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Ketoconazole Shampoo

Evidence
35%
Regrowth
Viability

Topical Ketoconazole

Evidence
25%
Regrowth
Viability
  • Shampoo
  • Topical
  • Ketoconazole
    Evidence Quality

    35%

    Regrowth Potential
    Long-Term Viability
    Written by Perfect Hair Health Team
    Medically Reviewed by Rob English
    First Published Oct 4, 2024
    Last Updated Oct 28, 2024

    Key Information

    Free Resources

    KEY INFORMATION

    What Is Ketoconazole?

    Ketoconazole is drug originally intended to treat fungal infections, but later reformulated as a shampoo to treat androgenic alopecia and telogen effluvium associated with dandruff, dermatitis, and excessive scalp oiliness.

    How Does Ketoconazole Work?

    Ketoconazole helps reduce pathogenic microorganisms in the scalp skin, which in turn helps reduce inflammation. When used as a topical and/or shampoo, it also may have mild antiandrogenic properties. Both of these mechanisms might explain its hair growth-promoting effects.

    What You Should Know

    For those who have androgenic alopecia alongside excessive dandruff, dermatitis, scalp itch, and/or scalp oiliness, 2% ketoconazole shampoo may act as a low-cost, low-effort, moderately-helpful intervention to improve hair counts.

  • Ketoconazole
    Evidence Quality

    25%

    Regrowth Potential
    Long-Term Viability
    Written by Perfect Hair Health Team
    Medically Reviewed by Rob English
    First Published Oct 4, 2024
    Last Updated Oct 28, 2024

    Key Information

    Free Resources

    KEY INFORMATION

    What Is Ketoconazole?

    Ketoconazole is drug originally intended to treat fungal infections, but later reformulated as a shampoo to treat androgenic alopecia and telogen effluvium associated with dandruff, dermatitis, and excessive scalp oiliness.

    How Does Ketoconazole Work?

    Ketoconazole helps reduce pathogenic microorganisms in the scalp skin, which in turn helps reduce inflammation. When used as a topical and/or shampoo, it also may have mild antiandrogenic properties. Both of these mechanisms might explain its hair growth-promoting effects.

    What You Should Know

    For those who have androgenic alopecia alongside excessive dandruff, dermatitis, scalp itch, and/or scalp oiliness, 2% ketoconazole shampoo may act as a low-cost, low-effort, moderately-helpful intervention to improve hair counts.

FREE RESOURCES

Articles

Explore the science behind hair loss and hair growth. Our in-depth articles cover topics ranging from natural remedies to pharmaceuticals to breakthroughs in hair loss science. Want to request an article topic? Contact us.

Why Am I Shedding After Starting Ketoconazole?
By Sarah King, PhD
Apr 19, 2024

Why Am I Shedding After Starting Ketoconazole?

Some people experience increased hair shedding after using ketoconazole shampoos or topicals. This can be due to several factors: treatment-induced hair shedding, a drug reaction, seasonal hair shedding, changes to other aspects of your hair growth regimen, ketoconazole overuse, scalp drying, & ...
Does Ketoconazole Work for Women?
By Sarah King, PhD
Apr 11, 2024

Does Ketoconazole Work for Women?

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 patter...
I Am Experiencing Side Effects From Ketoconazole. What Should I Do?
By Rob English
Apr 11, 2024

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

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 t...
The 6 Best DHT Blockers For Men
By Perfect Hair Health Team
Apr 6, 2022

The 6 Best DHT Blockers For Men

Which DHT blockers work? Which ones put hair loss sufferers at a greater risk of side effects? What does the actual evidence say versus marketing hype for the latest DHT-reducing supplements, topicals, and drugs? The answers may surprise you. In this article, the Perfect Health Team evaluates 6 DHT ...
Nizoral for Hair Loss – Does it Work?
By Perfect Hair Health Team
Mar 25, 2022

Nizoral for Hair Loss – Does it Work?

Ketoconazole, better known as Nizoral®, is often regarded as an effective hair growth shampoo. But does this antifungal, dandruff-reducing shampoo live up to its billing as a key member of the Big 3 of hair loss treatments? In this article, we’ll analyze the evidence to determine the effect of...
1% Or 2% Ketoconazole Shampoo For Hair Loss: Does It Matter?
By Perfect Hair Health Team
Jan 7, 2020

1% Or 2% Ketoconazole Shampoo For Hair Loss: Does It Matter?

While 1% ketoconazole is sold as an ingredient in hair loss shampoos worldwide, only 2% ketoconazole is clinically shown to improve pattern hair loss. Unfortunately, 2% ketoconazole requires a prescription. But is the 2% formulation really worth the the hassle of seeing your doctor for a prescriptio...
FREE RESOURCES

Articles

Explore the science behind hair loss and hair growth. Our in-depth articles cover topics ranging from natural remedies to pharmaceuticals to breakthroughs in hair loss science. Want to request an article topic? Contact us.

