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Ketoconazole — is it a trendy diet? Sounds like it, but it’s actually a chemical compound found in many hair loss shampoos. If you’re susceptible to the idea that hard-to-pronounce ingredients with lots of vowels are legit (looking at you, butylated hydroxytoluene), then, of course, you’d take one look at ketoconazole and think your hair loss prayers had been answered.
And while ketoconazole is a safe and useful addition to a hair loss prevention routine, it’s not a miracle cure for hair thinning or balding that’ll make you ditch all other products in your arsenal (which we’re secretly kinda happy about because we love our hair loss product line).
Still, ketoconazole has important uses and shows some promise when it comes to hair loss.
Here, we’ll talk about what ketoconazole actually is (fret not, you can still eat carbs), what the science says about ketoconazole and hair growth, plus any side effects of the ingredients and other hair loss treatments you’ll want to know about.
Read on to learn how ketoconazole fits into a male pattern baldness treatment plan.
If you’ve been following us for a while now (love to our fans), you may remember there are only two FDA-approved medications to treat hair loss: finasteride and minoxidil.
Ketoconazole is an antifungal medication FDA-approved to treat several infections affecting the skin (including the scalp), like athlete’s foot or ringworm. Limited research suggests it may help you hold onto your hair (which we’ll break down more in a minute), but it’s not specifically approved for that use.
The ingredient is available in tablet form and as a topical ingredient in creams, foams and shampoos. If you’ve ever used Nizoral shampoo, you’ve likely used ketoconazole.
At 1% strength, ketoconazole is available over the counter, but 2% ketoconazole requires a prescription.
We promise we’re going to answer if ketoconazole works for hair loss — but first, some context on why hair loss happens in the first place.
Most commonly, baldness is caused by a sweet, sweet combo of genetics and hormones. Androgenetic alopecia (that’s female pattern hair loss or male pattern hair loss) is genetic, and it affects as much as 50 percent of men and women.
But the hormone mainly responsible for hair loss isn’t part of the popular crew (looking at you, testosterone and cortisol). It’s a lesser-known male androgen called DHT.
DHT is short for dihydrotestosterone (you can see why it gets abbreviated), and it’s responsible for creating male sex hormones in utero. During puberty, it plays a role in the development of body hair, facial hair and a deepening voice. But don’t get too pumped on DHT just yet.
If all men have DHT, shouldn’t they all lose their hair? Great question. But just as two individuals can react differently to spicy food or a poor night of sleep, some people’s follicles are more sensitive to DHT — this sensitivity is genetically determined.
Now, unlike when you ask your spouse where your wallet is, we promise we’re going to answer your question. So, does ketoconazole work for hair loss? There’s not a ton of scientific research that proves there’s a link between ketoconazole and the amount of DHT your body produces — but at least one ketoconazole hair loss study is promising.
One analysis of androgenic alopecia treatment options found that the use of ketoconazole combined with oral finasteride (a well-studied DHT-blocking medication we’ll touch on later) may cause an additional decrease in scalp DHT levels.
A systematic review of seven ketoconazole studies (two animal studies and five human studies) found that ketoconazole seems to positively affect hair’s appearance.
The human studies reported increased hair shaft diameter following ketoconazole use, and marine studies demonstrated a significant increase in hair regrowth in those treated with ketoconazole compared to controls.
Remember, nothing short of a really good hair transplant will completely restore your hairline. So it’s important to have realistic expectations about the treatment of androgenetic alopecia.
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“I’m a 34-year-old father of two and have been using Hims for over a year now. My hair is back to what it was in my mid-twenties.”
Maybe a little bird (aka your buddy who always comes in hot) told you ketoconazole is more effective than minoxidil (which you may know as Rogaine®). Well, that information isn’t wrong per se, but it’s from an outdated study — we hate to say it, but the ‘90s were a long time ago, folks).
In that study, researchers compared the effectiveness of a 2% ketoconazole shampoo with the popular hair loss medication minoxidil (which, causal flex, you can buy here without getting up from your chair — unless you’re at a standing desk, you health god).
They found that both treatments improved hair size and increased the proportion of hairs in the anagen phase (growth phase) of the hair growth cycle by a similar amount.
While the findings of this study are interesting, the researchers noted that the clinical significance “awaits further controlled study in a larger group of subjects.”
There haven’t been many studies since, but an additional 2019 study on women (so it’s hard to know if the findings are true for men) looked at minoxidil and ketoconazole. In the study, one group received 2% topical minoxidil solution, and a separate group was treated with 2% topical ketoconazole.
The study (which was, admittedly, very small, with just 20 people in each group) found that topical ketoconazole had a “trichogenic effect” (a fancy way of saying it produces hair) with few side effects. However, ketoconazole was slower to work than minoxidil at similar concentrations.
If you’re into studies, here’s another one for ya: A small study on male mice looked at ketoconazole, minoxidil and minoxidil paired with tretinoin (that’s prescription retinol for the skincare gurus, and it’s thought to increase absorption of minoxidil into the skin). All three had a “significant stimulatory effect on hair growth” compared to the control group. Minoxidil was the most effective of the three.
So, if you’re looking for proven hair loss treatments, minoxidil (or finasteride, for that matter) is definitely a better bet than ketoconazole. There’s concrete evidence supporting the efficacy of both medications’ ability to slow hair loss or promote new hair growth. But a shampoo containing ketoconazole could still be worth a shot.
