A new study suggests that low-dose doxycycline is just as effective but significantly better tolerated than high-dose regimens for treating lymphocytic scarring alopecias. The findings were published in a research letter in the Journal of the American Academy of Dermatology on March 18.

The study, led by Carli Needle from the New York University Grossman School of Medicine, analyzed the medical records of 241 adults treated between 2009 and 2023. Researchers compared the efficacy and side effects of low-dose doxycycline (20 to 50 mg daily) against high-dose treatments (50 to 200 mg daily) in patients with lymphocytic scarring alopecias—a condition characterized by inflammation that leads to permanent hair loss.

While both low and high doses of doxycycline led to improvements in inflammation severity, high-dose doxycycline was associated with a significantly higher rate of adverse effects, particularly gastrointestinal issues and skin reactions like photosensitivity and rash. The study revealed that 20.4 percent of patients on high-dose regimens reduced or discontinued treatment due to side effects, compared to just 9.1 percent in the low-dose group.

Importantly, the research found no significant difference between high and low doses when it came to the progression of hair loss or improvement in scalp symptoms. Patient-reported outcomes also showed similar results across both groups after accounting for other anti-inflammatory treatments.

“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 concluded.

The findings could help guide dermatologists in prescribing safer and more comfortable long-term treatment strategies for patients suffering from this challenging hair loss condition.