The 6 Best DHT Blockers For Men
By Perfect Hair Health Team
Apr 6, 2022

The 6 Best DHT Blockers For Men

Which DHT blockers work? Which ones put hair loss sufferers at a greater risk of side effects? What does the actual evidence say versus marketing hype for the latest DHT-reducing supplements, topicals, and drugs? The answers may surprise you. In this article, the Perfect Health Team evaluates 6 DHT ...
  • FREE RESOURCES

    Research Tables

    Want the latest research on Ketoconazole Shampoo? Every quarter, our research team conducts a literature search on Ketoconazole Shampoo to keep you up-to-date on new studies. See our search criteria & research tables below – including a summary of key findings from every single study.

    Last updated: October 2024

    Results

    Search Criteria

    Parameter
    Inclusion Criteria
    Exclusion Criteria
    PatientsPatients of any age with hair loss.Patients with no hair loss disorder.
    InterventionKetoconazole shampoo as a standalone or adjunct therapy.A study that doesn’t contain ketoconazole shampoo either as a standalone or adjunct therapy.
    ComparatorPlacebo and/or other therapies or baseline, or in the observational studies - none.
    OutcomesPrimary Endpoints of phototrichogram, investigator, and/or patient assessments.Any study not designed to adequately test for the standalone or additive effect of ketoconazole shampoo.
    Study DesignProspective, observational, retrospective, and case series studies.Literature reviews, non-human subjects, or ongoing clinical trials.

    Search Terms

    Search Terms:
    shampoo hair loss alopecia ketoconazole
    • Abbreviations:
    • RCT
      Randomized Controlled Trial
    • AGA
      Androgenic Aloepcia
    • KTZ
      Ketoconazole
    • PTO
      Piroctone Olamine
    • ZPT
      Zinc Pyrrithione
    • PI
      Pilary Index

    Summarized Studies

    StudyParticipantsDesignTreatmentResultsKey TakeawayAdverse EffectsEvidence Quality
    Authors (year)SexHair Loss TypeDesignDoseUsageDurationEndpointsHair Growth AssessmentsSummaryLimitationsAdverse EffectsJadad Score
    Rafi & Katz.(2011)n = 15 (M)iconAGAProspective pilot study2% KTZ shampoo. 8 used NuH Hair + finasteride + minoxidil + KTZ, 5 used only NuH Hair, 1 used NuH Hair + finasteride + KTZ, 1 used NuH Hair + KTZ.KTZ shampoo used 2-3 times a week9 monthsAverage time for hair regrowth.30 days for hair regrowth with NuH Hair + finasteride + minoxidil + ketoconazole.

    30 days for hair regrowth with NuH Hair + finasteride + ketoconazole.

    60 days for hair regrowth with NuH Hair + ketoconazole.

    90 days for hair regrowth with NuH Hair alone.    		Ketoconazole works well as a combination therapy with finasteride and minoxidil and can improve AGA in men with atopic and/or seborrheic dermatitis.Small sample size, lack of control, short follow-up, ketoconazole was not used alone.No significant adverse effects were reported.
    1
    Khandpur et al. (2002)n = 100 (M)iconAGAOpen, randomized, parallel-group study.Finasteride 1 mg

    Finasteride 1 mg + Minoxidil 2%

    Minoxidil 2%

    Finasteride 1 mg + 2% KTZ shampoo    		Once daily

    Once daily



    Once daily

    Once daily
    		12 monthsPatient self-assessment and physicians’ assessment.Finasteride + minoxidil and finasteride + KTZ reap the best improvement scores for both self- and physician-assessments.

    However, finasteride + minoxidil slightly outperformed finasteride + ketoconazole.    		2% KTZ works well as a combination therapy with finasteride.Open-label design, no control, and subjective outcome measures.Finasteride 1 patient - loss of libido after 3 months but continued without further decline.

    Minoxidil 1 patient - low blood pressure and increased heart rate.
    2
    Pierard-Franchimont et al. (2002)n = 150 (M)Mild-to-
    moderate dandruff, telogen effluvium related to vertex iconAGA
    		RCT1% KTZ shampoo

    1% PTO shampoo

    1% ZPT shampoo
    		2-3 times weekly6 monthsHair shedding, hair density, percentage of anagen hairs, mean proximal hair shaft diameter, and sebum excretion rates.Pruritis and dandruff cleared rapidly in all 3 shampoo groups.

    Hair density remained unchanged in all 3 shampoo groups.

    Hair shedding decreased by 17.3% in the KTZ group, 16.5% in the PTO group, and 10.1% in the ZPT group.

    Anagen hair ratio increased by 4.9% in the KTZ group, 7.9% in the PTO group, and 6.8% in the ZPT group.

