Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 5/17/2021
Ketoconazole is an antifungal medication that’s approved by the FDA to treat several fungal infections that can affect the skin.
It’s also a common active ingredient in hair loss shampoos and a medication you’ll often see recommended, typically in the form of Nizoral® shampoo, as part of an at-home protocol used to prevent hair loss.
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 a week.
Here, we explain how ketoconazole shampoo works as a hair loss treatment, as well as how you can use it for hair loss and other conditions that may affect your scalp.
We’ve also listed other treatments for hair loss to be aware of if you’re starting to develop a receding hairline or other signs of male pattern baldness.
Ketoconazole is a popular over-the-counter product that’s used to treat several conditions that can affect your scalp.
Common uses for ketoconazole shampoo include treating fungal infections, reducing dandruff and providing relief from skin conditions such as psoriasis.
As an antifungal medication, ketoconazole is commonly used to treat fungal skin infections that can affect your scalp.
One common fungal infection is tinea capitis, or scalp ringworm–and it can cause an itchy, uncomfortable rash on the scalp. When severe, tinea capitis can lead to hair shedding and permanent damage to hair follicles.
Tinea capitis is similar to tinea versicolor (a fungal infection that typically develops on the trunk and/or shoulders), tinea cruris (known as jock itch) and tinea pedis (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 infection.
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, you may benefit from using 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 helped to control psoriasis.
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 treatments for seborrheic dermatitis and the dandruff it causes.
You’ll often find ketoconazole listed as an ingredient in shampoos designed to treat and prevent dandruff.
For example, Nizoral® and Head and Shoulders® both offer brand-name anti-dandruff shampoos that contain ketoconazole as an active ingredient.
Other ingredients, such as pyrithione zinc can also help control dandruff. Learn more about these treatment options in our guide to getting rid of dandruff for good.
Several studies have found that ketoconazole shampoo might help slow the effects of male pattern baldness and stimulate hair growth.
For example, one study published in the journal Dermatology compared ketoconazole and the hair loss medication 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 minoxidil.
A systematic review (a mix of both animal and human studies) published in the journal Dermatologic Therapy also looked at the effects of ketoconazole as a treatment for hair loss.
After reviewing seven articles involving ketoconazole and alopecia, 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.
While there isn’t yet firm research positioning ketoconazole as a definitive hair loss solution, the studies that have been performed show that ketoconazole has real potential as a possible treatment for forms of hair loss such as male pattern baldness.
While scientific studies largely show that ketoconazole stimulates hair growth, they’re far less conclusive about how and why it works.
Male pattern baldness is caused by dihydrotestosterone, or DHT, an androgen that can cause hair follicles to gradually miniaturize and stop producing new hairs.
As we’ve explained in our guide to DHT and male hair loss, not everyone is equally susceptible to the effects of DHT. This is why some men go bald relatively early in life, while others are able to maintain a full head of hair well into old age.
Medications like finasteride work by preventing your body from converting testosterone into the more potent hormone DHT.
Since finasteride lowers DHT levels, it also helps limit DHT-damage to your hair follicles and prevents male pattern baldness.
There’s limited scientific evidence to show that ketoconazole has the same effects on DHT levels as 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:
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 skin conditions that can affect your scalp.
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 to form a lather.
Rinse the shampoo out of your hair, making sure to remove all of the shampoo. Once the water runs clear, repeat the above steps and carefully rinse all of the shampoo out of your hair before finishing.
If you’re prescribed a ketoconazole shampoo to treat a fungal infection, it’s important to closely follow your healthcare provider’s instructions.
Although you may only need to apply this medication once, it may 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, be sure to fully rinse the ketoconazole shampoo from your hair before applying anything else.
Most people don’t develop problematic side effects from ketoconazole shampoo. However, as with other medications, ketoconazole can occasionally cause side effects. These include:
Itchy and/or dry skin
Blisters that form on your scalp
Changes to your hair texture
Overly dry or oily scalp and/or hair
Itching, stinging and/or skin irritation
Allergic reactions to ketoconazole are uncommon. If you develop any of the following signs, you should seek emergency medical advice and assistance:
Difficulty swallowing and/or breathing
Tenderness, swelling, pain or redness on your scalp
Much like minoxidil and finasteride, ketoconazole shampoo is often promoted online as one of the “big three” hair loss treatments.
Yet while there isn’t as much scientific research to support ketoconazole as a treatment for hair loss as there is for minoxidil and finasteride, the studies 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 hair loss treatment used 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 like to use the stronger ketoconazole 2% shampoo as part of your hair loss prevention regimen.
While the science behind ketoconazole shampoo is promising, it isn’t the most effective option available for treating hair loss.
Currently, the most effective treatments for hair loss include minoxidil and finasteride.
Minoxidil is a topical medication that works by encouraging hair to enter into the anagen (growth) phase of the hair growth cycle. It also increases blood flow to your scalp to provide hair follicles with needed nutrients for efficient growth.
Finasteride is an oral medication that works by stopping your body from converting testosterone into DHT.
We offer finasteride online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
Learn more about the factors that cause baldness, common early signs of hair loss and the steps you can take to protect your hair in our detailed guide to male pattern baldness.
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