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Pete Scott, MD Written by Erin D. Updated on 22 Mar 2024
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Ketoconazole Against Hair Loss: How Effective?

Pete Scott, MD

This text was written according to the highest scientific standards and reviewed by medical experts. Find out more about our quality assurance.

Written by Erin D. Updated on 22 Mar 2024

Ketoconazole is one of the primary ingredients in medicated shampoos designed to fight dandruff and itch. Recently, scientific evidence seems to be stacking up in favor of the chemical regarding its effect on stopping hair loss. So we have compiled some of the major studies advocating the chemical’s effects against hair loss in an effort to gauge how effective it can be as a possible treatment.

Most Important Findingssvg

How does it work? Increases DHT levels
How effective? Slows down hair loss
Forms Shampoo, Topical
Alternativees Finasteride, Minoxidil...

How can Ketoconazole Treat Hair Loss?

If you’re familiar with hair loss treatments, you will know that there are currently only two FDA-approved medications for treating hair loss. Namely, finasteride and minoxidil. 

Ketoconazole, in its own right, is an FDA-approved antifungal medication designed to treat various fungal infections affecting areas of your skin, including your scalp. That being said, it is not yet approved to treat hair loss. 

However, some limited studies do present evidence that ketoconazole, when applied in tandem with finasteride, could decrease DHT levels in the scalp. 

DHT (dihydrotestosterone) is a sex hormone that can latch onto the receptors in hair follicles, causing follicle miniaturization. Making them unable to produce hair. 

Additionally, the same study also hinted that the medication’s ability to reduce scalp inflammation could be instrumental in slowing down male pattern baldness.

Hair Growth Cycle

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How Effective is Ketoconazole

Of course, there is not enough conclusive evidence to prove that ketoconazole alone can be an effective treatment for hair loss. 

However, the limited amount of evidence available has persuaded many dermatologists to start prescribing ketoconazole shampoos to their patients. As an additional measure to slow down hair loss.

The table below contains a few major studies that advocate ketoconazole’s role in slowing down hair loss and possibly promoting hair growth. 

Study Result
A. W. Rafi, R. M. Katz et al (2011) A pilot study was conducted on 15 patients to test the efficacy of a novel topical combination of minoxidil, finasteride, and dutasteride named NuH hair. NuH hair was part of a 4-part regimen designed to treat hair loss. The other 3 components included Rogaine foam, Propecia, and ketoconazole shampoo. Every patient was prescribed NuH hair and allowed to have any or all of the other three components in their regimen. Patients’ scalps were photographed at regular intervals of 1, 3, 6, and 9 months to identify progress in hair growth. The final results showed that patients who utilized all 4 components displayed signs of significant hair growth in 30 days. Meanwhile, patients who chose to only utilize NuH hair showed signs of hair growth only after the 3-month mark.
C Piérard-Franchimont, P De Doncker, G Cauwenbergh, G E Piérard et al (1998) An experiment was conducted to determine if ketoconazole’s anti-inflammatory properties could reduce hair loss. The effect of 2% ketoconazole shampoo was compared with a 2% minoxidil solution. Both solutions seemed to improve hair density and size to a similar level.
Jaime R Fields, Peter M Vonu, Reesa L Monir, Jennifer J Schoch et al. (2020) This study conducted a systematic review of existing scientific literature related to ketoconazole’s efficacy as a treatment for hair loss. A total of 47 papers were reviewed, out of which 7 were considered eligible for the final report. 5 out of the 7 were human studies, while the other 2 were animal studies. The results of all 7 studies noted the positive effect of ketoconazole on hair growth. Almost all human studies reported increased hair shaft diameter after ketoconazole application. Plus, the clinical evidence gathered through photographs and subject evaluation also confirmed significant hair growth.

Can Women Use Ketoconazole Against Hair Loss?

Unfortunately, according to the scientific evidence available, ketoconazole is not touted to be nearly as effective against female-pattern hair loss as it is against male-pattern baldness. 

Primarily because one of the few ways in which it battles against hair loss is by lowering your scalp DHT levels. And since an abundance of DHT is not the primary reason for hair loss in women, many researchers conclude that ketoconazole just won’t be as effective for them. 

However, there is one small study that provides evidence to the contrary. Conducted in 2019, the study involved two groups of 20 patients who were administered a 2% topical minoxidil solution and a 2% ketoconazole preparation, respectively. After clinically evaluating the groups for 6 months, results showed that both groups received significant hair growth. 

Granted, the minoxidil group showed faster and greater hair growth with fewer side effects. But, the study ultimately proved that ketoconazole could be effective against hair loss in women under the right conditions. 

With that said, it is still quite early to determine ketoconazole solutions as a solid, stand-alone treatment for female pattern hair loss. Not until researchers come up with more studies that can back up these claims.

Typical female pattern hair loss: The ludwig scale.

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How can I Get Ketoconazole?

Ketoconazole is available both in shampoo form and topical form. You have probably already heard of branded shampoos like Nizoral, which contain Ketoconazole as one of their key ingredients. 

Alternatively, you can also find it in most medicated shampoos designed to treat fungal scalp infections or dandruff. 

In terms of topical form, 1% ketoconazole is available over the counter in most pharmacies. On the other hand, 2% ketoconazole is only available on prescription. 

What are the Alternatives to Ketoconazole?

We discussed previously how finasteride and minoxidil are both FDA-approved medications for treating hair loss. Therefore, they may be your best bet for stopping hair loss if it’s still in its early stages. 

Some doctors also recommend dutasteride as a stronger medication. But, the FDA has yet to approve it for specifically treating hair loss. The only problem with these medications is that you’ll probably have to take them for the rest of your life. 

Thus, we would actually advise opting for a more permanent solution i.e., getting a hair transplant to replace the hair you lost and promote new hair growth. 

Most common prescribed hair loss treatments



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