Ketoconazole Shampoo for Hair Loss: What to Know
Unless you’re Dwayne Johnson or Bruce Willis, hair is a big part of your identity. So when you start losing it, it can be stressful.
Luckily, treatments like ketoconazole shampoo may help.
The antifungal medication is normally used to treat skin infections, but ketoconazole is scientifically linked to improvements in hair growth, making it worth using as a hair loss treatment option.
Side effects are rare, and it’s easy to apply — just wash your hair with it once or twice a week.
Below, we’ll cover everything you need to know about ketoconazole shampoo for hair loss. Plus, we’ll dive into other hair loss treatments that have a lot more science behind them.
What Is Ketoconazole?
Ketoconazole is a medication that treats a range of fungal infections. It belongs to a class of antifungal medications called imidazoles and works by slowing the growth of fungi that cause infection.
You can get ketoconazole as an oral medication or as a topical medication in the form of a cream, foam or shampoo. Weaker formulations are available over the counter, but you’ll need a prescription for the stronger stuff.
Ketoconazole cream can treat issues such as:
Tinea corporis (ringworm)
Tinea cruris (jock itch)
Tinea pedis (athlete’s foot)
Yeast infections
Ketoconazole shampoo can treat:
Tinea versicolor (a skin and scalp fungal infection)
Seborrheic dermatitis (aka dandruff)
Flaking, scaling and itching on the scalp
You might have used ketoconazole shampoo if you’ve ever tried Nizoral® or Head & Shoulders®.
Ketoconazole is an older antifungal medication, so it’s not usually a first-line treatment. It’s typically used when other treatments aren’t available or haven’t worked.
Can Ketoconazole Shampoo Treat Hair Loss?
Ketoconazole shampoo may treat hair loss. But it isn’t approved by the FDA (U.S. Food and Drug Administration) as a hair loss treatment.
You probably noticed hair loss isn’t on the list of conditions ketoconazole shampoo usually treats. Why?
There’s not much research behind ketoconazole for hair loss. And the research we do have often shows that other hair loss treatments — like minoxidil — are just as (if not more) effective.
Many studies on ketoconazole for hair loss are also small. They most often involve 2% ketoconazole shampoo, which is stronger than the 1% products you'll find in drug stores.
In short, don’t rely on Nizoral shampoo for hair loss.
Here’s what the science has to say.
Ketoconazole Shampoo for Male Pattern Baldness
A small 2019 study looked at 40 women with androgenetic alopecia (which includes male pattern baldness and female pattern hair loss).
Twenty women were treated with a 2% ketoconazole shampoo, and the other 20 were treated with a 2% topical minoxidil solution (minoxidil is often sold under the brand name Rogaine®). Participants applied the treatments daily for six months.
After six months, their hair loss was evaluated. The results showed that both ketoconazole and minoxidil were effective at promoting hair growth. But minoxidil worked quicker — two months quicker, to be exact!
Still, the researchers said more studies into higher concentrations of ketoconazole shampoo are needed.
What about male pattern baldness? There’s research on that too.
Research from way back in 1998 found that ketoconazole shampoo worked just as well as minoxidil for men with male pattern baldness.
Both treatments increased hair density and size, as well as the proportion of anagen hair follicles (hair follicles in the growth phase of the hair growth cycle).
Another small study — this time from 2011 — looked at 15 men with male pattern baldness. The men used a topical hair loss treatment called NuH Hair that combined finasteride, dutasteride and minoxidil. Participants also had the option to add Rogaine, Propecia® and ketoconazole shampoo to their regimen.
All 15 men noticed significant hair growth by the end of the experiment. Those who just used NuH Hair saw hair growth after three months, while those who used NuH Hair with the additional treatments saw hair growth in as little as 30 days.
The problem? It’s unclear which additional treatments the men used, so we can’t say for sure if ketoconazole can take the credit for hair growth here.
But what we can take from this research is that aggressive treatment can get quicker results for your hairline.
Ketoconazole Shampoo for Tinea Capitis
Let’s switch lanes from male pattern baldness to talk about tinea capitis for a second.
Tinea capitis, or scalp ringworm, is a fungal infection of the scalp hairs. Along with an uncomfortable rash, you might experience hair shedding and scarring alopecia (permanent hair loss caused by the destruction of hair follicles).
Tinea capitis is often treated with oral antifungal medications, but antifungal shampoos — like ketoconazole shampoo — may be used as part of a treatment plan.
So if your hair loss is caused by tinea capitis, ketoconazole can help.
How Does Ketoconazole Work for Hair Loss?
Ketoconazole is linked to hair growth, but it’s not entirely clear how exactly it works.
Just like the meaning of life, maybe we’re not meant to know.
