Ketoconazole is an antifungal medication that’s widely used to treat skin and nail conditions like candidiasis, ringworm and seborrhoeic dermatitis.
It’s also a common ingredient in many hair loss shampoos and a substance that you’ll often find recommended, usually in the form of Nizoral shampoo, as part of a hair loss prevention stack.
Ketoconazole is scientifically linked to improvements in hair growth, making it worth using as a male pattern baldness treatment. It’s also easy to
In this guide, we’ll explain how ketoconazole works to help you prevent hair loss and fuel hair growth, as well as the most effective way to use a ketoconazole shampoo as part of your hair loss prevention stack.
While there isn’t quite as much scientific data about ketoconazole and hair loss as there is for minoxidil and finasteride, most studies related to ketoconazole and baldness show that it can be effective for improving hair growth.
One study from 1998 compared ketoconazole and minoxidil to see which had the best effects on hair growth. The researchers discovered that 2% ketoconazole shampoo increased the size and proportion of anagen hair follicles at a similar rate to the minoxidil spray.
There are also animal studies showing that regular use of ketoconazole significantly stimulates the rate of hair growth, even in hair follicles that aren’t usually affected by balding (such as the DHT-immune hair follicles on the back of the head).
Right now, there just isn’t enough data to conclusively say that ketoconazole prevents baldness or definitely regrows hair. However, the scientific evidence that’s currently available does show measurable improvements in hair growth when people use a ketoconazole shampoo.
While scientific studies show that ketoconazole seems to stimulate hair growth, they’re far less conclusive about how and why it does this.
Male pattern baldness is caused by dihydrotestosterone, or DHT, an androgen that affects the hair follicles in men with a genetic predisposition to baldness. Over time, DHT can cause hair follicles to miniaturize and gradually stop producing new hairs.
Medication like finasteride works by preventing DHT from developing in the first place, stopping any DHT-induced damage to hair follicles. Right now, there’s limited scientific evidence that use of ketoconazole can affect the same hormonal pathways as hair loss drugs like finasteride.
One scientific paper from 2004 presents a hypothesis that ketoconazole can disrupt the DHT pathway, potentially inhibiting DHT and slowing down hair loss. The researchers propose that ketoconazole could potentially be used as an adjunct to finasteride for stronger hair retention.
It’s important to point out that this is only a hypothesis. Right now, there aren’t any conclusive studies showing that ketoconazole has any measurable effect on DHT, even though it’s shown to have some positive effects on hair growth.
Since ketoconazole treats seborrhoeic dermatitis, it’s widely used as an anti-dandruff shampoo ingredient. This means that you’ll probably want to consider adding a ketoconazole shampoo to your hair care stack if you’ve noticed dandruff forming on your neck and shoulders.
Ketoconazole isn’t effective against all forms of dandruff, meaning you’ll want to try a variety of options if you have persistent dandruff that just won’t go away. Our post on preventing dandruff shares several treatment options for improving your scalp health.
Ketoconazole shampoos like Nizoral are often touted online as being one of the "big three" hair loss prevention products, the other being finasteride and minoxidil.
While the current studies don’t yet show ketoconazole as being as much of a help for hair loss as finasteride and minoxidil, it could be effective at helping you create a good environment for hair growth. You should note that the studies which reviewed ketoconazole for hair loss used the prescription strength 2% solution. In the US you can buy the 1% solution over the counter but would need a prescription for the 2% ketoconazole shampoo.
If you decide to add an over the counter ketoconazole shampoo to your hair loss prevention regimen, it’s suggested to use it once a week. You can use a gentler DHT blocking shampoo the rest of the week.
It’s important to remember that ketoconazole shampoos probably won’t do as much to stop your hair loss as finasteride. If you’ve noticed hair loss and don’t take finasteride, you should talk to your doctor and see if it could help you prevent further loss and keep the hair you already have.
You can read more about how male pattern baldness happens in our DHT and Male Hair Loss guide, which explains how you can prevent male hormones like DHT from damaging your hair follicles.