New Insights in COVID-19 from Dermatological Clues

During the continuing SARS-CoV-2 (COVID-19) pandemic, several studies have noted that the virus disproportionately affects men versus women, with the more than 58% of severe cases being experienced by men. Racial differences in disease severity have also been reported. These gender and demographic differences are very similar to those observed in dermatological conditions that are mediated by androgens, for example, androgenetic alopecia (AGA). Our past research in AGA has led us to investigate an association between androgens and COVID-19 pathogenesis.

The connection between COVID-19 and androgens is explained by the mechanism of viral entry into human lung cells. SARS-CoV-2 primarily infects type II pneumocytes and enters host cells by anchoring to the ACE2 cell surface receptor. In order to bind to the receptor, viral surface proteins require modification from another host protein, TMPRSS2. If the amount of TMPRSS2 can be reduced in the lung, the ability of the virus to enter the lung will be attenuated. In humans the TMPRSS2 gene is regulated by the androgen receptor.

As a first step, we have conducted preliminary studies looking for the incidence of androgen mediated hair loss in COVID-19 patients. In a study of 141 COVID patients with severe symptoms, the ratio of hair loss in male COVID-19 patients compared to that of the general male population was 77 to 60 percent, respectively. More interestingly, in females with severe COVID-19, we found 58% had androgenetic alopecia, more than five times higher than in the general female population of the same age.

In our past work we have explored the use of genetic polymorphisms in the androgen receptor gene as a biomarker for susceptibility to androgen mediate disease. We believe that these same biomarkers can be used to identify patients at high risk of severe COVID-19 disease. Similarly, a diagnostic device could be used to identify high-risk individuals within populations with high exposure to the virus, for example, healthcare workers. Currently, we are pursuing two research avenues: 1.) the development and registration of a diagnostic device for COVID-19 susceptibility and 2.) a prophylactic treatment options using existing androgen modulating drugs.

Other Studies

TITLE:

SARS-CoV-2 Environmental Testing Kit

STATUS:

Under development

Publications

Safety Measures in Dermatology Help Minimize Spread of COVID-19.

Goren A, Rathod D, Kroumpouzos G, Jafferany M, Goldust M.

Dermatol Ther. 2020 Jun 7. doi: 10.1111/dth.13773. Online ahead of print.

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Androgenetic Alopecia Present in the Majority of Hospitalized COVID-19 Patients - the "Gabrin sign".

Wambier CG, Vaño-Galván S, McCoy J, Gomez-Zubiaur A, Herrera S, Hermosa-Gelbard Á, Moreno-Arrones OM, Jiménez-Gómez N, González-Cantero A, Pascual PF, Segurado-Miravalles G, Shapiro J, Pérez-García B, Goren A.

J Am Acad Dermatol. 2020 May 21:S0190-9622(20)30948-8. doi: 10.1016/j.jaad.2020.05.079. Online ahead of print.

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Androgen sensitivity gateway to COVID-19 disease severity.

Wambier CG, Goren A, Vaño-Galván S, Ramos PM, Ossimetha A, Nau G, Herrera S, McCoy J.

Drug Dev Res. 2020 May 15:10.1002/ddr.21688. doi: 10.1002/ddr.21688. Online ahead of print.

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Racial Variations in COVID-19 Deaths May Be Due to Androgen Receptor Genetic Variants Associated with Prostate Cancer and Androgenetic Alopecia. Are Anti-Androgens a Potential Treatment for COVID-19?

McCoy J, Wambier CG, Vano-Galvan S, Shapiro J, Sinclair R, Müller Ramos P, Washenik K, Andrade M, Herrera S, Goren A.

J Cosmet Dermatol. 2020 Apr 25:10.1111/jocd.13455. doi: 10.1111/jocd.13455. Online ahead of print.

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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.

Goren A, Vaño-Galván S, Wambier CG, McCoy J, Gomez-Zubiaur A, Moreno-Arrones OM, Shapiro J, Sinclair RD, Gold MH, Kovacevic M, Mesinkovska NA, Goldust M, Washenik K.

J Cosmet Dermatol. 2020 Apr 16. doi: 10.1111/jocd.13443. Online ahead of print.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is likely to be androgen mediated.

Wambier CG, Goren A.

J Am Acad Dermatol. 2020 Apr 10:S0190-9622(20)30608-3. doi: 10.1016/j.jaad.2020.04.032. Online ahead of print.

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What does androgenetic alopecia have to do with COVID-19? An insight into a potential new therapy.

Goren A, McCoy J, Wambier CG, Vano-Galvan S, Shapiro J, Dhurat R, Washenik K, Lotti T.

Dermatol Ther. 2020 Apr 1:e13365. doi: 10.1111/dth.13365. Online ahead of print.

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