Ketoconazole is a synthetic anti-fungal drug used to treat a variety of skin conditions including dandruff and athlete’s foot. Although ketoconazole has not been specifically approved for the indication of treating hair loss, it remains an effective adjuvant to existing hair loss regimens. Ketoconazole is distributed by McNeill-PPC, Inc. as a shampoo under the brand name, Nizoral™.
There are several other formulations under which ketoconazole can be administered, including tablets taken orally and creams applied topically. While topical creams have recently been found to have positive effects on hair growth, oral tablets provide no such improvements and can have serious side-effects (especially when combined with other medicines).
In 1981, the U.S. Food and Drug Administration (FDA) approved ketoconazole for the treatment of seborrheic dermatitis. A study conducted in 1998 found Nizoral 2% to be just as effective as minoxidil 2% in men affected by androgenetic alopecia (AGA). Nizoral not only increased the number of hairs in the anagen phase of the follicle growth cycle, it also increased the diameter of hair shafts. Because Nizoral has not been specifically approved by the FDA to treat AGA, however, it cannot be marketed as a hair loss product. Nevertheless, many independent experts maintain that Nizoral 1% can significantly improve hair growth.
Method of Action
In addition to having potent anti-fungal properties, ketoconazole works as a 5-alpha-reductase inhibitor and hair growth stimulant. Ketoconazole will not result in the formation of new hair follicles, but it is effective at maintaining and thickening existing hair. When taken orally, ketoconazole can inhibit the production of testosterone within the body. When applied topically, however, this effect is greatly reduced.
It is recommended that a shampoo product containing ketoconazole (e.g. Nizoral) be used 3-4 times per week. This shampoo should be massaged into the scalp (to remove dead skin cells and increase blood circulation) and left in for 3-5 minutes before being rinsed thoroughly.