Study Finds Low-Dose Doxycycline Effective for Central Centrifugal Cicatricial Alopecia

The key takeaway from the analysis is that low-dose doxycycline (40-80 mg) should be promptly included in the initial treatment plan for central centrifugal cicatricial alopecia.

"This recommendation is supported by findings showing that patients who received low-dose doxycycline in addition to topical or intralesional steroids experienced hair regrowth at a rate seven times higher than those who only received steroids, even when treatment was started an average of seven years after the onset of the disease," the researchers wrote in Journal of the American Academy of Dermatology.

CCCA is characterized by progressive hair loss that starts at the crown of the scalp and spreads outward, often leading to significant emotional distress for those affected. Traditional treatments include topical and intralesional steroids. However, currently, there are no evidence-based studies that have thoroughly assessed the use of doxycycline for managing central centrifugal cicatricial alopecia. To fill this knowledge gap, Ashley Obi, Meharry Medical College, Nashville, Tennessee, and colleagues reviewed patients' medical records in the Mount Sinai Health System Data Warehouse with a histopathological and clinical diagnosis of CCCA.

The study analyzed 143 patients with central centrifugal cicatricial alopecia, dividing them into two treatment groups: Group 1 (doxycycline ± topical corticosteroids/intralesional triamcinolone [ILTAC], n = 115) and Group 2 (topical corticosteroids ± ILTAC, n = 28). Both groups were predominantly female (Group 1: 95.6%, Group 2: 100%) and mostly African American (Group 1: 80%, Group 2: 89.3%). Patients in Group 1 sought treatment an average of 7 years after disease onset, compared to 4.9 years in Group 2. Clobetasol 0.05% was the most used topical steroid in both groups. Group 1 had more severe scalp involvement and pruritus.

The following were the key findings of the study:

• The most common doxycycline doses were 40 mg daily (52.2%), 40 mg twice daily (27.8%), and 20 mg twice daily (19.1%), with 71.3% of subjects receiving a daily dose of 40 mg.
• Group 1 had a significantly higher rate of hair regrowth (70%) than Group 2 (39%).
• The average time for hair regrowth was 6.2 months in Group 1 and 5.6 months in Group 2.
• Analysis of nonstandardized photographs by two blinded dermatologists showed a significant difference in hair regrowth between groups, with Group 1 showing a notable improvement in hair loss patterns.

"Our study underscores the importance of conducting prospective clinical trials to quantitatively evaluate the effectiveness of doxycycline in managing CCCA, which could help solidify its role in treatment guidelines," the researchers concluded.

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DOI: https://www.jaad.org/article/S0190-9622(24)00474-2/fulltext