Not really. There are theories explaining how ketoconazole affects your hair. For example, it’s thought that ketoconazole impacts the hair-hating hormone dihydrotestosterone (DHT).
The 5-alpha-reductase enzyme converts testosterone into DHT. DHT is responsible for lots of good things, like the development of male genitalia before birth and, during puberty, facial hair and body hair growth. But it’s also responsible for a few bad things in adulthood, including male pattern baldness.
DHT binds to androgen receptors in hair follicles and causes the miniaturization of said follicles. This leads to thinner and shorter follicles and, eventually, the hair loss characteristic of male pattern baldness — think a receding hairline and a bald patch around the crown of the head.
Our guide to DHT and male pattern baldness goes into more detail about the effects of DHT on your hairline, along with your options for preventing DHT-related damage to your hair follicles.
Some hair loss treatments inhibit the conversion of testosterone to DHT. Less DHT in your system means less hair follicle miniaturization, leading to slowed hair loss and sometimes hair regrowth.
Medications like finasteride dramatically decrease the amount of DHT in your body. But it’s unclear if ketoconazole can do the same.
A scientific paper from 2004 suggested that ketoconazole 2% shampoo can disrupt the DHT pathway. It could inhibit DHT production or stop the hormone from binding to androgen receptors.
The paper said that using ketoconazole shampoo and finasteride together could block the DHT pathway more completely and, therefore, be a more effective treatment for male pattern baldness.
This is a promising theory, but more research is needed.
If your hair loss is caused by a fungal scalp infection, ketoconazole’s antifungal properties can treat the infection to stop the related hair loss and allow healthy hair to grow back.
To dive deeper into this topic, see our guide to ketoconazole and hair loss.
How Often Can You Use Ketoconazole Shampoo?
Prescription ketoconazole may be a one-and-done treatment, applied once to treat an infection.
Over-the-counter ketoconazole needs a bit more time to work its magic. You may need to use the dandruff shampoo every three to four days for up to eight weeks, and then as needed to keep dandruff in check.
But it’s unclear how often you need to use ketoconazole shampoo for hair loss.
The above-mentioned 2019 study on women with female pattern hair loss asked participants to use ketoconazole shampoo daily for six months. But the 2011 study on men asked them to use it two to three times a week alongside other hair loss treatments.
Always follow the instructions for the ketoconazole product you’re using, or ask your prescribing healthcare provider for more info.
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How to Use Ketoconazole Shampoo
Use ketoconazole shampoo similar to how you would a regular shampoo.
Here’s what to do:
Make sure your scalp isn’t irritated, cut or broken. Don’t use the shampoo if it is.
Wet your hair thoroughly.
Apply the shampoo evenly to your hair and scalp.
Massage the shampoo with your fingers until it lathers up.
Rinse the shampoo out of your hair.
Repeat steps one to five if needed.
Always follow the instructions provided by the ketoconazole shampoo you’re using or any directions you’re given by a prescribing healthcare provider or dermatology professional.
Don’t swallow ketoconazole shampoo, and try to avoid getting it in your eyes or mouth. If you do get it in your eyes, rinse them with plenty of water.
Types of Ketoconazole Shampoo
Not all ketoconazole shampoos are created equal.
You can get:
1% or less ketoconazole shampoos. These products contain a weaker concentration of ketoconazole. You can buy them over the counter, usually as a dandruff treatment.
2% ketoconazole shampoos. These medicated shampoos are only available by prescription and are usually used to treat fungal infections and seborrheic dermatitis.
You can also find shampoos that combine ketoconazole with other ingredients, such as salicylic acid or pyrithione zinc. These are often formulated to treat problematic dandruff and other scalp conditions.
Where to Get Ketoconazole Shampoo
You can get 1% or less ketoconazole shampoo over the counter. Check the aisles of your local drugstore or supermarket. Look out for products advertised as dandruff treatments, like Nizoral shampoo or Head & Shoulders.
For the strong stuff, you’ll need to speak to a healthcare provider to get prescription 2% ketoconazole shampoo. But FYI, a medical professional probably won’t prescribe ketoconazole for male pattern hair loss.
If your hair loss is caused by a scalp fungal infection, though, it’s worth reaching out to a dermatologist, your primary care provider or an online healthcare provider. They may prescribe ketoconazole shampoo or a better treatment.
In the market for a new shampoo? Our guide to what to look for in a men’s hair loss shampoo can help.
Ketoconazole Side Effects
You didn’t think you could get away without any potential side effects, did you? Like all medications, ketoconazole comes with the risk of side effects. They’re not guaranteed, of course, but you should know what to look out for.
