Lower doses of antibiotics -doxycycline provide an effective treatment for alopecia

Lower doses of antibiotics -doxycycline provide an effective treatment for alopecia

Small amounts of a common antibiotic and anti-inflammatory drug can curb symptoms in which a misdirected immune response (such as autoimmunity) can cause permanent hair loss, a new study shows. This regimen may also come with fewer side effects than higher doses of the medication.

Led by researchers at NYU Langone Health, the study examined lymphocytic scarring alopecia, a rare skin condition in which the body's immune cells damage hair follicles, leading to hair loss and scarring. Doctors typically treat this chronic disorder with relatively high doses of the antibiotic doxycycline, often for extended periods of time. However, the drug can cause nausea, vomiting and skin rashes, discouraging patients from continuing to take it, the study authors said. As a result, the team set out to see if lower doses might work instead.

Results in 241 men and women treated for various forms of lymphocytic scarring alopecia found that lower doses (usually 20 milligrams taken twice daily) and higher doses (up to 100 milligrams twice daily) were equally effective. Specifically, researchers found no significant difference between the two groups in assessments of scalp inflammation, perceptions of the severity of their hair loss, and clinical measurements of hair density, hair shaft diameter, and hair recession.

While 23% of those on the high-dose regimen experienced common negative side effects from doxycycline, only 12% of those taking smaller doses of the drug did. Another important finding was that 25% of the high-dose group stopped taking doxycycline due to gastrointestinal problems, while only 16% of the low-dose group stopped taking doxycycline due to this side effect.

Our results suggest that physicians can prescribe lower doses of doxycycline to patients struggling with lymphocytic cicatricial alopecia without compromising the efficacy and anti-inflammatory benefits of the therapy. “

Carli-Nadel, BA, co-lead author of studies

Needle, a medical student at NYU Grossman School of Medicine, adds that in addition to unpleasant side effects, gut health can prevent unpleasant side effects. Doxycycline, she notes, damages the helpful bacteria that live in the digestive tract and strengthens the body's defenses against disease-causing microbes. However, previous studies have shown that drug doses below 40 milligrams are less risky for beneficial microbes.

The new study is the first to directly compare the effectiveness of different doses of doxycycline for treating lymphocytic cicatricial alopecia, Nadel says.

A report on the findings will be published on March 18 in theJournal of the American Academy of Dermatology.

For the study, the research team collected data from electronic medical records of patients with cicatricial alopecia treated at NYU Langone Health between 2009 and 2023. Of these, approximately 27% were prescribed low doses of doxycycline, and nearly 73% were on traditional high-dose regimens. Next, the team conducted a statistical analysis to compare the two groups. The researchers derived from their analysis any effects of other medications that commonly accompany this treatment, such as the hair growth drug minoxidil.

According to the authors, another benefit of reducing doxycycline doses is that experts have linked the drug to the rise of dangerous bacterial populations that can survive antibiotic treatments. Clinicians worldwide are now trying to combat such antibiotic resistance by changing how often and in what quantities they prescribe these drugs, a practice called antibiotic stewardship.

“Our findings provide healthcare providers with another avenue to protect patients from harm caused by unnecessary use and address the rise of drug-resistant microbial strains,” said study co-lead author Anna Brinks, a medical student at NYU Grossman School of Medicine.

“Alopecia can have a devastating impact on self-image, leading to social judgment, depression and anxiety,” added study co-senior author Kristen Lo Sicco, MD. “Studies that advance the management of these conditions are critical to address not only the hair loss itself, but also the psychological and social consequences that accompany it.”

Lo Sicco, associate professor in the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, says the next researchers would like to repeat their work in a larger and more diverse group because the study patients were largely white.

In addition, the team intends to explore the triggers that cause lymphocytic scarring alopecia, which are poorly understood.

Study funding was provided by NYU Langone Health.

In addition to Nadel, Brinks and Lo Sicco, other participants in the study include NYU Langone researchers Akshay Pulavarty, MD, MPH; Caitlin Kearney, BS; Ambika Nohria, BA; Deesha Desai, BS; and Jerry Shapiro, Md.

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