Does Ketoconazole Work for Women?

Article Summary

Several clinical studies support the effectiveness of ketoconazole, an anti-fungal treatment, in treating androgenic alopecia and telogen effluvium. However, the evidence for ketoconazole in women is limited. One study found that daily ketoconazole use can facilitate hair growth in women with pattern hair loss. However, in that study, the ketoconazole was formulated as a topical rather than shampoo. While further research is warranted, ketoconazole may work as well for women as it does for men.

Full Article

Ketoconazole is used off-label to treat androgenic alopecia and telogen effluvium. While it is well-studied in men, there is a significant lack of clinical data showing its efficacy in women. In this guide, we will explore the evidence supporting the use of ketoconazole in androgenic alopecia, as well as answer whether it is suitable for use in women.

What is Ketoconazole?

Ketoconazole, primarily an antifungal drug, is commonly employed to combat diverse fungal infections within the body. Interestingly, it also finds application in addressing hair loss issues, including androgenic alopecia (AGA) and telogen effluvium (TE), typically through topical formulations and shampoos. Certain products containing ketoconazole for hair loss are accessible without a prescription, like shampoos containing 1% ketoconazole. Medical practitioners might advise or provide more potent ketoconazole treatments in specific cases.

How Does Ketoconazole Work?

Ketoconazole functions as an antifungal agent by disrupting the cell membranes of fungi, impeding their growth and replication. Its antifungal properties are beneficial for addressing scalp conditions by reducing fungal activity and inflammation. In hair loss conditions like AGA and TE, ketoconazole contributes to a healthier and less inflamed scalp, creating a more conducive environment for growth.

Moreover, recent studies have suggested that ketoconazole shampoo may lower dihydrotestosterone (DHT) levels by inhibiting five alpha-reductases. Combined with treatments like finasteride, this can offer a more comprehensive approach to addressing these conditions.^[1]Perez, B.S.H. (2004). Ketoconazole as an adjunct to finasteride in treating androgenetic alopecia in men. Medical Hypotheses. 62(1). 112-115. Available at: … Continue reading

What Evidence is there for Ketoconazole in Hair Loss?

The effectiveness of ketoconazole in treating hair loss, particularly in conditions such as AGA and TE is supported by various clinical studies. These studies have explored the impact of ketoconazole not only as a standalone treatment but also in combination with other hair loss therapies.

Study One

This study involved 39 male participants exclusively with androgenic alopecia (AGA); the effects of 2% ketoconazole shampoo were compared to those of regular shampoo over 21 months. 27 men used the ketoconazole shampoo, while 12 used a regular shampoo. Additionally, 22 individuals without AGA served as controls, half using ketoconazole and the other half using regular shampoo. The results revealed a significant difference between the two groups.

Results

Among the non-AGA control participants, the choice of shampoo had no discernable impact on their AGA pilary index (defined as the product of the percentage of hairs in the growth (anagen) phase and average diameter (in micrometers) of the hair shaft).

Conversely, among the participants with AGA who used an unmedicated shampoo, there was a gradual linear decline in their AGA pilary index over time. In contrast, the group using the ketoconazole shampoo exhibited a progressive increase in their AGA pilary index, and this effect became noticeable after six months. The increase seemed to plateau after approximately 15 months of using the ketoconazole shampoo.^[2]Piérard-Franchimont, C., De Doncker, P., Cauwenbergh, G., Piérard, G.E. (1998). Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology. 196(4). 474-477. Available at: … Continue reading

Study Two

Another study involved 150 male participants experiencing TE-related to AGA with associated dandruff. During the study, 150 male participants were split into three groups, and each group was given a different shampoo to use. One group used a shampoo containing 1% ketoconazole, another group used a shampoo with 1% piroctone olamine, and the third group used a shampoo with 1% zinc pyrithione.

The researchers measured hair shedding, hair density, the percentage of anagen (growth phase) hair, the average diameter of proximal hair shafts, and sebum excretion rates to evaluate the effectiveness of each shampoo.

