Man looking at his hair in the mirror

What Is Ketoconazole Used For?

No man wants to lose his hair, especially earlier than expected. There’s nothing wrong with sporting a chrome dome if that’s the look you want, and it’s a personal choice. If you’re one of the many men suffering from unwanted hair loss and want to do something about it, you may have heard of ketoconazole. You may also be wondering what it’s used for and if it’s the right option for you.

What Is Ketoconazole?

Ketoconazole is an antifungal medication available as an oral pill, topical cream and foam, topical gel, and shampoo. Although this medication is used as a treatment for yeast and fungal infections of the skin, nails, and hair, for some it’s been proven an effective treatment for hair loss, specifically male pattern baldness.

Ketoconazole is rarely prescribed as the first medication for fungal infections. There are more effective medications that doctors prescribe before recommending ketoconazole to a patient. It’s usually prescribed if the patient had an adverse reaction to one of the other more modern medications.

What Kind of Infections Does Ketoconazole Treat?

Ketoconazole is a common treatment for fungal skin infections. When directly applied to the skin in its cream, foam, or gel form, it’s been proven to be an effective treatment for fungal skin infections. Annoying conditions such as athlete’s foot, dandruff, sweat rash, and jock itch are typically treated with ketoconazole. Its primary function is to eliminate the fungus that can cause infections and skin irritations.

It should be noted that when used for treating fungal infections, ketoconazole in pill form has several side effects. The Mayo Clinic reports that some patients have experienced one or more of the following:

  • Chills
  • Confusion
  • Headache
  • Joint pain
  • Loss of appetite
  • Sore throat
  • Hives
  • Unusual tiredness or weakness

Does Ketoconazole Work Immediately?

When used to combat fungal infections, ketoconazole typically works within 2 to 3 weeks. For conditions such as athlete’s foot, the medication can take up to 6 weeks before some relief is noticed.

For men who use ketoconazole to slow down or possibly regrow hair, results vary. Some patients have seen positive results in 3 to 6 months when using ketoconazole shampoo. As a treatment for dandruff, users report relief in 2 to 4 weeks.

What Ketoconazole Shampoo Is Used for?

Ketoconazole shampoo has different uses. It’s a common treatment for fungal infections of the scalp such as dandruff and psoriasis. It can be purchased as an over-the-counter medication or for a stronger dose, by prescription.

Ketoconazole shampoo is used to combat the following:

Psoriasis and Dandruff

Psoriasis and other inflammatory skin diseases can be treated with ketoconazole shampoo. It’s an effective treatment for conditions that cause skin flaking and skin plaque.

Tinea Infections

For fungal scalp infections such as tinea capitis and tinea versicolor, ketoconazole shampoos are often used. Tinea capitis is a ringworm-type fungal infection that can affect the scalp. Tinea versicolor is caused by a yeast-like scalp infection.

Hair Loss

Although ketoconazole shampoo is more typically used for fungal infections of the skin, some studies suggest that it may help with the reduction of hair loss, and it could possibly help promote natural hair growth.

Can Ketoconazole Shampoo Regrow Hair?

The jury is still out on whether ketoconazole shampoo can regrow hair in all men, but many swear by it. Although it is not FDA-approved to treat hair loss issues, there is some promising scientific evidence that supports its use as a treatment option. Despite its lack of FDA approval, scores of doctors recommend it to their patients who are fighting the battle against hair loss.

In 1998, the scientific journal Dermatology published a study that suggested that a 2% ketoconazole shampoo not only increased hair density but also increased the size and proportion of hair follicles.

Six years later, researchers discovered that the cause of ketoconazole shampoo’s success at boosting hair follicles was due to a reduction in follicle inflammation. It’s been long established that some types of hair loss can be attributed to inflammation in hair follicles.

Ketoconazole’s main use is to fight fungal infections. Dandruff comes from a fungal infection known as Malassezia. We all have a small amount of this fungus on our scalps. When it’s in abundance, we develop dandruff. When it builds up it creates inflammation, and then the flakes appear. Many men with dandruff also experience hair loss, most likely due to an interference with the hair follicles.

Some studies suggest that using ketoconazole shampoo can help to restore hair growth by reducing the amount of Malassezia on the scalp, thus eliminating scalp inflammation. Once the inflammation is reduced, hair follicles regain their health and can again produce hair.

Other studies indicate that another benefit of using ketoconazole shampoo is that it can act as a dihydrotestosterone (DHT) blocker. High levels of DHT, an androgen hormone, have been linked to hair loss. Men with an abundance of this hormone have a higher probability of losing their hair. When DHT levels are high, they can bind to hair follicles, causing them to shorten the growing phase and lengthen the rest phase.

Ketoconazole shampoo has produced positive results in men looking to reverse their hair loss. Ongoing studies suggest it could be the answer to regrowing hair, although more research is needed.

Which Is Better? – Ketoconazole Shampoo 1% or 2%?

