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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.
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.
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 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.
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.
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.
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.
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.
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
Parameter | Inclusion Criteria | Exclusion Criteria |
---|---|---|
Patients | Patients of any age with hair loss. | Patients with no hair loss disorder. |
Intervention | Ketoconazole shampoo as a standalone or adjunct therapy. | A study that doesn’t contain ketoconazole shampoo either as a standalone or adjunct therapy. |
Comparator | Placebo and/or other therapies or baseline, or in the observational studies - none. | |
Outcomes | Primary 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 Design | Prospective, observational, retrospective, and case series studies. | Literature reviews, non-human subjects, or ongoing clinical trials. |
Study | Participants | Design | Treatment | Results | Key Takeaway | Adverse Effects | Evidence Quality | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Authors (year) | Sex | Hair Loss Type | Design | Dose | Usage | Duration | Endpoints | Hair Growth Assessments | Summary | Limitations | Adverse Effects | Jadad Score |
Rafi & Katz.(2011) | n = 15 (M) | AGA | Prospective pilot study | 2% 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 week | 9 months | Average 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) | AGA | Open, 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 months | Patient 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 AGA | RCT | 1% KTZ shampoo 1% PTO shampoo 1% ZPT shampoo | 2-3 times weekly | 6 months | Hair 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 | AGA | Comparative, observational study. | 2% KTZ shampoo Normal Shampoo | 2-4 times weekly | 21 months | AGA pilary index (PI): defined as the percentage of hairs in anagen x average diameter of the hair shafts 1.5 cm from the hair bulb | The 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 size | None reported | 0 |
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
Parameter | Inclusion Criteria | Exclusion Criteria |
---|---|---|
Patients | Patients of any age with hair loss. | Patients with no hair loss disorder. |
Intervention | Topical ketoconazole as a standalone or adjunct therapy. | A study that doesn’t contain ketoconazole either as a standalone or adjunct therapy. |
Comparator | Placebo and/or other therapies or baseline, or in the observational studies - none. | |
Outcomes | Primary 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 Design | Prospective, observational, retrospective, and case series studies. | Literature reviews, non-human subjects, or ongoing clinical trials. |
Study | Participants | Design | Treatment | Results | Key Takeaway | Adverse Effects | Evidence Quality | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Authors (year) | Sex | Hair Loss Type | Design | Dose | Usage | Duration | Endpoints | Hair Growth Assessments | Summary | Limitations | Adverse Effects | Jadad Score |
El-Garf, Mohie, and Salah (2019) | n = 40 Group A = 20 Group B = 20 | FPHL | RCT | Group A: 2% Minoxidil Group B: 2% KTZ | 1 mL daily | 6 months | Hair 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) | AGA | Open-label | 2% KTZ lotion | Almost every day during or immediately after hair washing with an unmedicated shampoo. | Up to 12 months | Hair 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 |