10.5826/dpc.1401a18
text/xml
2160-9381
3403
en
Daniel  Fernandes Melo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
therapy
Is there a rationale for the Use of Lymecycline for Frontal Fibrosing Alopecia?
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Commentary
2024-01-31
2023-04-06
2024-01-31
2024-02-21
e2024018
Dermatol Pract Concept
Daniel  Fernandes Melo
2024/01/31
10.5826/dpc.1401a18
e2024018
Department of Dermatology, State University of Rio de Janeiro – UERJ, Rio de Janeiro, Rio de Janeiro, Brazil
2160-9381
therapy
en
e2024018
Therianou A, Singh S. Facial papules in frontal fibrosing alopecia. J Am Acad Dermatol. 2017;76(6 Suppl 1): AB139. DOI: https://DOI.org/10.1016/j.jaad.2017.04.542.
Is there a rationale for the Use of Lymecycline for Frontal Fibrosing Alopecia?
https://dpcj.org/index.php/dpc/article/download/3403/2445
       Is there a Rationale for the Use of Lymecycline
               for Frontal Fibrosing Alopecia?
      Flavia Oliveira Xavier de Brito1, Rita Fernanda Cortez de Almeida1, Sidney Frattini2,
              Carlos Baptista Barcaui1, Michela Starace3,4, Daniel Fernandes Melo1


1 Department of Dermatology, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Rio de Janeiro, Brazil
2 The Mole Clinic, Private Practice, Ancaster, Ontario, Canada
3 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
4 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy



Citation: Xavier de Brito F, Cortez de Almeida RF, Frattini S, Barcaui CB, Starace M, Melo DF. Is there a rationale for the Use of
Lymecycline for Frontal Fibrosing Alopecia? Dermatol Pract Concept. 2024;14(1):e2024018. DOI: https://doi.org/10.5826/dpc.1401a18
Accepted: May 7, 2023; Published: January 2024
Copyright: ©2024 Xavier de Brito et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Flavia Oliveira Xavier de Brito, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro - RJ, 20551-030, Brazil.
Email: flaviaoxb@gmail.com



Frontal fibrosing alopecia (FFA) is a primary lymphocytic                     Lymecycline is the semisynthetic byproduct of the tet-
scarring alopecia considered a variant of lichen planopi-                racycline ring combined with the amino acid L-lysine. This
laris. It affects mainly postmenopausal women, and its inci-             combination enhances drug absorption and serum levels,
dence has been increasing worldwide [1-3]. Its pathogenesis              increases tissue penetration, and reduces the biodegrada-
remains to be fully appreciated, but it seems related to an              tion rate [8,9]. It can thus be administered once a day with
autoimmune reaction targeting follicular antigens [2,4].                 less phototoxicity or food interaction. The result is a better
Clinical manifestations include a recession of the fronto-               cost-effective profile compared to its counterparts [8]. Lyme-
temporal hairline, loss of body hair and eyebrow, and skin               cycline is a short-acting tetracycline already well-documented
changes such as facial papules and lichen planus pigmento-               for acne treatment [9]. All tetracyclines have antibacterial
sus. Pruritus, pain and burning happen in variable degrees               and anti-inflammatory properties by inhibiting the synthesis
[2,5-7].                                                                 of cytokines and macrophage function [8]. Its most frequent
    There is no curative treatment for FFA, so therapy aims              side effects include nausea, diarrhea, and headache [8].
to control the symptoms and stop its progress [3]. ­Tetracycline              Considering that FFA is in great part related to an in-
and doxycycline are effective therapeutic ­options for some              flammatory attack of CD8 T lymphocytes at the bulge level,
types of alopecia due to their anti-inflammatory properties              lymecycline may be able to control this inflammatory pro-
at various levels of the inflammatory cascade [8,9]. Lymecy-             cess, as illustrated in Figure 1 [2,10]. A study with patients
cline has also been cited in a few FFA reports, however its              affected by neutrophilic cicatricial alopecia suggested a dose
wider recommendation requires further studies [10,11]. This              of 300 mg per day for approximately 3 months, as it showed
article discusses the theoretical rationale for lymecycline as           a better outcome compared to the use of 45 days [8]. The
an alternative for FFA.                                                  advantages of this regimen are superior gastrointestinal



Commentary | Dermatol Pract Concept. 2024;14(1):e2024018                                                                                  1
Figure 1. ​​​​​​​(A) Trichoscopy of a frontal fibrosing alopecia patient before treatment with oral lymecycline showing peripilar scaling. (B) Trichos-
copy after treatment with oral lymecycline showing reduction of peripilar scaling.

tolerance compared to other tetracyclines and better patient                   5. Starace M, Orlando G, Iorizzo M, et al. Clinical and Dermo-
adherence due to a single daily dose of the medication. Short-                      scopic Approaches to Diagnosis of Frontal Fibrosing Alopecia:
                                                                                    Results From a Multicenter Study of the International Dermos-
term maintenance treatment of 300 mg every other day may
                                                                                    copy Society. Dermatol Pract Concept. 2022;12(1):e2022080.
also be considered in refractory FFA, showing signs of active
                                                                                    DOI: 10.5826/dpc.1201a80. PMID: 35223189. PMCID:
inflammation [8].                                                                   PMC8824238.
    FFA is a distressful condition with a profound psycho-                     6.   Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C, et al.
social impact. This article discussed the rationale behind the                      Frontal fibrosing alopecia: a multicenter review of 355 patients.
use of oral lymecycline as a therapeutic option for FFA. The                        J Am Acad Dermatol. 2014;70(4):670-678. DOI: 10.1016/j
                                                                                    .jaad.2013.12.003. PMID: 24508293.
biochemical profile of lymecycline seems to support its effec-
                                                                               7.   Melo DF, Barreto TM, Faro GBA, Machado CJ, Donati A. Occip-
tiveness, potentially expanding the armamentarium against
                                                                                    ital hairline involvement in frontal fibrosing alopecia: frequency,
FFA. While future randomized controlled trials may clarify                          clinical presentation and trichoscopy findings in a series of twenty
the therapeutic impact of lymecycline, the discussion above                         patients. J Eur Acad Dermatol Venereol. 2020;34(8):e405-e407.
suggests a promising role for this drug in this challenging                         DOI: 10.1111/jdv.16337. PMID: 32153060.
disease.                                                                       8.   Melo DF, Jorge Machado C, Bordignon NL, da Silva LL,
                                                                                    Ramos PM. Lymecycline as a treatment option for dis-
                                                                                    ­
                                                                                    secting cellulitis and folliculitis decalvans. Dermatol Ther.
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