal and permanent electrolysis, which is more suitable for me? What is the cost and how many sessions are needed?"
• "Could any of my current medications be causing this? Should I stop taking them?"
• "I am planning a pregnancy. What treatment options are safe?"

Examples of Condition-Specific Questions

• In cases of acute and rapid progression (suspected tumor)
  • "Over the past few months, my hair has rapidly become thicker and more abundant. Which blood tests (such as total and free testosterone and DHEA-S) and imaging tests (ovarian ultrasound, adrenal CT, and, if necessary, brain MRI) are immediately needed to rule out the possibility of an ovarian or adrenal tumor?"
• When PCOS is suspected
  • "Based on my hormone tests and menstrual history, PCOS is suspected. Which combination of medications (oral contraceptives, metformin, and spironolactone) is appropriate for my pregnancy plans, and what are the risks of side effects?"

(Note) Preliminary tests that may be considered include blood total and free testosterone, DHEA-S, LH/FSH, prolactin, and 17-OH progesterone (when congenital adrenal hyperplasia is suspected), as well as adrenal and pelvic imaging and pituitary MRI when necessary.