Reply to comment on: The Gabrin sign
Authors: Carlos Gustavo Wambier, Sergio Vaño-Galván, Andy Goren
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: We thank Trüeb et al1Trüeb R.M. van Neste D. Gavazzoni Dias M.F.R. et al.Comment on: the Gabrin sign.J Am Acad Dermatol. 2021; https://doi.org/10.1016/j.jaad.2020.11.046Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar for their compassion for Dr Gabrin. We share their thoughts about the COVID-19 androgen theory. Because of the COVID-19 worldwide crisis, it is imperative to identify COVID-19 patients at increased risk for mortality and disease severity. Although several risk factors such as obesity, cardiovascular disease, and diabetes have been initially associated with increased COVID-19 disease burden, with the exception of obesity and aging, no other visual marker existed. Over the last 6 months, it has become evident that males and individuals with baldness are more vulnerable. Goren et al2Goren A. McCoy J. Wambier C.G. et al.What does androgenetic alopecia have to do with COVID-19? An insight into a potential new therapy.Dermatol Ther. 2020; 33: e13365Crossref PubMed Scopus (57) Google Scholar were the first to hypothesize that androgens and androgenetic alopecia (AGA) could be associated with COVID-19 disease severity; however, other independent groups have arrived at similar conclusions. The frequency of men taking 5-α reductase inhibitors (5ARi) among hospitalized COVID-19 patients was significantly lower than the frequency of men taking 5ARi in the age-matched population, which is in agreement with the previous observation that the use of androgen depravation therapy was associated with reduced infectivity among prostate cancer patients.3Lazzeri M. Azzolini E. Buffi N.M. Fasulo V. Impact of anti-androgenic therapies on COVID-19: an observational study in male population from a COVID-19 regional centre of Lombardy (Italy).MedRxiv. 2020; (preprint)https://doi.org/10.1101/2020.04.20.20068056Google Scholar In fact, uro-oncologists worldwide are conducting studies on the use of androgen deprivation therapy for COVID-19. For example, the United States Department of Veterans Affairs is conducting a multicenter study on the use of degarelix in hospitalized COVID-19 patients (NCT04397718), and Umean University in Sweden is evaluating enzalutamide as a treatment for hospitalized COVID-19 patients (NCT04475601). We expect results of a randomized, placebo-controlled clinical trial to evaluate the effects of dutasteride or proxalutamide as Early Antiandrogen Therapy (EAT) for COVID-19 soon (NCT04446429). Pertaining to AGA, Lee et al examined hair loss severity in 1,941 hospitalized COVID-19 patients. And Ramos et al conducted a controlled cross-sectional survey with 43,595 valid questionnaires (39,789 controls, 2,332 suspected COVID-19 cases, and 1,474 confirmed COVID-19 cases).4Wambier C.G. Mehta N. Goren A. Cadegiani F.A. COVID-19, androgens, and androgenic alopecia.Dermatological Rev. 2020; https://doi.org/10.1002/der2.50Crossref Google Scholar Their findings supported the association between severe AGA and vulnerability to COVID-19. The protective role of antiandrogens is supported by the results of a prospective cohort of 77 hospitalized men that showed that antiandrogens, particularly dutasteride, may protect against COVID-19–associated intensive care unit admissions, as well as significant reduction in COVID-19 symptoms among men with AGA undergoing long-term 5aRi therapy compared with age-matched controls.5McCoy J. Cadegiani F.A. Wambier C.G. et al.5-alpha-reductase inhibitors are associated with reduced frequency of COVID-19 symptoms in males with androgenetic alopecia.J Eur Acad Dermatol Venereol. 2020; (jdv.17021)https://doi.org/10.1111/jdv.17021Crossref Scopus (33) Google Scholar Undoubtably results of randomized clinical trials of EAT for COVID-19 are needed; however, as many medical professionals are oblivious to AGA in medical emergency settings, it is essential to share that hyperandrogenic individuals exhibit visual markers for significant COVID-19 disease burden. Finally, we honored Dr Gabrin with the medical eponym to remind the medical community of the vulnerability imposed by androgens. Many merits include his extreme humanistic approach to care, which he communicated in online videos and the article Discovering the Heart of Care. He will be remembered as the first physician to fall in this fight against the COVID-19 pandemic in the United States. He is a martyr for his tragic death caused by providing care and for his will to help others in the front-line of the heart of the world's pandemic. None disclosed. Comment on: The Gabrin signJournal of the American Academy of DermatologyVol. 84Issue 3PreviewTo the Editor: COVID-19 has sparked uncertainties and controversies worldwide as to its origin, epidemiology, and natural course. In this situation, the different medical disciplines strive to contribute to a better understanding of the disease, some with a sound and sober scientific approach, others with a propensity for publicity and sensationalism, further igniting the emotional overtones associated with the pandemic. The study of the cutaneous manifestations of COVID-19 has evolved with the hope that they may be useful as markers for the disease, for prognostication, and for further insights into the pathogenesis of the disease manifestations. Full-Text PDF