Low-Dose Doxycycline Effective for Managing Lymphocytic Scarring Alopecia Symptoms

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Recent findings demonstrate that lower doses of doxycycline, a commonly used antibiotic and anti-inflammatory medication, may help patients effectively manage symptoms and reduce side effects of lymphocytic scarring alopecia.1

Lymphocytic scarring alopecia is a rare immune-related condition that results in permanent hair loss. This analysis was conducted by an investigative team at NYU Langone Health, led by co-senior author Kristen Lo Sicco, MD, an associate professor in the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine.2

“Alopecia can have a devastating effect on self-image and can lead to social judgment, depression, and anxiety,” Lo Sicco said in a statement.2 “Studies that advance the management of these conditions are critical to addressing not only hair loss itself but also the psychological and social consequences that accompany it.”

Lymphocytic scarring alopecia is a rare skin disease in which the immune system attacks patients’ hair follicles. Lo Sicco and colleagues noted that the condition is typically treated with high doses of doxycycline for extended treatment periods.2 However, they highlighted that a regimen using doxycycline has been linked with side effects like vomiting, nausea, and rashes, consequently leading to cessation of the medication.

In order to address the potential discontinuation of doxycycline, the investigators looked into whether lower doses of the antibiotic could provide those reporting lymphocytic scarring alopecia with the same therapeutic benefits. The team looked at 241 male and female patients’ electronic medical records, specifically those treated for scarring alopecia at NYU Langone Health between 2009 and 2023.1

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The team carried out statistical analyses intending to compare outcomes between the low and high-dose groups, excluding any influence from other treatments commonly used alongside doxycycline, such as minoxidil. They highlighted that approximately 27% had given a prescription for low-dose doxycycline (typically 20 mg twice per day), adding that close to 73% had been given the typical high-dose regimens (up to 100 mg twice per day).1,2

In their assessment of data from the 241 subjects with lymphocytic scarring alopecia, the research team did not identify any significant differences in efficacy between the results of those in the low-dose and high-dose doxycycline arms of their research. In both of the treatment groups, the team found that comparable outcomes had been reported in terms of perceived severity of hair loss, scalp inflammation, and clinical assessments of hair-shaft thickness, hair density, and receding hairlines.

When looking at both regimens’ side effects, the investigators found that 23% of individuals in the high-dose arm were shown to have adverse reactions commonly linked to the use of doxycycline, whereas only 12% of subjects in the lower-dose arm of the analysis reported such effects.1 Additionally, while 25% of individuals in the high-dose group discontinued treatment due to gastrointestinal issues, only 16% of subjects in the low-dose arm terminated the medication for the same reason.

According to the researchers, this is the first study to directly compare varying dosages of doxycycline for the treatment of individuals with lymphocytic scarring alopecia.

“These findings indicate that physicians can effectively prescribe lower doses of doxycycline for patients with lymphocytic scarring alopecia without compromising its anti-inflammatory benefits,” co-lead author Carli Needle, BA, NYU Grossman School of Medicine, said in a statement.2

Needle further expressed that although doxycycline can disrupt beneficial gut bacteria, prior research has suggested that doses of the antibiotic under 40 mg may be less likely to harm these microbes. Beyond improving patient tolerability, lowering doxycycline doses may also help combat antibiotic resistance.2

The study's authors also noted that excessive doxycycline implementation has been linked to the emergence of antibiotic-resistant bacterial strains. As a result, they wrote that medical professionals worldwide are emphasizing antibiotic stewardship—a strategy aimed at diminishing antibiotic prescriptions deemed to be unnecessary as a means to mitigate antibiotic resistance.

“Our results offer another avenue for healthcare providers to protect patients from harm caused by unnecessary antibiotic use and address the rise of drug-resistant strains of microbes,” co-author Anna Brinks, BA, NYU Grossman School of Medicine, said in a statement.2

The investigative team noted their plan to repeat their research using a larger and more diverse patient population, as those involved as trial participants were predominantly White.2

References

1. Needle C, Brinks A, Sicco K. Efficacy and Tolerability of Low-Dose Versus High-Dose Doxycycline in the Management of Lymphocytic Scarring Alopecias. Journal of the American Academy of Dermatology, 2025, ISSN 0190-9622. https://doi.org/10.1016/j.jaad.2025.02.028.

2. Low doses of antibiotic work just as well as higher ones to treat rare type of chronic hair loss. News release. NYU Langone Health / NYU Grossman School of Medicine. March 18, 2025. https://www.eurekalert.org/news-releases/1076645. Date accessed: March 19, 2025.