What is Ketoconazole?

Ketoconazole is an antifungal drug, which in the UK is licensed to treat certain skin conditions, including dandruff. However, Ketoconazole is sometimes also prescribed off-label as a hair loss treatment for male pattern baldness (androgenetic alopecia) in both men and women.

When prescribed for the treatment of hair loss, it is usually used in the form of a Ketoconazole 1-2% shampoo and is more commonly known under its brand name Nizoral. As part of the hair loss treatment, the shampoo is usually recommended to be used not more than 3-4 times a week.

Finasteride (Propecia) and Minoxidil (Regain) are the only MHRA approved medications to treat male pattern baldness, however, scientific research has found Ketoconazole to be effective in treating hair loss and in some instances even show improvements in hair growth. It was found to be most effective when used in conjunction with Finasteride or Minoxidil.

In this post, we will dive into Ketoconazole and see how effective the shampoo has been as a treatment for hair loss and what the scientific evidence behind it is.

Does Ketoconazole Shampoo work for hair loss?

Whilst there are far less scientific studies assessing the effectiveness of Ketoconazole shampoo on male pattern baldness, the existing research has found that Ketoconazole to be effective in reducing hair loss and stimulating hair growth.

An early study from 1998 compared the effect of Minoxidil and Ketoconazole on male pattern baldness and hair growth. The researchers found that the hair density and proportion of hair follicles in the growth phase (anagen phase) improved almost similarly by both Minoxidil and Ketoconazole. In other words, both were found equally effective in treating male pattern baldness.

A study from 2002, found evidence to support the hypothesis that Ketoconazole 2% shampoo was effective in inhibiting the production of DHT, the male sex hormone mainly responsible for male pattern baldness. It is hence recommended to be used in conjunction with the DHT-blocker Finasteride.

Other scientific research has focussed on assessing the effectiveness of Ketoconazole when used in conjunction with Minoxidil or Finasteride. The researchers have independently found Ketoconazole to significantly improve the outcome of treatment in male pattern baldness.

More recent studies on mice demonstrated that Ketoconazole had a significant stimulatory effect on hair growth when compared with the control group.

Although there are no extensive long-term studies assessing the effectiveness of Ketoconazole on a large group of men, the current scientific research provides strong evidence that Ketoconazole is effective in its treatment for male pattern baldness, particularly when used in conjunction with Finasteride and/or Minoxidil.

How does Ketoconazole work for hair loss?

The truth is that researchers are not entirely sure how exactly Ketoconazole works as a treatment for male pattern baldness. A previously mentioned study concluded that Ketoconazole shampoo was either blocking the production of DHT in itself or blocking DHT binding to androgen receptors in hair follicles. Both of which would have the the desired positive effect of stopping hair loss.

The same researchers concluded that Finasteride is effective at reducing scalp DHT level, but it does nothing to stop the remaining DHT from binding to the androgen receptors found in patients with male pattern baldness. Local Ketoconazole 2% shampoo can inhibit DHT production and/or DHT binding to AR. Hence Ketoconazole shampoo was found to be effective when used in conjunction with Finasteride therapy to potentially block the DHT pathway more completely.

So should I use Ketoconazole to prevent hair loss?

Ketoconazole shampoo is unlikely to be as effective as Finasteride (Propecia) or Minoxidil (Regain) as a treatment for hair loss when used as a sole product. However, scientific research has shown it to be effective, especially when used in conjunction with Finasteride and Minoxidil. That is why it forms part of The Big 3 in Hair Loss.

Unlike Finasteride and Minoxidil, Ketoconazole should not be used on a daily basis, but rather limit it to 3-4 times a week.

Check here to learn more about The Big Three hair loss treatment and see if it is the right treatment for you.

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