Results

The study results indicated that all three shampoo formulations promptly addressed pruritus (itching) and dandruff symptoms, leading to rapid clearance. No significant changes were observed in any of the three shampoo groups regarding hair density.

However, there was a noteworthy reduction in all three groups regarding hair shedding. The ketoconazole group experienced a 17.3% decrease, the piroctone olamine group saw a 16.5% reduction, and the zinc pyrithione group had a 10.1% decrease in hair shedding.

Furthermore, the percentage of anagen hair increased in all three shampoo groups. The ketoconazole group exhibited a 4.9% rise, the piroctone olamine group showed a 7.9% increase, and the zinc pyrithione group demonstrated a 6.8% increase.

All groups showed a decrease in sebum secretion rates, with the ketoconazole group experiencing a 4.8% reduction, the piroctone olamine group showing a 2.9% decrease, and the zinc pyrithione group recording a 5.5% decline.^[3]Piérard-Franchimont, C., Goffin, V., Henry, F., Uhoda, I., Braham, C., Piérard, G.E. (2002). Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine, … Continue reading

Other Studies

Two other studies evaluated the efficacy of ketoconazole in combination with other hair loss treatments like finasteride and minoxidil in men with AGA. They found it works well as a combination therapy and can even improve AGA in men with atopic and/or seborrheic dermatitis.

So, clinical evidence shows that ketoconazole can improve hair loss outcomes. However, all these studies suffer from a significant limitation; they have only included male subjects. Let’s find out if there is evidence for using ketoconazole in women.

Clinical Evidence for Ketoconazole for Women

There is currently no published evidence for using ketoconazole shampoo in women. However, one study did compare the efficacy of a 2% ketoconazole solution to 2% minoxidil in female pattern hair loss. The study involved 40 female pattern hair loss patients. 20 were in Group A using 2% topical minoxidil, and 20 were in Group B treated with 2% topical ketoconazole. Both groups received treatment for six months, with changes to the Ludwig scale and trichoscopic (magnified images of the scalp, typically used for counting hairs) outcomes evaluated.

Results

The results showed that both groups experienced improved hair growth (Figure 1 & 2), but the minoxidil group responded faster. In contrast, the ketoconazole group had a delayed response, which became significant at the 6-month. Side effects were also less common in the ketoconazole group (10% vs. 55% in the minoxidil group), and patient satisfaction did not significantly differ between the two groups.^[4]El-Garf, A., Mohie, M., Salah, E. (2019). Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss: a clinical and trichoscopic evaluation. Biomed Dermatol. 3(8). … Continue reading

 

 

The study indicates that applying ketoconazole topically can facilitate hair regrowth in women with fewer side effects than minoxidil. Ketoconazole is probably as effective for women as it is for men. However, additional research is necessary to obtain a more comprehensive understanding of its efficacy and safety.

Can I Use Ketoconazole If I am Pregnant or Breastfeeding?

We always recommend a trip to the doctor before using any product if you are pregnant or breastfeeding. While certain patient informational leaflets suggest ketoconazole shampoo can be used during pregnancy and breastfeeding, the ketoconazole dilutions in those leaflets only reference products with 20 mg per gram of ketoconazole.^[7]Nizoral, (no date). Nizoral Anti-Dandruff Shampoo Ketoconazole. Nizoral. Available at: https://www.medicines.org.uk/emc/files/pil.6456.pdf (Accessed: 03 November 2023) Be sure to check with your doctor to confirm your dilution of ketoconazole shampoo matches that of 20 mg/gram, and that your doctor also agrees with these recommendations.

Can I Use Ketoconazole Alongside Other Hair Loss Medications?

Researchers have observed that combining ketoconazole with other treatments works best in treating AGA in humans. This is because ketoconazole has different mechanisms of action than minoxidil, microneedling, and finasteride. Targeting multiple mechanisms generally leads to better results. If you’re interested in seeing a real-life example of hair regrowth achieved using ketoconazole in combination with other treatments, you can find it here.