Publication of US National Library of Medicine and National Institutes of Health.
By Justin Lee, BS, Ahmed Yousaf, BA, Wei Fang, PhD, and Michael S. Kolodney, MD, PhD.
Male Pattern Baldness: Androgenetic Alopecia May Worsen Covid-19
Recent observations by Wambier et al. [1] suggest that men with pattern baldness are at high risk of severe symptomatic COVID-19 infection. Two preliminary studies [1], [2] observed high rates of androgenetic alopecia in men hospitalized for severe COVID-19. Both uncontrolled observational studies were limited by small sample size. To further evaluate this intriguing observation, we examined the severity of hair loss in 1.941 hospitalized male patients tested for COVID-19 using data from the UK Biobank. Multivariate logistic regression analysis was performed, in which the outcome was a positive COVID-19 test result, and the main variable of interest was the severity of baldness. Other variables considered were age, body mass index (BMI), hypertension, dyslipidemia and diabetes.
From 2006 to 2010, the UK Biobank recruited approximately 500 individuals from the United Kingdom and collected detailed information about their medical history, with participant consent. Data were updated regularly, and the most recent data from 2019 were used for all covariates analyzed in this study. During the original intake, 226.938 men chose one of 4 options that best characterized their hair loss using images adapted from the Hamilton-Norwood scale [3]. The options included the following text:
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[One_half]
Default 1
Default 2
Default 3
Default 4
[/one_half]
[One_half_last]
No hair loss
Slight hair loss
Moderate hair loss
Severe hair loss
[/ One_half_last]
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COVID-19 testing was performed on symptomatic patients in accordance with National Health Service guidelines [5].
The descriptive frequencies of COVID-19 results, baldness patterns, age, and BMI are presented in Table 1. The cohort included 1.605 patients with a negative COVID-19 result and 336 patients with a positive result. The mean age and BMI were similar between both groups. As shown in Table 1, COVID-19 positivity tended to increase with increasing baldness. Of the 592 patients reporting pattern 1, 15,03% tested positive. Of the 404 patients reporting pattern 2, 16,83% tested positive. Of the 551 patients reporting pattern 3, 18,15% tested positive. Of the 394 patients reporting pattern 4, 20,05% tested positive.
[info_box title=”Table 1″ titleColor=”#0B615E” titleBgColor=”#DDFF41″ txtColor=”#0B615E” txtBgColor=”#EDFF96″]
Descriptive frequencies for COVID-19 test results, baldness patterns, age, and BMI.
[One_third]
Variable
Total
Pattern 1 (%)
Pattern 2 (%)
Pattern 3 (%)
Pattern 4 (%)
Middle Ages
Average BMI*
[/ one_third]
[One_third]
COVID-19 positive
1605
503 (84,97%)
336 (83,17%)
451 (81,85%)
315 (79,95%)
59,13
28,67 kg / m²
[/ one_third]
[One_third_last]
COVID-19 negative
336
89 (15,03%)
68 (16,83%)
100 (18,15%)
79 (20,05%)
59,03
29,11 kg / m²
[/ One_third_last]
*BMI – Body Mass Index
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The odds ratios for baldness patterns are shown in Table 2. When compared with pattern 1, patients reporting pattern 4 were significantly more likely to test positive for COVID-19 in the hospital. The patterns did not reach significance from pattern 1 on the rates of positive COVID-19 test results. None of the covariates were associated with a positive COVID-19 test result.
[info_box title=”Table 2″ titleColor=”#0B615E” titleBgColor=”#DDFF41″ txtColor=”#0B615E” txtBgColor=”#EDFF96″]
Odds ratios for baldness patterns and covariates from a multivariate logistic regression analysis where the outcome is a positive COVID-19 test result*.
[two_third]
Effect
Pattern 2 vs 1
Pattern 3 vs 1
Pattern 4 vs 1
Age
BMI
Hypertension vs non-hypertension
Dyslipidemia vs non-dyslipidemia
Diabetes vs non-diabetes
[/two_third]
[One_third_last]
Probability Rate**
1,144
1,271
1,408
0,995
1,014
0,941
1,240
1,041
[/ One_third_last]
*All statistical analyses were performed using SAS 9.4 (SAS Institute, Cary, North Carolina, USA).
**How many times more likely to develop serious cases.
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Conclusion
A notable limitation of the study is that the baldness data were self-reported. Although the exact mechanism remains unknown, severe androgenetic alopecia appears to be associated with hospitalization for Covid-19. The large effect of baldness on COVID-19 risk suggests that the presence of severe baldness could help doctors and public health officials identify and protect people at highest risk.
References:
[1] Wambier CG, Vaño-Galván S., McCoy J. Androgenetic alopecia present in the majority of hospitalized COVID-19 patients—the “Gabrin sign” J Am Acad Dermatol. 2020;83:680–682.
[2] Goren A., Vaño-Galván S., Wambier CG 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;19:1545–1547.
[3] Norwood OT Male pattern baldness: classification and incidence. South Med J. 1975;68(11):1359–1365.
[4] UK Biobank. UK Biobank; 2007. Resource 100423: screenshot from touchscreen questionnaire used to capture field 2395.
[5] National Health Service. 2020. Coronavirus staff guidance: inpatient testing protocol.
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