Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 6/21/2022
If you’ve ever looked into treatments for hair loss, you’ve likely heard of shampoos that contain the active ingredient ketoconazole.
Ketoconazole is an antifungal medication that’s approved by the FDA to treat numerous fungal infections that can affect the skin.
It’s also an ingredient in hair loss shampoos and something you’ll often see recommended as a part of an at-home protocol to prevent hair loss, usually in the form of Nizoral® shampoo.
Ketoconazole is scientifically linked to improvements in hair growth, making it worth using as a hair loss treatment option. It’s also easy to apply, since all that’s required is a quick wash in the shower a few times per week.
Below, we’ve explained what ketoconazole is, as well as how ketoconazole works as a form of treatment for male pattern baldness.
We’ve also discussed other options you may want to consider if you’re starting to develop hair loss, including FDA-approved medications, cosmetic procedures and more.
Ketoconazole is a medication that’s used to treat and manage fungal infections. It belongs to a class of drugs called imidazole antifungals and works by inhibiting the synthesis of compounds that fungi need to grow.
Like many other antifungal medications, ketoconazole comes in several forms. It’s available in tablet form as an oral medication, as a cream that’s applied to the skin and as an ingredient in antifungal shampoo.
Your healthcare provider may prescribe ketoconazole if you have a fungal skin infection. As an older antifungal, ketoconazole generally isn’t used as a first-line treatment. Instead, it’s typically used when other antifungal medications aren’t effective or suitable.
Although ketoconazole is best known as an antifungal medication, there’s also some evidence that it can help to treat scalp conditions and stop hair loss from androgenetic alopecia, or male pattern baldness.
Other common uses for ketoconazole shampoo include reducing dandruff, providing relief from skin conditions such as psoriasis and stopping scalp fungal infections from spreading.
We’ve discussed these uses below, as well as the scientific evidence to back up ketoconazole shampoo for each condition.
As an antifungal medication, ketoconazole is commonly used to treat fungal skin infections that can affect your scalp.
One common fungal infection that affects the scalp is tinea capitis, or scalp ringworm. This skin infection can cause an itchy, uncomfortable rash that forms across your scalp. When it’s severe, tinea capitis can potentially lead to hair shedding and permanent damage to your hair follicles.
Tinea capitis is similar to tinea versicolor (a fungal infection that can develop on the trunk and/or shoulders), tinea cruris (a skin infection of the groin and inner thighs referred to as jock itch) and tinea pedis (an infection of the feet and toes referred to as athlete’s foot).
Although tinea capitis is best treated using oral antifungal medication, ketoconazole shampoo is often used as a secondary treatment for this type of skin infection.
Seborrheic dermatitis is an inflammatory disorder that can cause a greasy, scaly rash on your scalp and in the folds of your skin. The rash caused by seborrheic dermatitis is often itchy and when scratched, may cause skin flaking and dandruff.
Ketoconazole shampoo is one of the most common treatment options for seborrheic dermatitis, as well as the dandruff it can cause. As such, you’ll often find ketoconazole listed as an active ingredient in shampoos designed to treat and prevent dandruff.
For example, Nizoral® and Head and Shoulders® both sell anti-dandruff shampoos that contain ketoconazole as an active ingredient.
Other ingredients, such as pyrithione zinc can also help control dandruff. We’ve discussed these active ingredients and other treatment options in more detail in our full guide to the best ways to get rid of dandruff for good.
Ketoconazole shampoo is also a common treatment for psoriasis, a skin disorder that can cause the growth of red, raised and scaly patches of skin.
If you have psoriasis that affects your scalp, your healthcare provider may recommend washing your hair and scalp with a ketoconazole shampoo, either on its own or in combination with other treatments.
In a study published in the British Journal of Dermatology, researchers found that regular use of a shampoo containing ketoconazole and clobetasol propionate, a corticosteroid that can reduce skin inflammation, helped to control moderate to severe scalp psoriasis.
So, does ketoconazole shampoo actually treat hair loss? Over the years, several studies have looked into the efficacy of ketoconazole as a potential hair loss treatment, with most producing promising results.
