Evaluating the Role of the Gabrin Sign in Predicting COVID-19 Severity Among Patients with Androgenic Alopecia.

Introduction: The "Gabrin sign" has been named after Dr Frank Gabrin, who was the first American physician to succumb to the novel coronavirus disease 2019 (COVID-19). The physician also suffered from androgenetic alopecia (AGA), thence came the eponymous sign. It has been widely postulated that the androgen pathway is a contributing factor in COVID-19 disease severity.

Aims and objectives: This case-control study was aimed at assessing the prevalence of AGA in patients admitted to the intensive care unit due to severe COVID-19 from three tertiary care centers in Rajasthan.

Materials and methods: During the overwhelming surge of cases between March 2021 and August 2021, the investigators randomly examined patients for the presence of AGA. AGA severity was assessed by the Hamilton-Norwood Scale and Ludwig Scale.

Results: The study included 379 cases of AGA with confirmed COVID-19 infection admitted in COVID-19 dedicated wards and 379 age- and sex-matched controls without AGA from the same wards. The male-to-female ratio was 3.9:1. The disease severity of COVID-19 was significantly higher in cases than controls (P < 0.0001). Cases with severe AGA had a significantly higher proportion of COVID-19 severity (P < 0.0001).

Conclusions: Our study provides preliminary evidence that COVID-19 severity could be androgen-mediated. However, this hypothesis requires further validation. In addition, antiandrogen treatments such as spironolactone, degarelix, and bicalutamide could theoretically be investigated in the management or prophylaxis of COVID-19 severity.