International Journal of Dermatology | 2021
Androgens and women: COVID‐19 outcomes in women with acne vulgaris, polycystic ovarian syndrome, and hirsutism
Abstract
with acne vulgaris, polycystic ovarian syndrome, and hirsutism Dear Editor, Disproportionately increased COVID-19 severity in men has resulted in investigation into androgen-regulated transcription of transmembrane protease-serine 2 (TMPRSS2), which mediates SARS-CoV-2 infectivity. Several dermatologic disorders are associated with androgen excess, such as polycystic ovarian syndrome (PCOS), acne cystica, and hirsutism in women. Considering the implication that androgens play a role in COVID-19 infection-related outcomes in men, we examined COVID-19 incidence and severity in women with these dermatologic conditions. The HIPAA-limited University of California COVID Research Data Set (UC CORDS) provides access to health records for patients tested for COVID-19 across UC medical institutions. As of October 8, 2020, it had COVID-19 test results, demographics, hospitalization, and mortality on 117,529 women, age 0–65. Data on diagnoses of acne vulgaris, PCOS, or hirsutism, and concomitant use of spironolactone, estradiol (proxy for oral contraceptive pills), or metformin for at least 30 days were collected. Chi-squared and Fisher’s exact tests were used for statistical analysis. The UC CORDS female population had a 4.0% (n = 4,693, age: 0–65, avg age: 35) COVID-19-positive test rate. Of these, 6,195 had acne vulgaris, with a 3.2% (n = 201, age: 0–65, avg age: 33) COVID-19 infection rate, 1,590 women had PCOS, of which 3.1% (n = 49, age: 18–50, avg age: 34) were COVID-19 positive, and 687 had hirsutism, with a 3.6% (n = 25, age: 19–65, avg age: 38) COVID-19-positive rate, none of which were different from women without these conditions (P = 0.002, P = 0.062, P = 0.635, respectively) (Table 1). Analysis of hospitalization rates among COVID-19-positive women (n = 4,693) in the UC CORDS indicated that 11.4% (n = 535, avg age: 41) were hospitalized within 2 weeks (1 week prior or subsequent) of testing. COVID-19-positive women with acne (n = 201) had a 4.5% (n = 9, average age: 38) hospitalization rate (P = 0.002). COVID-19-positive women with PCOS or hirsutism had 6.1% (n = 3, average age 32) and 8.0% (n = 2, average age 40) hospitalization, respectively, which was not significantly different from those without (P = 0.363, P = 1.0, respectively). Lastly, these women did not