For example, one study published in the journal Dermatology compared ketoconazole and the hair loss medication minoxidil (a topical treatment often sold under the brand name Rogaine®) 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 minoxidil.
One systematic review consisting of a mix of animal and human studies published in the journal Dermatologic Therapy also looked at the effects of topical ketoconazole as a treatment for male pattern hair loss.
After reviewing seven articles involving ketoconazole and hair loss, the researchers noted that ketoconazole appears to produce a clinically significant improvement and is a promising option for treating male pattern baldness.
Finally, a small study published in 2019 found that ketoconazole helps to treat pattern hair loss in women, albeit at a slower rate than minoxidil.
Although these findings are promising, it’s important to keep in mind that ketoconazole doesn’t yet have completely firm research to back it up as a treatment for hair loss.
Still, the existing research shows that ketoconazole has real potential as a hair loss medication, and that it may work well alongside other treatments for male pattern baldness.
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While scientific studies largely show that ketoconazole stimulates hair growth, they’re much less conclusive about how and why it works.
Before we get into the specifics of ketoconazole, it’s important to go over the basics of how male pattern baldness develops in the first place.
Contrary to popular belief, male pattern baldness isn’t caused by wearing a hat daily or brushing your hair too aggressively. Other hair loss myths, such as the idea that hair loss is inherited from your mother’s father, also aren’t supported by scientific evidence.
Instead, male pattern baldness is caused by a combination of genetic factors and the effects of a hormone called dihydrotestosterone, or DHT.
DHT is an androgen, or male sex hormone. It’s produced as a byproduct of testosterone. Early in your life, DHT plays a vital role in the development of your male sex characteristics, such as facial and body hair. It also helps to form your male genitalia and prostate gland.
However, as you get older, DHT becomes less vital for your wellbeing and can have a range of negative effects within your body.
One of these effects is called follicular miniaturization, in which DHT binds to receptors in your scalp and causes your hair follicles to gradually stop producing new hairs.
Our guide to DHT and male pattern baldness goes into more detail about the effects of DHT on your hairline, as well as your options for preventing DHT-related damage to your hair follicles.
Some medications for hair loss, such as finasteride, work by stopping your body from producing DHT. This shields your hair follicles from the effects of DHT and either slows down, prevents or reverses hair loss.
Currently, there isn’t any evidence that ketoconazole reduces DHT levels throughout your body like finasteride. However, a scientific paper from 2004 presents a hypothesis that ketoconazole may disrupt the DHT pathway in your scalp, potentially inhibiting DHT and slowing hair loss.
The researchers propose that ketoconazole could be used alongside finasteride for a stronger inhibition of DHT and better results.
While this is a promising finding and an interesting theory, 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 levels, even though it is shown to have some positive effects on hair growth.
Several different types of ketoconazole shampoo are available to treat seborrheic dermatitis and other issues that can affect the scalp. These include:
Mild ketoconazole shampoos. These contain a small amount of ketoconazole, typically 1% ketoconazole or less. This type of ketoconazole shampoo is sold over the counter as a treatment for dandruff.
2% ketoconazole shampoos. These contain 2% ketoconazole and other ingredients to treat seborrheic dermatitis, dandruff and fungal infections. You’ll need a prescription from your healthcare provider to purchase this type of medicated shampoo.
Other shampoos may use ketoconazole in combination with other ingredients, such as salicylic acid or pyrithione zinc. These are often formulated to treat problematic dandruff and other scalp conditions.
Using ketoconazole shampoo is simple. Most over-the-counter ketoconazole shampoos can be used every three to four days for up to eight weeks, then used as needed to control dandruff or other skin conditions.
You can use over-the-counter ketoconazole shampoo by following these steps:
Check that your skin isn’t irritated, cut or broken. If your skin is okay, wet your hair before applying the shampoo.
Apply the ketoconazole shampoo to wet hair. Gently rub the shampoo into your hair until a lather forms. Make sure to apply the shampoo evenly to your hair and scalp.
Rinse the shampoo out of your hair, making sure to wash away all of the shampoo. Once the water runs clear, repeat the steps above and carefully rinse all of the shampoo out of your hair before you finish cleaning yourself.
