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Multicenter Study
. 2020 Aug;83(2):680-682.
doi: 10.1016/j.jaad.2020.05.079. Epub 2020 May 22.

Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: The "Gabrin sign"

Carlos Gustavo Wambier  1 , Sergio Vaño-Galván  2 , John McCoy  3 , Alba Gomez-Zubiaur  4 , Sabina Herrera  5 , Ángela Hermosa-Gelbard  2 , Oscar M Moreno-Arrones  2 , Natalia Jiménez-Gómez  2 , Alvaro González-Cantero  2 , Pablo Fonda-Pascual  6 , Gonzalo Segurado-Miravalles  2 , Jerry Shapiro  7 , Bibiana Pérez-García  2 , Andy Goren  3
Affiliations
Multicenter Study

Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: The "Gabrin sign"

Carlos Gustavo Wambier et al. J Am Acad Dermatol. 2020 Aug.
No abstract available

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Figures

None
Graphical abstract
Fig 1
Fig 1
Epidemiologic characteristics of 175 individuals hospitalized due to severe symptoms of COVID-19 from March 23, 2020, to April 12, 2020. A, The study population had male-to-female ratio of 2.3:1. B, Androgenetic alopecia (AGA) was present in 42% of the women and in 79% of the men. C, Notably, the violin plots demonstrate there was an older age distribution in the women compared with the men. AGA severity was categorized by specific sex scales: Hamilton–Norwood scale (HNS) for men and Ludwig scale (LS) for women into groups: “no alopecia” for HNS = 1 or LS = 0; “moderate AGA” for HNS = 2 or LS = 1; or “severe AGA” for HNS >2 or LS >1. D, Although age was widely proportional among patients with no alopecia, moderate AGA, and severe AGA, there was a slight tendency for younger age in men with moderate AGA and in women with no alopecia compared with the respective severe AGA groups. The white circle represents the median, the bar in the center represents the interquartile range, and the thin lines represent the 95% confidence interval. The wider sections of the violin plot represent a higher probability that members of the population will take on the given value and the thinner sections represent a lower probability.
Fig 2
Fig 2
Possible targets of the androgen pathway for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prophylaxis and adjuvant therapy. Antiandrogen therapies include gonadotropin-releasing hormone (GnRH) analogs (degarelix, goserelin, leuprolide, leuprorelin, nafarelin), which stop luteinizing hormone (LH) secretion and induce chemical castration. Testosterone is regarded as the main androgen hormone, and its production is inhibited by ketoconazole, an inhibitor of steroidogenesis. Dutasteride and finasteride, 5-α-reductase inhibitors, target synthesis of dihydrotestosterone, the most potent intrinsic androgen hormone. Androgen receptor inhibitors may be steroidal (abiraterone, cyproterone, nomegestrol, or spironolactone), or nonsteroidal (apalutamide, bicalutamide, darolutamide, enzalutamide, flutamide, or nilutamide). Transmembrane protease, serine 2 (TMPRSS2) blockers include bromhexine, camostat, and nafamostat. ACE, Angiotensin converting enzyme.
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References

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    1. Wambier C.G., Goren A. SARS-COV-2 infection is likely to be androgen mediated. J Am Acad Dermatol. 2020;83(1):308–309. - PMC - PubMed
    1. Richardson S., Hirsch J.S., Narasimhan M., et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052–2059. - PMC - PubMed
    1. Goren A., Vaño-Galván S., Wambier C.G., et al. A preliminary observation: male pattern hair loss among hospitalized COVID-19 patients in Spain—a potential clue to the role of androgens in COVID-19 severity. J Cosmet Dermatol. 2020 doi: 10.1111/jocd.13443. [e-pub ahead of print] - DOI - PubMed
    1. Birch M.P., Messenger J.F., Messenger A.G. Hair density, hair diameter and the prevalence of female pattern hair loss. Br J Dermatol. 2001;144(2):297–304. - PubMed

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