Ketoconazole and Hair Loss: Is It Effective?
Reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
If you’ve ever searched for information about over-the-counter treatments for hair loss, you may have heard of ketoconazole.
Ketoconazole is an antifungal medicine that’s used to treat skin infections. In addition to treating fungal infections, some research has found that ketoconazole may help to treat hair loss caused by male pattern baldness.
Researchers believe that ketoconazole may do this by affecting DHT, the hormone responsible for hair loss in men.
While ketoconazole is a safe and useful addition to a hair loss prevention routine, it’s also not a miracle hair loss cure.
Like many non-prescription hair loss treatments, there are lots of myths and rumors about what ketoconazole can and can’t do for your hair health.
Below, we’ve listed some of the most common myths about ketoconazole as a non-prescription treatment for hair loss.
We’ve also shared the most recent scientific evidence on ketoconazole to explain what it can do for your hair, as well as how you can fit it into your routine to treating male pattern baldness.
What is Ketoconazole?
Ketoconazole is an antifungal medication. It’s available in tablet and cream form and is used to treat many common fungal infections, including tinea corporis (widely referred to as ringworm), tinea cruris (jock itch) and tinea pedis (athlete’s foot) through topical application.
Currently, ketoconazole is rarely used as a first-line treatment for fungal infections. Instead, it’s typically only prescribed when newer, more effective antifungal drugs can’t be used due to lack of availability or side effects.
Some medicated shampoos designed to treat fungal scalp infections, such as scalp ringworm, also contain ketoconazole as an active ingredient.
Ketoconazole hair care products are often marketed for the treatment of dandruff and common skin irritation issues that can affect the scalp, such as seborrheic dermatitis. One popular brand of ketoconazole shampoo is Nizoral®.
Does Ketoconazole Work for Hair Loss?
If you’ve ever spent time on discussion boards or blogs that deal with men’s hair loss, you may have seen ketoconazole shampoo recommended as one of the “big three” hair loss treatments, alongside the medications minoxidil and finasteride.
Proponents of ketoconazole shampoo believe that it can disrupt the effects of DHT, a hormone produced as a byproduct of testosterone that can cause androgenetic alopecia, or male pattern baldness.
If you’re genetically predisposed to male pattern baldness, DHT can attach to receptors in your scalp and, over time, damage your hair follicles. This can cause gradual hair thinning that may, over time, result in noticeable pattern hair loss and a reduction in your hair density.
Our guide to DHT and male pattern baldness discusses this process and its effects on your hair in more detail.
Research on the relationship between ketoconazole and male pattern baldness is largely mixed, although some studies have found that long-term use of ketoconazole might help to prevent hair loss.
For example, a systematic review published in the journal Dermatologic Therapy found that use of topical ketoconazole can increase the diameter of the hair shaft (the physical part of hair that grows out from the hair follicle).
The same review noted that one study found that ketoconazole can increase the pilary index, a measure of the percentage of hairs in the anagen (growth) phase of the hair cycle multiplied by the hair shaft diameter.
Is Ketoconazole More Effective Than Minoxidil?
One of the more common myths about ketoconazole is that it’s just as effective at treating and preventing hair loss as FDA-approved hair loss medications such as minoxidil.
The truth is that while ketoconazole does appear to have some positive effects on hair growth, there’s only a small fraction as much research into the effects of ketoconazole on hair loss like androgenic alopecia as there is for minoxidil.
This myth appears to stem from a single study that was published in the journal Dermatology in the late 1990s.
In this study, researchers compared the effectiveness of a 2% ketoconazole shampoo with the popular hair loss medication minoxidil.
They found that both treatments improved hair size and increased the proportion of hairs in the anagen phase, or growth phase, by a similar amount.
While the findings of this study are interesting, it’s important to note that the researchers noted that the clinical significance “awaits further controlled study in a larger group of subjects.”
In simple terms, more research is needed before it’s possible to make any serious conclusions about the effectiveness of ketoconazole shampoo for hair loss in comparison with more proven treatments like topical minoxidil.
Despite this study’s relatively small size, it’s definitely interesting to see that ketoconazole had such a noticeable effect on the hair growth cycle.
If you want to improve your hair density and stimulate healthy hair growth, adding products that contain ketoconazole to your hair care routine as an adjunct to finasteride or minoxidil could be a good idea.
Just don’t assume that ketoconazole is more effective on its own as a hair loss treatment than minoxidil or finasteride, as there just isn’t enough data to support this conclusion right now.
Does Ketoconazole Block DHT?
Another common ketoconazole myth, as we mentioned earlier, is that it blocks the conversion of testosterone to dihydrotestosterone, or DHT — the male hormone that damages hair follicles and causes male pattern baldness.
Currently, there’s very little scientific research on the link between ketoconazole and the amount of DHT your body produces.
One paper published in the journal Medical Hypotheses theorized that ketoconazole may help to disrupt the DHT pathway in the scalp, which could have an effect on DHT-related hair loss.
However, this paper isn’t a study itself, and it’s published only in a journal without a conventional peer review process.
Currently, there are no large-scale studies showing that ketoconazole causes any real reduction in DHT levels in the scalp or throughout the body.
