What Is Ketoconazole For Hair Loss?

Despite statistics suggesting nearly 80 percent of men and 50 percent of women experience hair loss in their lifetime, the condition can often feel like a lonely battle. Whether you're already experiencing shedding or you know it runs in your family and you're trying to get a jump on it, there are a variety of treatment options out there. This includes everything from over-the-counter topicals to more heavy-duty, in-office procedures. As far as at-home solutions go, most people know of the big ones like minoxidil and even all-natural remedies like rosemary oil, but ketoconazole is a lesser-known ingredient that might be worth exploring.

Ketoconazole has been around for quite some time; it's an antifungal medication that's used to treat a variety of medical conditions, but many doctors are touting its ability to help with some forms of hair loss. If you've ever used a dandruff shampoo, chances are you might have encountered the ingredient without even knowing.

To learn more about using ketoconazole for hair loss, we consulted with a board-certified dermatologist and hair expert, ahead.

Ketoconazole is an antifungal medication that's widely used across the medical field to treat infections such as athlete's foot, ringworm, and yeast infections. When it comes to hair, it's commonly used for dandruff and seborrheic dermatitis, which is an inflammatory condition of the scalp. It can be found in oral and topical formulations, but doctors recommend using it topically for hair specifically (more on that ahead).

We know what you're probably thinking: how does a medicine for fungal infections help with hair loss? Because ketoconazole can treat yeast infections, it's actually great for inhibiting the growth of Malassezia, a yeast of the skin commonly associated with dandruff and seborrheic dermatitis.

"Malassezia can cause irritation of the scalp by triggering an inflammatory response," Spencer Hawkins, MD, a board-certified dermatologist at Advanced Dermatology and Cosmetic Surgery in East Greenwich, RI, and the editor of HairMedicine.org, tells POPSUGAR. "The yeast feeds on natural scalp oils, breaking them down into substances that some people may be sensitive to. This can lead to itching, flaking, and overall discomfort, affecting scalp health." That's where ketoconazole comes in. "By reducing the presence of this yeast, ketoconazole can help improve scalp health and reduce the occurrence of flaking and itching."

But that's not the full extent of ketoconazole's hair benefits. "In addition to the anti-inflammatory benefits, there is some research to suggest ketoconazole can reduce levels of androgens (male sex hormones) in the scalp, reducing miniaturization of hair over time." This means there's a chance ketoconazole can help prevent certain types of hair loss, but it won't reverse what's already been done.

Dr. Hawkins says the science is not fully understood. A study published by Hormone and Metabolic Research in 1992 "showed in a laboratory setting that ketoconazole can reduce production of androgens, such as DHT, in the scalp," he says. "By doing so, it may help mitigate the effects of androgens on hair follicles, particularly in conditions like androgenetic alopecia (pattern baldness)."

Continued research has found additional evidence to suggest ketoconazole's impact on the hair. In a study published by Dermatologic Therapy in 2020, "Researchers found in human and mouse studies that ketoconazole can increase hair shaft diameter," Dr. Hawkins says. "However, it's important to note that more research is needed to fully understand the extent of ketoconazole's anti-androgenic effects and its precise mechanisms in this regard." He emphasizes that known hair loss treatments like minoxidil are still believed to be more effective.

Many other hair loss treatments on the market may be more effective, but they don't come without their drawbacks, while using ketoconazole is fairly low stakes. With that said, if you want to try it, Dr. Hawkins recommends incorporating it topically. "While it's available in topical and oral forms, with respect to hair and scalp concerns, topical ketoconazole is a safer and more effective approach, as it minimizes potential side effects, targets the affected area directly, and reduces the risk of drug interactions."

It's commonly found in the form of shampoos and scalp creams at one percent over the counter and two percent by prescription. "It can also be compounded with salicylic acid to further remove scale and increase absorption," Dr. Hawkins says. Two popular options include the Nizoral AD AntiDandruff Shampoo ($12, originally $16), which is available over the counter, and the Keeps Ketoconazole Shampoo 2% ($7, originally $11, per month), which is available with a prescription.

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You should always follow the instructions on the product's packaging. Dr. Hawkins advises incorporating it into your routine one to three times a week. "People frequently do not leave the medicine on the scalp long enough," he says. "If you apply ketoconazole and wash it out after a minute, it's not going to have sufficient time to treat the yeast. It's critical you leave it on the scalp for at least three to five minutes."

It's also worth noting that like other hair loss medications, you'll need to use the product long-term to continue reaping the benefits. "If you stop using ketoconazole, the yeast will recur."

"While topical ketoconazole is generally considered safe, some individuals may experience side effects such as skin irritation, itching, or dryness," Dr. Hawkins says. However, the side effect profile is dramatically different for oral ketoconazole (which Dr. Hawkins doesn't recommend for hair loss), and you should consult with a doctor before starting it.

Because there still needs to be more research done on the use of ketoconazole for hair, there isn't much data involving pregnant women. "The FDA takes the position that ketoconazole should be used during pregnancy only if the potential benefit justifies use," Dr. Hawkins says. "The NHS says you can use ketoconazole cream or shampoo if you're pregnant as only tiny amounts are absorbed into your body." Ultimately, you should consult with your doctor before starting or continuing use if you're pregnant.