Androgenetic alopecia in women and men is not related to COVID-19 infection severity: a prospective cohort study of hospitalized COVID-19 patients

A Cross-Sectional Study on Post-Coronavirus Disease (COVID-19) Hair Loss at a Tertiary Care Hospital

INTRODUCTION

Severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) was responsible for coronavirus disease (COVID-19) pandemic. As patients recovered from COVID-19 infection, hair loss was increasingly observed as a distressing symptom.

METHODS

This was a cross-sectional study of patients with post COVID-19 hair loss between July to December 2021 at a tertiary care center. Detailed history, clinical examination, trichoscopy and biochemical tests were performed and recorded. COVID-19 disease severity was assessed based on duration of COVID-19 infection and place of management.

RESULTS

The study included 120 patients with a mean age of 39.6 years. The majority of the patients were females treated at home and had COVID-19 infection for >2 weeks. The mean visual analog scale (VAS) score for stress was 5.25. Vitamin D deficiency was present in 56.7% and low ferritin in 30% of cases. The mean time of onset of hair loss post COVID-19 was 49 days. Patients mainly presented with diffuse hair loss. Trichodynia was present in 15.8% of cases. The degree of hair loss was severe in 55.8% of the subjects. Positive hair pull test was seen in 65% of patients. Most common trichoscopic features included single hair follicles (81.7%) and vellus hair >10% (60%).

CONCLUSIONS

The mean time of onset of hair loss post COVID-19 infection was less than 2 months. Majority patients had diffuse pattern and severe degree of hair loss. Trichoscopy can aid in unmasking co-existing patterned hair loss in patients presenting clinically with diffuse hair loss.

Male-pattern hair loss: Comprehensive identification of the associated genes as a basis for understanding pathophysiology

Male-pattern hair loss (MPHL) is a highly heritable and prevalent condition that is characterized by progressive hair loss from the frontotemporal and vertex scalp. This androgen-dependent hair loss may commence during puberty, and up to 80 % of European men experience some degree of MPHL during their lifetime. Current treatment options for MPHL have limited efficacy, and improved understanding of the underlying biological causes is required to facilitate novel therapeutic approaches. To date, molecular genetic studies have identified 389 associated genomic regions, have implicated numerous genes in these regions, and suggested pathways that are likely to contribute to key pathophysiological mechanisms in MPHL. This review provides an overview of the current status of MPHL genetic research. We discuss the most significant achievements, current challenges, and anticipated developments in the field, as well as their potential to advance our understanding of hair (loss) biology, and to improve hair loss prediction and treatment.

Alopecia in COVID-19 Patients: Systematic Review and Meta-analysis

Background

COVID-19 is associated with androgenetic alopecia (AGA), telogen effluvium (TE), and alopecia areata (AA). No studies have analyzed the aggregate data to date.

Objective

We conducted a systematic review to characterize the types, incidence, timing, and clinical outcomes of COVID-19–associated alopecia.

Methods

We searched PubMed/MEDLINE, Scopus, and Embase for articles published between November 2019 and August 2021 using the key words “alopecia” or “hair” and COVID-19–related search terms, identifying 41 original articles describing patients with alopecia and COVID-19.

Results

The current review included 1826 patients with alopecia and COVID-19 (mean age, 54.5 years; 54.3% male). The most common types of alopecia identified were AGA (30.7%, 86.4% male), TE (19.8%, 19.3% male), and AA (7.8%, 40.0% male). AGA preceded COVID-19 symptoms. TE was usually newly triggered by COVID-19 (93.6%). AA usually occurred in patients with preexisting disease (95.1%).

Limitations

Definitions of COVID-19 onset varied. Studies differed in methodology and were susceptible to reporting and sampling bias. Studies with large sample sizes may exert a disproportionate influence on data.

Conclusion

AGA may be a risk factor for severe COVID-19, whereas TE presents as a sequela of COVID-19. AA generally occurs as a relapse in patients with preexisting alopecia.

Systematic investigation of a potential epidemiological and genetic association between male androgenetic alopecia and COVID-19

Background

Male androgenetic alopecia (AGA) has been implicated as a putative risk factor in severe COVID‐19 based on high incidences of advanced AGA in male hospitalized COVID‐19 patients. Research further suggests that androgen signalling, which plays a central role in AGA aetiology, promotes SARS‐CoV‐2 infection and is associated with severe COVID‐19 symptoms in men.

Objectives

We aimed to systematically investigate a potential association between AGA and COVID‐19 both on an epidemiological and a genetic level in a large single‐population cohort.

Methods

We performed regression, genetic correlation and polygenic risk score (PRS) analyses using data from the UK Biobank and published GWAS data on AGA and COVID‐19.

Results

Our analyses did not reveal any significant epidemiological or genome‐wide genetic association between AGA and severe COVID‐19. Pathway‐based PRS analyses however revealed a significant association in specific pathways, namely vitamin metabolism, natural killer cell‐mediated cytotoxicity, WNT signalling and aryl hydrocarbon receptor signalling.

Limitations

We restricted our analyses to the white British population and used self‐reported AGA status. Sample size may be a limitation in our regression and PRS analyses.

Conclusions

Our data yield no evidence for an epidemiological association between AGA and COVID‐19 but suggest that a shared genetic basis for both traits exists in specific pathways.