Most over-the-counter ketoconazole shampoos contain a 1% concentration of ketoconazole. While this may eliminate the problems of mild dandruff, it may not be suitable for men whose goal is to stop hair loss. A shampoo with a concentration of 2% ketoconazole requires a prescription from a healthcare provider. This higher concentration is better suited for hair loss issues.

Although much more convenient, 1% ketoconazole shampoos should be avoided when their use is directed at hair loss. Studies suggest that although both products are highly effective at combating dandruff and fungal scalp infections, a 2% concentration is better suited for men looking to retard hair loss.

One study revealed that men with male pattern baldness who used a 2% ketoconazole shampoo did show success at growing more hair. An interesting fact of this study is that it suggests that a 2% ketoconazole shampoo is nearly twice as effective as minoxidil. This could be credited to the fact that it can severely reduce the amount of Malassezia found on the scalp. Less of this scalp fungi can lessen scalp inflammation, which in turn allows previously inflamed hair follicles to begin the growth cycle of new hair.

Another advantage of using 2% ketoconazole shampoo is its ability to lower levels of scalp DHT quickly and effectively. This reduction allows hair follicles to resume producing new hair since the DHT is no longer binding and inhibiting new growth.

The research done so far suggests that a 2% ketoconazole shampoo is much more effective at eliminating hair loss than a 1% concentration, and it can help to reintroduce hair growth. Although it does require a prescription, it’s a small inconvenience when it comes to keeping your hair versus using an inferior, but easier-to-obtain medication.

How Do I Use Ketoconazole Shampoo?

Once you’ve made the decision to use ketoconazole shampoo, you’ll want to ensure that you’re using it properly to gain the most benefit. For use as a hair loss prevention shampoo, you can purchase an over-the-counter brand or obtain a prescription from your doctor for a more effective treatment. Be sure to read the manufacturer’s suggested use. Here are some general guidelines to follow:

  1. Wet the area of your scalp where you’re experiencing hair loss.
  2. Apply a small amount of the shampoo to the affected area including a small radius surrounding it.
  3. Massage the shampoo into the scalp and surrounding area for a full minute to ensure absorption.
  4. Allow the shampoo to rest on the affected area for 5 minutes.
  5. Thoroughly rinse with lukewarm to cool water.

Ketoconazole shampoo can be applied to the entire scalp for easier washing of the hair, however, pay more attention to massaging it into the necessary areas. It’s more beneficial to rinse the shampoo out with lukewarm to cool water. Hot water can cause damage to the scalp and hair follicles and can lead to scalp dryness and inflammation. Since hair follicle inflammation has been linked to hair loss, it’s a good practice to rinse your hair with cooler water.

This medication is designed for short-term use, typically between 6 to 8 weeks. With more frequent use, the hair shaft can become brittle and prone to breakage. Men with longer hair may notice that after washing it may be more tangled than usual, and it could require more care when combing and styling. For this reason, it’s a good practice to only use ketoconazole shampoo on the areas you’re targeting for hair loss.

After using ketoconazole shampoo for a month or two, take a break from using it. This can help to avoid your hair becoming brittle and dry. After a month’s break, you can return to your ketoconazole regimen for an additional 6 to 8 weeks.

If you’re using ketoconazole shampoo and experience unruly hair as a result, your solution could be better grooming. For example, use a high-quality hair conditioner after washing. Those that contain peppermint, coconut, argan, or jojoba oils can help to reduce the effects of ketoconazole shampoo that cause hair to be difficult to manage. A bonus is that some research suggests that these oils are beneficial to healthy hair growth. If you’re fighting hair loss, the more products you use that are good for your hair, the better your chances are of succeeding.

What Are the Major Side Effects of Ketoconazole Shampoo?

As is common with most medications, ketoconazole shampoo does have its share of possible side effects. Some users have experienced the following conditions:

  • Dry or itchy scalp
  • Scalp rash
  • Dry or oily hair
  • Scalp irritation or stinging
  • Changes in hair texture
  • Scalp blisters
  • Swelling of the face, throat, or tongue

These side effects are rare, and they usually only affect a small number of patients using ketoconazole shampoo. Most are temporary and will subside over time. These side effects won’t directly cause hair loss. However, due to the scalp irritation from some of them, those who experience scalp dryness or itchiness may experience more hair loss from scratching or pulling on the hair to provide some relief.

To lessen the severity of these side effects and to help prevent further hair loss, it’s best to speak to your dermatologist if you experience any of these unpleasant conditions. They can suggest other medications or treatments to help you curb the urge to scratch.

Is Ketoconazole a Good Choice for Hair Loss?

More research is necessary before a definitive answer can be found. However, clinical studies suggest that a 2% ketoconazole shampoo can help slow down or eliminate hair loss and promote new hair growth, even for those with male pattern baldness.

If you’re losing your hair and want to do something about it, speak to your primary healthcare provider who can determine if ketoconazole shampoo is a good choice for you, along with supplements and vitamins for hair problems.