You started applying minoxidil to stop your hair loss, and so far it’s working great. There’s only one problem: the intense itching and flakiness of your scalp.

You feel like you’re left to choose between hair regrowth or a head that doesn’t require constant scratching. You’re convinced you can’t have both.

Fortunately, that’s not quite true. Ketoconazole can help treat dandruff and reduce the side effects of minoxidil solution—primarily, that annoying flaking and itching. Clinical evidence suggests that ketoconazole may even be an effective hair loss treatment in its own right.

But what does it do, how does it work, and how can you use it? Here’s what you need to know.

What is ketoconazole?

Ketoconazole is a medication that’s used to treat infections caused by a fungus or yeast—think things like ringworm or athlete’s foot. In those cases, it’s available as a cream, foam, or gel.

However, ketoconazole is also available as both a prescription or over-the-counter shampoo that’s specifically designed to control dandruff, as well as scaling, flaking, and itching of the scalp (much like what happens when you’re using minoxidil).

There’s both 1% and 2% ketoconazole shampoo (which refers to the concentration of ketoconazole in the solution). The 1% shampoo is available over the counter, while the 2% version is obviously stronger and requires a prescription from a healthcare provider.

Does ketoconazole stop hair loss?

The scientific data isn’t fully conclusive about how ketoconazole contributes to stopping hair loss or increasing hair growth, but there is a lot of evidence that it can help. For example, one 1998 study indicated that 2% ketoconazole shampoo increased hair density, as well as the proportion and size of anagen hair follicles, at nearly the same rate as minoxidil regimens. More recent ketoconazole hair loss studies have confirmed its effectiveness both as a standalone treatment and as a supplement to finasteride.

Despite the strong record of evidence, the FDA hasn’t yet approved the use of ketoconazole shampoo to treat hair loss. But many hair loss specialists have been prescribing it that way for years and consider it a standard part of the treatment regimen. “I recommend ketoconazole shampoo to many of my patients who have androgenic alopecia, even if they don’t have dandruff,” said Dr. Antonella Tosti, hair loss expert and Keeps Medical Advisor. “The data shows that it can help regrow hair and fight the inflammation that is associated with androgeneic alopecia.”

How else is it used?

Again, ketoconazole is used in a variety of ways. As the Mayo Clinic explains, ketoconazole cream, foam, or gel is used to treat things like:

  • Athlete’s foot
  • Ringworm of the body
  • Ringworm of the groin
  • Seborrheic dermatitis
  • Yeast infection of the skin

Ketoconazole shampoo is used for dandruff, itching, flakiness, and hair loss. Studies show that, because it’s stronger, 2% ketoconazole shampoo is often more effective and, as a result, is used for more severe cases of itching and flakiness.

How is it different than Nizoral®️ shampoo?

It’s not any different. Nizoral®️ is a brand name for ketoconazole, just like Advil®️ is a brand name for ibuprofen. Nizoral®️ is also available as a cream, but shampoo is the more convenient option if you’re using ketoconazole to treat dandruff and not athlete’s foot or ringworm.

How does it work to treat your scalp issues?

Here’s something you might not know: Dandruff is actually caused by a fungus that’s found on every human head called Malassezia.

But here’s the thing: Malassezia depends on environmental and genetic factors. Everything from hormones to climate, stress, and diet impact the growth of the fungus.

Our scalp cells are constantly renewing (seriously, it’s totally natural), and Malassezia accelerates this renewal process by causing inflammation. So, to put it simply, it increases the cell turnover and the number of dead cells that fall off, which results in itching, flaking, and dandruff. Inflammation can also lead to increased shedding. (In fact, guys with male pattern hair loss tend to have more Malassezia on their heads than other men.)

Because ketoconazole is an antifungal medication, it kills Malassezia. That not only curbs dandruff and itching but also reduces hair loss caused by inflammation, which is why ketoconazole shampoo can slow down shedding.

How do you apply it?

Ketoconazole is a shampoo, so it’s only for external use. Of course, it’s always wise to check the packaging to ensure you’re following all the directions.

As the Cleveland Clinic explains, you should wash your hands before and after use. Make sure your scalp is thoroughly damp and then apply enough shampoo to cover all of the affected areas of your scalp and work it into a lather.

For the best results let it sit on your scalp for five minutes before rinsing completely with water. Even if you’re using an over-the-counter version, it should not be rinsed immediately after it’s lathered.

Much like any other shampoo, be careful not to get the shampoo in your eyes. If you do, rinse your eyes thoroughly with cool water.

How often do you use it?

How often you use ketoconazole shampoo depends on whether you’re using the 1% over-the counter shampoo or the 2% prescription strength shampoo. Again, you should read the directions on the label to understand the necessary application frequency.

Usually, prescription ketoconazole is used at least twice a week for dandruff, and three times a week for hair loss. Over-the-counter versions can even be used daily.

What are the side effects?

Ketoconazole shampoo is generally safe, but like all medicines, it is associated with some rare but potentially serious side effects.

Get in touch with your doctor right away if you experience any of the following:

  • An allergic reaction like skin rash, itching or hives, swelling of the face, lips, or tongue
  • Pain, tingling, numbness

Other potential side effects can include:

  • Dry skin
  • Hair discoloration or abnormal texture
  • Skin irritation

While those don’t require immediate medical attention, you should speak with your doctor if they’re persistent or have become overly bothersome.

How long does it take to start working?

There isn’t one right answer for everybody. It depends on the strength of the shampoo as well as the severity of the dandruff that you’re treating. In general, improvement is fast but you often need to continue to use the shampoo to prevent relapses. If you’re using ketoconazole to treat hair loss, talk to your doctor before stopping.

Follow the directions on the package or as outlined by your healthcare provider, and speak with your doctor if the itching, flaking, and dandruff isn’t clearing.

And there you have it: everything you need to know about how ketoconazole shampoo treats dandruff, itching, and hair loss. If you’re a Keeps customer and want to find out if ketoconazole is the right treatment for you, message your Keeps doctor to learn more.

Not a Keeps customer yet? Well, what are you waiting for? Get started here.

The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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If you would like to learn more about finasteride, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: or call 1-800-FDA-1088.)

If you would like to learn more about ketoconazole, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: or call 1-800-FDA-1088.

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