Doxycycline and Minocycline Show Benefit in OLP Gingival Lesions

Key Takeaways

• A new retrospective study showed significant improvement with doxycycline or minocycline therapy in topical treatment-refractory patients with inflammatory oral lichen planus (OLP) involving the gingiva.

• Patients with mild inflammation responded better than those with desquamative gingivitis.

• Second-generation tetracyclines may be safer alternatives to systemic immunosuppressants for gingival OLP, the authors suggested.

A retrospective analysis suggests doxycycline and minocycline may offer an effective systemic option for patients with inflammatory oral lichen planus (OLP) involving the gingiva who fail to respond to topical agents.

Study researchers reviewed the clinical records of 254 patients with biopsy-confirmed OLP and erythematous or erosive gingival involvement who were refractory to topical therapy alone. All patients received a 2-month course of doxycycline or minocycline (100 mg BID), in addition to topical treatments. 

According to the results, after two months, 60.6% of patients achieved marked clinical improvement in gingival erythema (95% CI, 54.6% to 66.6%). Patients with milder baseline inflammation were significantly more likely to improve (80.3%; 95% CI, 71.3% to 89.2%) vs. those presenting with desquamative gingivitis (29.4%; 95% CI, 16.9% to 41.9%). About a quarter of the patients experienced acute flare-ups after therapy cessation, which responded to short repeat courses. Ten patients reported mild, transient adverse effects that resolved upon discontinuation.

“These findings support the use of second-generation tetracyclines as systemic first-line agents in gingival OLP patients who do not respond to topical agents, as alternatives to more aggressive immunosuppressive therapies,” the authors concluded.

Source: Eisen D. Journal of Drugs in Dermatology. 2026;25(2):9159.