I Am Experiencing Side Effects From Ketoconazole. What Should I Do?

Article Summary

Ketoconazole shampoo, a anti-fungal medication, is widely used to treat dandruff and seborrheic dermatitis. It is also sometimes used as an off-label treatment for androgenic alopecia and telogen effluvium. Some users experience side effects such as scalp itchiness & dryness. But with a bit of troubleshooting, these adverse events are often resolvable. This article reveals a scientific, step-by-step framework for troubleshooting side effects from ketoconazole shampoo.

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Hair Shedding

Understanding the reasons behind hair shedding is important when using ketoconazole shampoo, as it helps in distinguishing between normal hair loss and the potential side effects of the treatments. Various factors can influence hair shedding, and it’s important to identify whether this shedding is (1) a positive shed in response to starting ketoconazole, (2) a reaction to the ketoconazole itself, and/or (3) if this hair shedding is actually coincidental to your introduction of ketoconazole, and is instead caused by other factors: seasonal hair cycling, the introduction or withdrawal of other hair loss treatments, and/or telogen effluvium sheds.

Medical and legal consensus – with any treatment-related side effect – is to stop that treatment and consult with your doctor immediately. Nonetheless, we’ll go through a few of these situations below, along with potential troubleshooting advice for resolution:

Scalp Issues

If your hair shedding is accompanied by scalp dryness, hair dryness, and/or itchiness, then this might be a reaction from the ketoconazole shampoo, and you can follow the above-mentioned measures to mitigate the side effects.

If your hair shedding is accompanied by scalp redness, then there is a slight possibility that you are having a very rare allergic reaction to the shampoo. In cases like this, we recommend stopping the ketoconazole and seeing a doctor or dermatologist who can further assess your tolerability. While allergic reactions to ketoconazole are rare, it is usually best to err on the side of caution – especially as ketoconazole tends to be a lower-leverage treatment option (meaning that it often does not produce vast amounts of hair regrowth).

Scalp Adjustment to Treatment

If any other side effects do not accompany your hair shedding and you have just started ketoconazole in the last 3 months, then it may just be that your scalp is still adjusting (and responding) to new treatments. Therefore, it might be that some of your shedding is due to a positive treatment response. We’ll have more articles about this soon.

Seasonal Shedding

Sometimes, increases to hair shedding have nothing to do with your hair loss treatments and, instead, are simply a function of seasonal hair shedding.

Humans undergo a temporary uptick in shedding due to hair cycle seasonality. In the northern hemisphere, these upticks typically occur in July and August, then settle into lower shedding rates in winter. While this shedding is mostly unavoidable, there’s also good news: it doesn’t really interfere with the success of your long-term hair loss treatments. So, if you’re within peak windows of time for seasonal hair shedding, you may want to consider that at least some of this shedding might not be due to ketoconazole, but instead, due to seasonality.

Recent Introduction/Withdrawal of Other Treatments

It may also be that the hair shedding might not be related to ketoconazole use. If you have withdrawn from or introduced other hair loss treatments within the last three months, these changes may also explain recent upticks to hair shedding.

Skin Burning, Peeling, or Redness

As mentioned above, scalp redness has a slight possibility of being a rare allergic reaction to the shampoo. We recommend stopping using the shampoo and seeing your doctor or dermatologist for advice.

Hair Discoloration

Hair discoloration is a rarer side effect of ketoconazole shampoo, but a few long-term treatment users have reported it. Under these circumstances, we recommend you stop using ketoconazole shampoo and instead switch to other shampoos with anti-dandruff and antifungal properties, but that work through different mechanisms and thus may not evoke the same effect. Consider shampoos with the following active ingredients: selenium sulfide and/or zinc pyrithione.

Shampoos with these ingredients are widely sold over the counter and are specifically formulated to reduce dandruff and skin flaking. There’s also some evidence that they may support hair growth in those with androgenic alopecia, female pattern hair loss, and/or telogen effluvium associated with microorganism overgrowths.^[3]Trueb, R.M., Henry, J.P., Davis, M.G., Schwartz, J.R. (2018). Scalp Condition Impacts Hair Growth and Retention via Oxidative Stress. International Journal of Trichology. 10(6), 262-270. Available … Continue reading,^[4]McGinley, K.J., Leyden, J.J. (1982). Antifungal activity of dermatological shampoos. Archives of Dermatological Research. 272(3-4). 339-342. Available at: https://doi.org/10.1007/BF00509065

Other Side Effects

If you experience any other side effects and want advice from the community, feel free to make a forum post describing your growth regimen, ketoconazole shampoo routine, and specific side effects. Our team and community will chime in with resources and strategies to help you resolve this. You can post your questions here.