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Low-Dose Doxycycline Effective for Lymphocytic Scarring Alopecias

Medically reviewed by Carmen Pope, BPharm. Last updated on March 21, 2025.

By Lori Solomon HealthDay Reporter

FRIDAY, March 21, 2025 – Relative to high-dose doxycycline, low-dose doxycycline is comparably effective but more tolerable for lymphocytic scarring alopecias, according to a research letter published online March 18 in the Journal of the American Academy of Dermatology.

Carli Needle, from the New York University Grossman School of Medicine in New York City, and colleagues evaluated the efficacy and tolerability of low- (20 mg twice daily [BID], 40 mg daily, and 50 mg daily) versus high-dose (50 mg BID, 100 mg daily, and 100 mg BID) doxycycline for lymphocytic scarring alopecias in a retrospective review. The analysis included 241 adults treated between 2009 and 2023.

The researchers found that high-dose doxycycline was associated with significantly higher rates of adverse effects (AEs), most commonly gastrointestinal symptoms and photosensitivity/rash. One in five (20.4 percent) of high-dose patients and 9.1 percent of low-dose patients reduced/discontinued doxycycline due to AEs. Doxycycline use was associated with improvement in inflammation severity, regardless of dose, when adjusting for the presence of at least one adjunctive anti-inflammatory medication. There was no significant difference seen between the groups for progression of hair loss or improvement in number of scalp symptoms. For patient-reported outcomes, there were no significant differences between dose groups after controlling for adjunctive therapies.

"This study highlights the benefits of low-dose doxycycline for lymphocytic scarring alopecias, showing comparable efficacy and improved tolerability relative to high doses," the authors write.

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Posted March 2025

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