The jury’s out on ketoconazole for hair loss. But research unequivocally supports the idea that topical application of ketoconazole helps treat seborrheic dermatitis (aka dandruff), a condition affecting nearly 12 percent of the adult population (and a whole lot of babies).
While seborrheic dermatitis doesn’t cause permanent hair loss, some research has found that Malassezia — a fungi contributing to dandruff — is linked to hair shedding.
This type of hair loss isn’t caused by genetics or the effects of DHT and is largely unrelated to male pattern baldness. Ketoconazole decreases Malassezia colonization and acts as an anti-inflammatory.
TL;DR? If you’re dealing with dandruff, flaking or other scalp conditions, there’s plenty of solid research backing the efficacy of ketoconazole.
Every rose has its thorn, right? While ketoconazole is considered safe, there are some potential side effects you’ll want to know about.
Potential side effects of topical ketoconazole include:
Itchy skin (sometimes referred to medically as pruritus)
Changes in hair texture
Irritation and/or stinging
Blistering skin on the scalp
These side effects aren’t very common and only affect a small percentage of people who use ketoconazole. They’re often temporary and go away over time.
Others wonder, Can ketoconazole cause hair loss? Does Nizoral cause hair loss? It seems odd, given that we’re here discussing how the ingredient may cause hair growth, but times are strange. Rest assured, this is a myth.
But like most weird rumors, a teeny kernel of truth got seriously mangled in the re-telling. If you’re using ketoconazole because you have an itchy scalp, chances are, you’ve been scratching. All that scratching can damage the hair follicle, causing new hair growth that’s thinner, shorter and eventually unable to penetrate the outermost layers of your skin.
There are some cosmetic side effects of ketoconazole as well, including making hair dry or oily (could go either way) or stripping colored hair.
Oral ketoconazole has side effects too. In 2016, the FDA (U.S. Food and Drug Administration) limited the use of Nizoral oral tablets due to a potential risk of liver and adrenal damage. In some cases, these pills may be deemed necessary, but they’re no longer a first line of defense.
If you’re experiencing side effects, speak to a dermatologist or another healthcare provider.
Looking for other ways to increase hair density and promote growth? We’ve got you covered with these scientifically-backed hair loss treatments.
Two’s better than one when it comes to our topical finasteride & minoxidil spray. Why double-down?
Studies have found topical finasteride has an effect on DHT, increasing hair count while slowing hair loss. Minoxidil, on the other hand, dilates blood vessels, which brings blood, nutrients and oxygen to the scalp.
People with longer hair sometimes prefer the liquid solution because the dropper can penetrate further. And the foam may be better for those with a sensitive scalp.
Biotin supplements give you an extra boost of the vitamin (B7, that is). This is helpful if you have a true biotin deficiency, which is extremely unlikely if you eat a somewhat varied diet (eggs, meat, fish and certain fruits and vegetables all contain biotin).
Although rare, it’s not entirely impossible to have a deficiency, which could contribute to hair loss. Our biotin gummies contain other essential nutrients for healthy hair, like folic acid, niacin and vitamins D and E.
If dandruff is your main concern, our dandruff detox shampoo has your name on it. Perfect for anyone who wants to avoid ketoconazole, its active ingredients are pyrithione zinc 1% and salicylic acid.
Generic for Rogaine®, this FDA-approved over-the-counter version of topical minoxidil is used for regrowth on the crown of the head.
This is the FDA-approved dynamic duo. When used together, men saw better results in clinical trials compared to using either alone.
If you’re looking for something effective but don’t want too many steps in your routine, this once-a-day pill could be right for you.
Clinically proven to regrow hair in 3-6 months, no pills required.
Ketoconazole is linked to some improvements in hair health, and it may have certain effects on the hormone DHT at the hair follicle level. However, no high-quality research suggests that ketoconazole is as effective at treating hair loss as minoxidil or finasteride.
Here are a few things to remember about ketoconazole for hair growth:
Ketoconazole is a powerful antifungal often used to treat skin conditions like athlete’s foot, ringworm and seborrheic dermatitis.
Ketoconazole products might be a helpful addition to your hair loss treatment regimen. But they’re best used in combination with evidence-based hair loss treatments, like minoxidil or finasteride.
Wondering how to use ketoconazole for hair? Ketoconazole 2% shampoo should be used three times a week, left on for five minutes, then rinsed off.
Check out our guide to explore other shampoos for thinning hair.
And if you found this corner of the internet in the search for dandruff solutions, ketoconazole is an effective treatment. For more ideas, read our blog on how to get rid of dandruff.
Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!
Dr. Knox Beasley is a board certified dermatologist specializing in hair loss. He completed his undergraduate studies at the United States Military Academy at West Point, NY, and subsequently attended medical school at Tulane University School of Medicine in New Orleans, LA.
Dr. Beasley first began doing telemedicine during his dermatology residency in 2013 with the military, helping to diagnose dermatologic conditions in soldiers all over the world.
Originally from Nashville, TN, Dr. Beasley currently lives in North Carolina and enjoys spending time outdoors (with sunscreen of course) with his wife and two children in his spare time.
Bachelor of Science, Life Sciences. United States Military Academy.
Doctor of Medicine. Tulane University School of Medicine
Dermatology Residency. San Antonio Uniformed Services Health Education Consortium
Board Certified. American Board of Dermatology
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