SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 155 

RISING DERM STARS® 
 

 
The use of doxycycline in lichen planopilaris and frontal fibrosing alopecia: a 
retrospective study of 138 patients at a tertiary referral clinic 
 
Janice Tiao, MD1, Lynne J. Goldberg, MD 
 
1Department of Dermatology, Boston University Medical Center, Boston, MA, USA 
 

 
 
Background/Objectives: Lichen 
planopilaris (LPP) and frontal fibrosing 
alopecia (FFA) are lymphocyte-mediated 
primary cicatricial alopecias (1). They are 
rare, and limited evidence exists on treatment 
options (1-2). The best data supports 
hydroxychloroquine as the first-line systemic 
therapeutic agent (1,3), although expert 
opinion cites doxycycline as an acceptable 
first-line alternative and small series support 
its potential efficacy (4-5). The purpose of this 
study is to describe the use of doxycycline in 
patients with LPP and FFA at a single tertiary 
referral clinic.  
 
Methods: After obtaining IRB approval, the 
authors reviewed the medical records of 138 
patients with LPP and FFA who presented to 
the outpatient specialty Hair Clinic at Boston 
University Medical Center from 2015-2017.  
 
Results: Of 138 subjects, 1 was excluded 
because there was no electronic medical 
record on file. Thirty-one subjects had a 
diagnosis of LPP, 103 had a diagnosis of 
FFA, and 3 were diagnosed with both LPP 
and FFA. Of the 31 LPP-only subjects, 16 
had been prescribed doxycycline for their 
condition. Of these subjects, 9 (56.3%) 
reported or were observed to improve or 
stabilize, 2 (12.5%) did not improve, and 5 
(31.3%) had unclear response or were lost to 
follow up. Of the 106 subjects with FFA, 40 

had been prescribed doxycycline for their 
condition. Of these 40 subjects, 17 (42.5%) 
were felt to improve or stabilize, 7 (17.5%) did 
not improve, and 15 (37.5%) had unclear 
response or were lost to follow up. The 
average duration of use was 8 months. Of 
note, 14 of 56 (25%) subjects who took 
doxycycline discontinued the medication 
secondary to side effects, most commonly 
gastrointestinal. 
 
Conclusion: Although a number of subjects 
did not tolerate the medication, the data 
confirm that doxycycline may be helpful in the 
treatment of LPP and FFA. 
 

References: 
1. Bolduc, C., Sperling, L.C., Shapiro, J. 

Primary cicatricial alopecia. J Am Acad 
Dermatol 2016;75:1081-99. 

2. Ochoa, B.E., King, L.E., Price, V.H. Lichen 
planopilaris: annual incidence in four 
hair referral centers in the United 
States. J Am Acad Dermatol 
2008;58:352-3. 

3. Errichetti, E., Figini, M., Croatto, M., 
Stinco, G. Therapeutic management of 
classic lichen planopilaris: a systematic 
review. Clin Cosmet Investig Dermatol 
2018;11:91-102. 

 



SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 156 

4. Spencer, L.A., Hawryluk, E.B., English, 
J.C. Lichen planopilaris: Retrospective 
study and stepwise therapeutic 
approach. Arch Dermatol 2009;45:333-
4. 

5. Lyakhovitsky, A., Amichai, B., 
Sizopoulou, C., Barzilai, A. A case series 
of 46 patients with lichen planopilaris: 
Demographics, clinical evaluation, and 
treatment experience. J Dermatolog 
Treat 2015;26:275–9.