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New Study Investigates Low-Dose Antibiotic Treatment for Hair Loss Condition
A recent study reveals that administering small quantities of a widely used antibiotic and anti-inflammatory medication can mitigate symptoms associated with lymphocytic scarring alopecia, a condition often linked to autoimmune responses that result in permanent hair loss. This alternative approach may present fewer side effects compared to traditional higher dosages.
Conducted by researchers at NYU Langone Health, the study focused on lymphocytic scarring alopecia, a rare disorder where the immune system inadvertently harms hair follicles, leading to hair loss and scarring. Clinicians typically prescribe high doses of doxycycline, the antibiotic in question, for extended periods to treat this chronic condition. However, side effects such as nausea, vomiting, and rashes can hinder patient compliance, prompting the team to investigate whether lower dosages could yield similar effectiveness.
Involving 241 participants diagnosed with various forms of lymphocytic scarring alopecia, the research demonstrated that lower doses (20 milligrams taken twice daily) were just as effective as higher doses (up to 100 milligrams taken twice daily). Evaluations regarding scalp inflammation, subjective severity of hair loss, and clinical assessments of hair density, hair-shaft diameter, and hairline recession showed no significant differences between the two dosages.
Moreover, the study noted that 23% of participants on the high-dose regimen reported common adverse reactions to doxycycline, whereas only 12% experiencing negative effects were on the lower dosage. Further, gastrointestinal side effects prompted 25% of those taking high doses to discontinue medication, compared to 16% of the lower dose group.
According to Carli Needle, BA, co-lead author of the study, “Our findings suggest that lower doses of doxycycline can be effectively prescribed without sacrificing the treatment’s anti-inflammatory benefits.” Needle, who is a medical student at NYU Grossman School of Medicine, also emphasized that reduced doses could protect gut health, as doxycycline is known to negatively impact beneficial bacteria in the digestive system. Past research indicates that doses below 40 milligrams pose a lesser risk to these organisms.
The current research is notable for being the first to systematically compare varying doses of doxycycline specifically for lymphocytic scarring alopecia treatment, as highlighted by Needle.
A report detailing these findings will be published on March 18 in the Journal of the American Academy of Dermatology.
To conduct the study, researchers analyzed electronic medical records of scarring alopecia patients treated at NYU Langone Health from 2009 to 2023. Out of these records, approximately 27% showed prescriptions for low doses of doxycycline, while nearly 73% were on traditional high doses. The researchers performed statistical comparisons between the two groups while mitigating the effects of other common medications used in conjunction with doxycycline, such as minoxidil.
The authors also noted that one of the benefits of using lower doses is the potential to reduce the risk of developing antibiotic-resistant bacteria—a significant concern in medical communities worldwide. Antimicrobial stewardship is increasingly emphasized, advocating for the cautious prescription of antibiotics to curb the prevalence of resistant strains.
“Our results present healthcare providers with an important option to minimize harmful antibiotic misuse while also addressing the issue of drug-resistant microbes,” remarked Anna Brinks, BA, co-lead author and medical student at NYU Grossman School of Medicine.
Kristen Lo Sicco, MD, co-senior author and an associate professor at the Ronald O. Perelman Department of Dermatology, noted, “Alopecia can severely impact a person’s self-esteem and lead to issues such as social stigma, depression, and anxiety. It is essential to advance treatment strategies to address not just hair loss, but its psychological and social implications.”
Moving forward, Lo Sicco stated that the research team plans to replicate the study on a larger and more diverse population, as the current cohort is predominantly White. Additionally, they hope to investigate the underlying triggers of lymphocytic scarring alopecia, a topic that remains inadequately understood.
The study was funded by NYU Langone Health. In addition to Needle, Brinks, and Lo Sicco, the research involved several other experts from NYU Langone, including Akshay Pulavarty, MD, MPH; Caitlin Kearney, BS; Ambika Nohria, BA; Deesha Desai, BS; and Jerry Shapiro, MD.
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