Does Ketoconazole—an Anti-Dandruff Ingredient—Actually Help With Hair Loss?

Scalp issues are normal and common. The abundance of hair usually found on the scalp makes an ideal environment for developing build-up—oil, bacteria, dead skin cells, products, yeast, you name it. And that doesn't even consider outside factors like stress, diet, the weather, and infrequent hair washing.

That said, scalp issues are nothing to be ashamed of. Luckily, there are many solutions out there these days, and some even target several issues simultaneously. Take ketoconazole, an antifungal medication mainly used to target dandruff on the scalp, which also helps with hair thinning and loss.

Read on for everything you need to know about ketoconazole, according to experts.

What is Ketoconazole?

Ketoconazole is an antifungal medication commonly used on the scalp for conditions like dandruff and seborrheic dermatitis. It's available over the counter as a 1% shampoo or by prescription in a 2% shampoo, cream, or foam formula. Zeichner and Castilla carefully point out that ketoconazole treats the scalp, not the hair. According to Longsworth, ketoconazole also treats other fungal infections like athlete's foot, tinea, cutaneous candidiasis, and pityriasis versicolor.

Benefits of Ketoconazole

Ketoconazole has a slew of benefits beyond its antifungal properties. When used on the scalp, these include:

• Lower yeast levels on the scalp: Per Longsworth, ketoconazole treats dandruff and seborrheic dermatitis by lowering the level of yeast on the scalp and preventing further growth. Lowering the levels of yeast on the scalp is the primary benefit of ketoconazole on the scalp. But by doing that, it's able to address a host of other concerns—including inflammation, redness, itching, and flaking.
  
• Calms inflammation: By lowering levels of yeast, ketoconazole is able to subsequently reduce inflammation on the scalp, Zeichner explains.
• Reduces flaking and itching: Calms inflammation and reduces flaking and itching, soothing symptoms of dandruff and seborrheic dermatitis.
• Lessens redness: According to Zeichner, reduced redness goes hand in hand with calmed inflammation.
• Help thinning hair and hair loss: Limited data suggest that it might also help with thinning hair. As Zeichner explains, low-grade inflammation and skin issues caused by yeast overgrowth may interfere with the optimal functioning of hair follicles and therefore contribute to hair thinning or loss. By addressing yeast overgrowth and reducing inflammation, ketoconazole can help the scalp and hair follicles function optimally.

Does Ketoconazole Help With Hair Loss?

Longsworth also points to limited clinical studies suggesting ketoconazole shampoo used alone or in combination with other treatments may be useful in reducing hair loss in some cases. In fact, ketoconazole has been used off-label to treat hair loss and other hormonal conditions.

She points to a 1998 study published in a Swiss dermatology journal that found that 2% ketoconazole shampoo was effective for stimulating hair growth.The study compared the efficacy of 2% ketoconazole shampoo (which is available by prescription) and a placebo shampoo mixed with or without 2% minoxidil. The results showed that both 2% ketoconazole and 2% minoxidil increased hair density as well as the size and population of hair follicles during the anagen phase of the hair growth cycle. Longsworth stresses that because there are limited studies available, more research is needed for conclusive data.

Hair Type Considerations

Ketoconazole shampoo can be drying, and Zeichner says it can strip hair color. For those reasons, he tries to limit use to a scalp treatment and has patients follow with whatever regular shampoo they use for their hair.

Alternatively, patients can also switch between two shampoos every other night. Castilla often pairs ketoconazole shampoo with a salicylic shampoo, which helps exfoliate the scalp and allows the ketoconazole to penetrate the skin further. Ketoconazole shampoo can also be combined with topical prescription steroids if there's a particularly bad itch component to dandruff.

Longsworth notes that patients with increased bone fragility, such as post-menopausal women and older adults, should use ketoconazole with caution to avoid the risk of fracture. Castilla says ketoconazole works well for patients with dandruff and seborrheic dermatitis. Otherwise, it's not necessary for a typical hair care routine.

How to Use Ketoconazole for Scalp

Ketoconazole is available over the counter in a 1% shampoo formula or by prescription in a 2% shampoo, foam, or cream. For over-the-counter options, Zeichner suggests Nizoral Anti-Dandruff Shampoo ($12).