Side effects of ketoconazole may include:
Changes in hair texture
Oily or dry scalp or hair
Irritation, itching or stinging
Dry skin
Blisters on the scalp
Heads-up for those with a perm: Ketoconazole shampoo can remove the curl from your hair.
Some more serious side effects include:
Rash
Hives
Redness, tenderness, swelling, pain or warmth where you apply the medication
Difficulty breathing or swallowing
If you experience any of these more serious side effects, get medical advice immediately.
Tell your healthcare provider or pharmacist about any medical conditions and allergies to medications, creams or shampoos. And let them know if you’re taking any medications, nutritional supplements, vitamins or herbal products.
Side effects are rare. In the 2019 study we mentioned earlier comparing ketoconazole shampoo to minoxidil, only 10 percent of people reported side effects from ketoconazole. May the odds be ever in your favor.
Does Nizoral Cause Hair Loss?
Nizoral doesn’t generally cause hair loss. It can help with dandruff and fungal infections, and it’s been linked to hair growth.
But, as with everything in life, there may be some exceptions.
One less common Nizoral shampoo side effect includes alopecia (hair loss).
If you notice worsening hair loss when using over-the-counter ketoconazole shampoo, stop using it and switch to another treatment. If you’re on prescription ketoconazole, speak to your prescribing healthcare provider.
Should You Use a Ketoconazole Shampoo Like Nizoral?
Ketoconazole is often promoted as one of the “big three” treatments for male pattern baldness, along with the medications finasteride and minoxidil.
But there isn’t enough research behind ketoconazole shampoo to say for sure whether it can help with hair loss.
Though the studies we have are promising, they’re small and often involve 2% ketoconazole, which is only available by prescription.
Our advice? Using ketoconazole for hair loss probably won’t hurt. But consider other hair loss treatments with more science behind them, either instead of or alongside ketoconazole shampoo.
Other Options for Treating Hair Loss
Looking for something backed by more research? Here are a few other treatment options for hair loss.
Minoxidil. Minoxidil is a topical product available as drops or in a foam or spray formulation. It’s been shown to stimulate hair growth and prevent further hair loss. Give it time, though, as it may take six to 12 months to see results. Check out our minoxidil foam and minoxidil liquid solution to get started.
Finasteride. Oral finasteride is a prescription pill you pop once a day. It’s FDA-approved for male pattern baldness and works by stopping the production of DHT. It can help slow hair loss and promote new hair growth. Give it about four months to see improvements. Finasteride works best when you start taking it as soon as you notice hair loss or hair thinning, so no hangin’ about.
Minoxidil and finasteride together. The haircare dream team. Minoxidil and finasteride can be more effective when used together. Our topical finasteride & minoxidil spray does the trick.
Supplements. Biotin, iron or zinc deficiencies may contribute to hair loss. Check out our biotin gummies, which contain everything your body needs for a strong and healthy head of hair.
Hair-friendly products. Give your hair an extra boost with volumizing shampoo, volumizing conditioner or thickening shampoo with saw palmetto. And if dandruff is making you itchy, our dandruff detox shampoo can help fight the flake.
Microneedling. Sounds scary, but hundreds of tiny needles pricking your scalp can stimulate hair growth. Studies show that 12 weeks of weekly microneedling and twice-a-day minoxidil use led to significantly more hair growth than using a minoxidil treatment alone.
Speak to a healthcare provider about your hair loss. They can determine what type of hair loss you’re suffering from — such as male pattern baldness or a fungal scalp infection.
They’ll then be able to recommend the best treatment options for you and prescribe ketoconazole shampoo or finasteride if suitable.
Shop by treatment options
No matter the treatment plan, the best place to start is somewhere. Early action is the best hair loss prevention.
Final Thoughts on Ketoconazole Shampoo for Hair Loss
Ketoconazole shampoo is linked to hair growth, and side effects are rare and usually mild, so there’s no harm in adding it to your hair care routine. But, if hair loss is a problem for you, don’t stop there.
Here’s a quick recap:
Ketoconazole shampoo is linked to hair growth. Studies are small and show that other treatment options are just as if not more effective, so we can’t fully back Nizoral for hair loss.
Ketoconazole is an antifungal treatment. So if your hair loss is linked to scalp ringworm, a healthcare provider may recommend ketoconazole shampoo as part of your treatment plan.
There are hair loss treatments with more scientific evidence. Minoxidil and finasteride are FDA-approved for the treatment of male pattern baldness. Turn to these treatments instead of, or alongside, ketoconazole shampoo.
For the best advice, connect with one of our licensed healthcare providers online.
We offer men’s hair loss treatments, including finasteride and minoxidil. You might also consider our Hair Power Pack, which contains finasteride, minoxidil and several other hair-friendly products.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.