key: cord-294871-bqw48zi5
authors: Wambier, Carlos Gustavo; Vaño-Galván, Sergio; McCoy, John; Pai, Suraj; Dhurat, Rachita; Goren, Andy
title: Androgenetic alopecia in COVID-19: compared to age-matched epidemiologic studies and hospital outcomes with or without the Gabrin sign
date: 2020-07-29
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.07.099
sha: 
doc_id: 294871
cord_uid: bqw48zi5

nan

We would like to motivate other groups to evaluate AGA in their populations, specifically 55 comparing outcomes in COVID-19 positive individuals. For example, our Indian colleagues, in a 56 pilot observational prospective study (raw data available at doi.org/10.17632/jdkx76y8fz.1), 57 examined outcomes in admitted COVID-19 patients by AGA severity. In their cohort of 44 men 58 admitted for severe COVID-19, all patients had clinically significant androgenetic alopecia. 59 However, the most severe outcomes (respiratory failure requiring ventilators or fatal 60 outcomes) happened when HNS was greater than 2. One patient was 45 years-old, and had no 61 previous co-morbidities; he required prolonged ICU stay due to ventilator use, and had HNS=3v. 62 study 3 show an increase of relative proportions for HNS=2-7 of 7%, HNS=3-7 of 26%, and 67 HNS=4-7 of 33%. This gap becomes particularly obvious when comparing the frequencies of 68 HNS=4-7 in the age range of 55-69 years (Fig.2) , 4 which is the age group that contains the 69 median age of the 122 COVID-19 hospitalized men. 1 Severe AGA in young men also confers 70 increased vulnerability. To further exemplify that, we present in this reply letter one of our 71 unpublished patients from Brazil: a previously healthy 37-year-old physician (HNS=5, depicted 72 in Fig1), with no previous co-morbidities; he required hospitalization for 21 days, which 73 included 16 days in the ICU (ventilator for 10 days and hemodialysis for 5 days). 74

Since vaccines are still not available, and the epidemic is affecting men disproportionately, 75 particularly bald individuals, more emphasis could be given to investigations directed at anti-76 androgen therapies which are routinely prescribed both for hair loss and benign prostatic 77 hyperplasia as standard of care (such as dutasteride and finasteride). Finally, severe AGA, 78 (HNS=3-7) -the Gabrin Sign -is an objective phenotype, which reflects the individual androgen 79 sensitivity throughout decades of life. AGA is associated with individual vulnerability to severe 80 SARS-COV-2 infection through the androgen gateway. 5 It is remarkable that severe outcomes 81 such as requirement for ventilator and/or fatalities have occurred in men with this phenotype 82 without other known co-morbidities at younger age groups, such as 35-45 years. 83 

Androgenetic Alopecia Present in the 86

Majority of Hospitalized COVID-19 Patients -the "Gabrin sign

Androgenetic alopecia in COVID-19: Compared to what?

Male pattern baldness: Classification and incidence

Androgenetic alopecia in men 93 aged 40 -69 years : prevalence and risk factors

Androgen sensitivity gateway to COVID-19 95 disease severity

Photograph of a 100 37 year-old survivor hospitalized in Brazil for severe COVID-19, without co-morbidities; required 101 ventilator for 10 days. The bars depict outcomes of a pilot study performed in India in May 102 2020 among 44 men who had AGA scored with HNS. Gabrin sign was associated with worse 103 hospital outcomes (use of ventilator and deaths

Only men with Gabrin sign had worse outcomes (red and black bars)

Age-matched comparison of AGA, of very severe baldness between the Australian 108 2003 data (general population) versus the Spanish 2020 data (hospitalized men with severe 109

COVID-19 patients showed higher frequencies of very severe baldness at all age 110 groups. The gap significantly increases after 55 years. The majority of hospitalized patients due 111 to severe COVID-19 over 55 years presented with very severe baldness. *Very severe baldness 112 accounted for "frontal and vertex" in data from Severi et

data from Wambier et al. more details available at