Reply to Letter to the Editor: A Response to 'Male Balding Is a Major Risk Factor for Severe COVID-19'

The document is a reply to a letter concerning the proposed relationship between male balding and severe COVID-19. The authors acknowledge the novel perspective of COVID-19 potentially being transmitted through the skin in bald individuals due to factors like photo-aging and oxidative stress but emphasize that further research is needed to confirm if the virus can infect epidermal keratinocytes or if skin inoculation leads to systemic disease. They also discuss hand eczema as another skin condition that could facilitate SARS-CoV-2 transmission due to compromised skin barriers. The document cites a study where 8.0% of 18,221 participants tested COVID-19 positive compared to 10.1% of 139 participants with hand eczema. The authors suggest that balding may serve as a visible biomarker for an aging immune system, which is less capable of neutralizing viruses and more prone to inflammation, thus making bald individuals potentially more susceptible to severe COVID-19. They conclude that balding, along with male sex and advanced age, which are already known risk factors for COVID-19, could help clinicians rapidly identify patients at higher risk.