Ciclopirox Shampoo vs. Ketoconazole: Which Is Best For Dandruff?

Dealing with dandruff can be frustrating. Two possible treatments are ciclopirox and ketoconazole, both of which are found in anti-dandruff shampoos. But which should you opt for? To help you decide, here’s a closer look at ciclopirox shampoo versus ketoconazole shampoo.

Ciclopirox shampoo is a prescription-only anti-dandruff shampoo. Ketoconazole — which is also found in shampoos for thinning hair — is available over the counter and by prescription.

Both ciclopirox and ketoconazole are effective at treating dandruff, but there are some major differences between the two. Below, we’ll explain these differences and share some alternatives to ciclopirox and ketoconazole.

So why are anti-fungal treatments used to treat dandruff? You’ll often hear dandruff referred to as seborrheic dermatitis, which is a common skin condition that occurs on oily areas like the scalp and usually causes a scaly rash. Technically, dandruff is considered a mild form of seborrheic dermatitis, according to the American Academy of Dermatology Association. Seborrheic dermatitis also causes cradle cap and rashes on the face.

Dandruff and seborrheic dermatitis are usually caused by an overgrowth of the Malassezia yeast. This fungus thrives in areas of the body that produce oil, like the scalp. When it overgrows, it irritates the skin, including the scalp.

This leads to the symptoms of dandruff so many people are familiar with, such as:

• White or yellow flakes

• Pruritus (itchiness)

• Dryness

• Erythema (redness)

Antifungal treatments help with seborrheic dermatitis because they target fungal growth. In turn, this soothes symptoms like itching, dryness, and flaking.

Ciclopirox shampoo is a prescription antifungal shampoo that targets the fungal infection responsible for dandruff.

The active ingredient, ciclopirox olamine, works by disrupting the production of essential enzymes within fungal cells, which leads to the breakdown of the fungal cell walls and prevents them from growing further.

Ciclopirox is well-studied: Plenty of double-blind, randomized clinical trials show it’s highly effective in treating seborrheic dermatitis. It doesn’t only target the fungus but also has anti-inflammatory properties, which helps soothe the itchiness and redness caused by dandruff.

Usually, you’d use ciclopirox cream (Loprox®)  twice a day for a treatment period of four weeks. But in shampoo form, you typically wash your hair with it twice a week for four weeks, waiting at least three days between washes.

One drawback? Ciclopirox (in shampoo or cream form) can’t be bought over the counter. If you think you could benefit from using ciclopirox, you’ll need to make an appointment with a healthcare professional.

Ciclopirox is generally well-tolerated, but like any medication, it may cause some mild side effects, including skin irritation, redness, or itching at the application site. These side effects are usually minimal and resolve quickly after you stop using the shampoo.

Ketoconazole shampoo is a well-known antifungal product available in both over-the-counter and prescription-strength formulations.

Topical ketoconazole works similarly to ciclopirox by targeting the fungal infection and reducing inflammation. As a result, it can relieve symptoms like itching, dryness, and scaling.

One of the main advantages of ketoconazole is its availability. The shampoo comes in both 1% OTC formulas and 2% prescription-strength formulas.

According to a 2024 review, there are plenty of comparative and placebo-controlled clinical trials that suggest ketoconazole is effective at treating dandruff.

The review also noted that higher concentrations of ketoconazole tend to be more effective. But the 1% version, commonly found in products like Nizoral®, is still effective for mild to moderate dandruff. For more severe cases, healthcare providers may prescribe the 2% version, which has stronger antifungal properties. One wash with ketoconazole shampoo may be enough to treat your symptoms.

As a bonus, ketoconazole also reduces your levels of dihydrotestosterone (DHT) — the hormone associated with androgenic alopecia, also known as male pattern baldness. So if you’re experiencing hair loss and dandruff, ketoconazole may help with both.

Like ciclopirox, ketoconazole is generally safe, with mild side effects like itching or redness being rare. Most users tolerate it well, and side effects typically resolve after stopping the shampoo.

While both ciclopirox and ketoconazole are highly effective antifungal shampoos, there are some key differences to consider:

• Ciclopirox shampoo is available by prescription only while ketoconazole shampoo is available in both over-the-counter and prescription formulations.

• For mild dandruff, 1% ketoconazole is generally recommended, and the course of treatment is shorter. Both 2% ketoconazole shampoo and ciclopirox shampoo are recommended for severe dandruff.

• Ketoconazole is also used to treat male pattern hair loss, although more placebo-controlled studies are needed before we fully understand the effect of ketoconazole on hair loss.

• In terms of tolerability, both ketoconazole and ciclopirox are quite safe to use — although some people may experience mild side effects like itching or redness.

The bottom line? Ciclopirox might be a better choice if you have severe seborrheic dermatitis. Talk to your healthcare provider to see if this is the right treatment for your scalp condition.

If you’re dealing with mild to moderate dandruff and want an easily accessible solution, ketoconazole’s 1% version could be a good option. For more severe cases, you can also consider the 2% prescription strength option. Ketoconazole may also be a better choice if you’re showing some early signs of balding.

What if neither ciclopirox or ketoconazole work for you? Fortunately, there are some other options for the treatment of seborrheic dermatitis of the scalp.

Look for medicated shampoos, per the American Academy of Dermatology Association, that include ingredients like:

• Pyrithione zinc

• Salicylic acid

• Selenium sulfide

• Corticosteroids (like hydrocortisone)

• Coal tar

Our dandruff detox shampoo contains 1% pyrithione zinc and salicylic acid. It works to reduce buildup, itchiness, and irritation.

It’s definitely worth talking to a healthcare professional if anti-dandruff shampoos aren’t working for you. You might need a prescription-strength treatment. Or, your flaking, itchy scalp may be caused by something else — like eczema or psoriasis.

If you’re concerned about balding, keep in mind there are many other hair loss treatments out there. You could try FDA-approved options like finasteride and minoxidil or thickening shampoos.

Ciclopirox and ketoconazole are both topical antifungal treatments that come in shampoo forms. They’re both effective in the treatment of seborrheic dermatitis or dandruff of the scalp.

But there are some differences between the two treatment options.

Keep the following in mind:

• Ketoconazole is generally more accessible. You’ll need a prescription for ciclopirox shampoo and 2% ketoconazole shampoo, but 1% ketoconazole shampoo is available over the counter.

• 1% ketoconazole usually does the trick for mild dandruff. If you have severe seborrheic dermatitis, you might need 2% ketoconazole or ciclopirox shampoo.

• There are alternatives. While both of these shampoos are great, there are other (effective) treatment options out there. Consider trying products that contain pyrithione zinc, salicylic acid, or selenium sulfide, especially if ciclopirox or ketoconazole don’t work.

So, which is better, ciclopirox or ketoconazole? Dandruff treatment is seldom a one-size-fits-all thing, so it’s all about what works for you.

If you’re considering a prescription dandruff treatment, or if you want to explore more treatments for dandruff, it’s a good idea to chat with an expert.

We can help you book an online appointment with a healthcare professional so you can take your first step to getting a clear, healthy scalp.