    Sebum excretion rate decreased by 4.8% in the KTZ group, 2.9% in the PTO group, and 5.5% in the ZPT group.    		1% KTZ shampoo 2-3 times weekly lessened hair shedding by ~20%, increased hair shaft thickness by ~5%, and decreased sebum output by ~5%. No placebo, short follow-up.None reported
    2
    Pierard-Franchimont et al. (1998)n = 61 (M)
    n = 39 with AGA

    n = 22 without AGA    		iconAGAComparative, observational study.2% KTZ shampoo

    Normal Shampoo
    		2-4 times weekly21 monthsAGA pilary index (PI): defined as the percentage of hairs in anagen x average diameter of the hair shafts 1.5 cm from the hair bulbThe PI of non-AGA controls remained unchanged regardless of the type of shampoo used (KTZ vs. normal shampoo).

    The PI of only AGA subjects with unmedicated shampoo showed a slow linear decrease over time, while the ketoconazole group showed a progressive increase evident after 6 months.    		In men without AGA, KTZ doesn’t improve hair counts or hair shaft diameter.

    In men with AGA, KTZ improves both anagen hair counts and overall hair shaft diameter.    		Small sample sizeNone reported
    0
  • FREE RESOURCES

    Research Tables

    Want the latest research on Topical Ketoconazole? Every quarter, our research team conducts a literature search on Topical Ketoconazole to keep you up-to-date on new studies. See our search criteria & research tables below – including a summary of key findings from every single study.

    Last updated: October 2024

    Results

    Search Criteria

    Parameter
    Inclusion Criteria
    Exclusion Criteria
    PatientsPatients of any age with hair loss.Patients with no hair loss disorder.
    InterventionTopical ketoconazole as a standalone or adjunct therapy.A study that doesn’t contain ketoconazole either as a standalone or adjunct therapy.
    ComparatorPlacebo and/or other therapies or baseline, or in the observational studies - none.
    OutcomesPrimary Endpoints of phototrichogram, investigator, and/or patient assessments.Any study not designed to adequately test for the standalone or additive effect of topical ketoconazole.
    Study DesignProspective, observational, retrospective, and case series studies.Literature reviews, non-human subjects, or ongoing clinical trials.

    Search Terms

    Search Terms:
    topical hair loss alopeci ketoconazole
    • Abbreviations:
    • RCT
      Randomized Controlled Trial
    • AGA
      Androgenic Aloepcia
    • KTZ
      Ketoconazole
    • PTO
      Piroctone Olamine
    • ZPT
      Zinc Pyrrithione
    • AR
      Androgen Receptors
    • FPHL
      Female Pattern Hair Loss
    • MXT
      Topical Minoxidil

    Summarized Studies

    StudyParticipantsDesignTreatmentResultsKey TakeawayAdverse EffectsEvidence Quality
    Authors (year)SexHair Loss TypeDesignDoseUsageDurationEndpointsHair Growth AssessmentsSummaryLimitationsAdverse EffectsJadad Score
    El-Garf, Mohie, and Salah (2019)n = 40

    Group A = 20

    Group B = 20
    		iconFPHLRCTGroup A: 2% Minoxidil

    Group B: 2% KTZ
    		1 mL daily6 monthsHair growth (clinical and trichoscopic) and patient satisfaction.Hair Growth:
    Group A: Significant improvement in hair growth at months 4 and 6 compared to the baseline.

    Group B: Hair growth is delayed compared to minoxidil, and it is seen only in month 6 of treatment. A notable improvement was observed in reducing brown peripilar signs (related to perifollicular inflammation).

    Ludwig Score:
    Group A: Significant improvement in severity seen by months 4 and 6.

    Group B: Significant improvement by the 6th month.

    Patient satisfaction:
    No significant difference between the two groups. 75% of patients in both groups reported being satisfied. 20% in each group were very satisfied.
    		KTZ demonstrated significant hair growth but with a delayed response compared to minoxidil. KTZ had fewer side effects, making it a potentially safer alternative for FPHL.Small sample size, short duration, no placebo, no long-term follow-up.Group A: 55% reported side effects, including dermatitis and facial hypertrichosis

    Group B: 10% reported minor cases of dermatitis.
    3
    Inui and Itami (2007)n = 6 (M)iconAGAOpen-label2% KTZ lotionAlmost every day during or immediately after hair washing with an unmedicated shampoo.Up to 12 monthsHair regrowth, consistency of hair regrowth, and mechanism of action.2 of 6 participants showed significant hair regrowth on the vertex area after 6 and 10 months of using KTZ.

    1 of 6 patients showed mild improvement in vertex hair density after one year of consistent use.

    3 of 6 participants did not show any noticeable hair regrowth during the study.

    Laboratory tests indicated the KTZ suppressed AR activity in cell assays.
    		KTZ might promote hair growth through an anti-androgenic mechanism.Small sample size, lack of control, no quantitative measures.None reported.
    1