If you’re prescribed ketoconazole shampoo to treat a fungal scalp infection such as tinea capitis, it’s important to closely follow your healthcare provider’s instructions.
Although you may only need to apply this medication once, it can take several months for your skin to improve and for all symptoms of your infection to disappear. You may need to reuse this type of shampoo if you develop a recurring infection.
You can use prescription ketoconazole shampoo by following these steps:
Wet the affected area of your scalp, then carefully apply the shampoo to this area and the surrounding skin.
Using your fingers, gently rub the shampoo into your skin to form a lather. Make sure to leave the shampoo on your scalp for five minutes.
Rinse the shampoo out of your hair, making sure to completely wash the shampoo off from your skin.
If you use other hair products, such as conditioner, make sure to totally rinse the ketoconazole shampoo from your hair before applying anything else to your hair or scalp.
Most people don’t develop problematic side effects from ketoconazole shampoo. However, like with other medications, ketoconazole can potentially cause side effects and allergic reactions.
Potential side effects of topical ketoconazole include:
Blisters on the scalp
Dry hair and changes in hair texture
Oily hair and/or scalp
Skin irritation and/or stinging
These common side effects are typically mild and are often temporary. If you develop persistent or severe adverse effects while you’re using ketoconazole shampoo, it’s important to talk to your healthcare provider as soon as you can.
In rare cases, ketoconazole may cause an allergic reaction. Tell your healthcare provider if you develop hives, skin rash, redness, tenderness, warmth or pain in your scalp, difficulty breathing or swallowing.
Ketoconazole should not be ingested. If you accidentally get ketoconazole shampoo or cream in your eyes, carefully wash them using plenty of water until the offending substance is completely removed.
Ketoconazole is often promoted as one of the “big three” treatments for male pattern baldness, along with the medications finasteride and minoxidil.
While there isn’t as much scientific research to support ketoconazole as a treatment for hair loss as there is for other medications, the studies that are available look promising.
Ketoconazole appears to have real benefits, although we don’t yet know how effective it is over the long term. It’s worth noting that the studies which reviewed ketoconazole as a treatment for hair loss tend to use the stronger ketoconazole 2% solution, which requires a prescription.
In the United States, the less powerful 1% version of ketoconazole shampoo is widely available over the counter.
However, you’ll need to talk to your healthcare provider if you’d prefer to use ketoconazole 2% shampoo as part of your hair loss prevention routine.
While the science behind ketoconazole shampoo is promising, it isn’t the most effective option available for treating hair loss.
Right now, the two most effective treatments for male pattern baldness are the FDA-approved medications finasteride and minoxidil.
Finasteride is an oral prescription medication that works by stopping the production of DHT. It works well as a treatment for hair loss, with one study finding that more than 80 percent of all balding men who use it show improvements after one year.
We offer finasteride online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
Minoxidil is a topical, over-the-counter medication that works by increasing scalp blood flow and moving hair follicles into the anagen, or growth, phase of the hair growth cycle.
Like finasteride, it can promote growth and improve hair density, with the same study finding that 59 percent of men showed improvements after using minoxidil.
While finasteride and minoxidil are effective on their own, they’re even more effective at treating hair loss when they’re used together. In fact, in the same study, more than 94 percent of balding men who used both medications showed improvements after one year of treatment.
We offer finasteride and minoxidil together, along with several other hair-friendly products, in our Hair Power Pack. We also offer a Topical Finasteride and Minoxidil Spray that combines the two hair loss medications into a single, easy-to-use spray for your scalp.
If you have dandruff, a fungal infection on your scalp or psoriasis, your healthcare provider may recommend using ketoconazole shampoo to control your symptoms.
When it comes to treating hair loss, the evidence for ketoconazole is promising but not quite at the right stage for it to be recommended as a proven treatment. However, it may offer benefits when used alongside established treatments such as finasteride and minoxidil.
Worried about losing your hair? We offer a range of men’s hair loss treatments online, including proven medications, shampoos and dietary supplements for promoting optimal hair growth.
You can also learn more about the best options for slowing down, preventing and reversing hair loss in our detailed guide to treatments for thinning hair.