This means that you shouldn’t rely on ketoconazole hair care products, shampoos or creams as potential DHT blockers.
If your hairline is starting to recede and you’d like to reduce your DHT levels, you’ll get far better results with an evidence-based treatment such as finasteride — a medication we’ve discussed in more detail further down the page.
Can Ketoconazole Regrow Lost Hair?
Another common myth about ketoconazole is that it can cause you to regrow hair that you’ve already lost due to male pattern baldness.
Like most myths, this one has an ounce of truth to it. While ketoconazole can’t regrow hair that has fallen out as a result of male pattern baldness, it may potentially help you regrow hair that’s temporarily fallen out due to seborrheic dermatitis.
Seborrheic dermatitis is a scalp condition that could cause temporary hair loss. Some research has found that Malassezia — a type of fungi that contributes to seborrheic dermatitis — 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.
Since ketoconazole is an effective treatment for seborrheic dermatitis, it’s easy to mistake the hair you may regrow after successfully treating seborrheic dermatitis as "permanent" hair loss that’s reversed because of ketoconazole.
The unfortunate truth is that any hair you’ve lost due to male pattern baldness is, for the most part, gone for good unless you treat it very quickly using medication.
This is because male pattern baldness occurs when DHT harms your hair follicles, resulting in new hair growth that’s thinner, shorter and eventually unable to penetrate the outermost layers of your skin.
Hair loss medications like finasteride and minoxidil may help to regrow some hair that’s lost due to male pattern baldness, but there’s very little evidence that these medications can “reactivate” hair follicles that have been significantly miniaturized by DHT.
Beyond this, the only proven way to "regrow" patches of permanently shed hair is through hair transplant surgery.
Does Ketoconazole Shampoo Cause Hair Loss?
Like with many other treatments for hair loss, there are several theories about ketoconazole that aren’t supported by any evidence. One of these is that ketoconazole may cause hair loss, rather than reducing its severity.
Currently, there’s no scientific research to suggest that ketoconazole can increase the degree of hair loss you experience, or that it can speed up the development of male or female pattern hair loss.
However, like other medications, ketoconazole can cause side effects, including some that may affect your scalp and head of hair.
Potential side effects of topical ketoconazole include:
Oily or dry hair
Changes in your hair texture
Irritation and/or stinging
Blistering skin on your 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.
Although these effects don’t cause hair loss directly, you may experience changes in your hair growth if you scratch your scalp to relieve itchy or scaly skin, pull on your hair or use any other medications to reduce the severity of side effects from ketoconazole.
Because of this, it’s important to inform your healthcare provider if you notice any side effects after applying ketoconazole. They’ll be able to help you get relief without causing any harm to your hair follicles or inhibiting hair growth effects from your hair care routine.
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Is Ketoconazole the Only Hair Loss Treatment You Need?
Finally, one annoyingly common myth about ketoconazole is that it’s the only product you need to use to stop hair loss.
This one is easy to understand. After all, who wouldn’t rather just apply daily hair care products for fuller hair than take a pill and apply a hair growth serum or foam?
Unfortunately, while ketoconazole might be effective in treating hair loss and increasing the rate at which you grow new anagen hairs, there’s no proof that it’s an effective hair loss treatment on par with FDA-approved medications like finasteride.
If you’re suffering from severe hair loss caused by male pattern baldness, ketoconazole usually won’t be enough to stop it on its own.
This is particularly true if you have hair that’s highly sensitive to DHT and noticeable, worsening hair loss.
To stop male pattern baldness, you need to dramatically reduce your levels of DHT. This means that you can’t use ketoconazole on its own with any likelihood of success.
Currently, most research shows that the most effective treatment for male pattern baldness is a combination of finasteride and minoxidil.
These treatments are both supported by large amounts of scientific research, as well as millions of successful users around the world.
They’re also both approved by the FDA as treatments for androgenetic alopecia, or male pattern baldness.
Finasteride works by reducing DHT levels throughout your body, while minoxidil works locally by stimulating hair growth at the scalp level. In one study, experts found that upwards of 94 percent of balding men showed improvements after using both medications for one year.
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The Bottom Line on Ketoconazole and Hair Growth
Thanks to its antifungal properties, ketoconazole is commonly recommended to treat skin infections such as ringworm and athlete’s foot.
Ketoconazole is also linked to some improvements in hair health, and it may have certain effects on the hormone DHT at the hair follicle level. However, there’s currently no high quality research to suggest that ketoconazole is as effective at treating hair loss as minoxidil or finasteride.
As such, although ketoconazole products might be a helpful addition to your hair loss treatment regimen, they’re best used in combination with evidence-based hair loss treatments.
Worried about hair loss? Whether you’re considering trying ketoconazole for hair loss or simply want to learn more about your options, talking with a healthcare provider can give you a better understanding of what you can do to prevent further hair thinning and stimulate regrowth.
With our online platform, you can take part in a hair loss consultation with a healthcare provider from your home and, if appropriate, receive a prescription for hair loss medication.
You can also find out more about your options for stopping thinning and promoting the healthiest environment for hair growth in our detailed guide to the best treatments for thinning hair.