Does ketoconazole shampoo cause scalp irritation

Ketoconazole shampoos have become an increasingly popular way to treat hair loss, but is there actually any evidence to show it can regrow your hair? Could it even make hair loss worse over the long-term?

This in-depth guide will take a close look at ketoconazole. This will include its uses, how it works, and the research studies which back its claims.

It’s important to disclose, however, that I’ve never personally used ketoconazole myself, nor would I recommend this particular course of treatment.

While the results are certainly encouraging (as will be seen later), I believe that all-natural is the only way to go if you want to treat the root cause of your hair loss.

Many over-the-counter ‘hair loss products’ just mask the symptoms, while also causing further harm down the road, because they don’t attack the root cause.

In fact, a much better option (after 4 years researching and experimenting) is to simply use 4 teaspoons of apple cider vinegar to wash your hair, once or twice per week.

In my experience it’s a bad idea to use any kind of chemicals on your head in any form!

However, if you do decide that this treatment is right for you, I’ll also offer some tips on how to use it most effectively.

What Is Ketoconazole?

An antifungal drug used primarily in the treatment of fungal infections, Ketoconazole was discovered in 1976 by Janssen Pharmaceutica in Belgium.

There are a few brand names associated with this synthetic drug, such as Extina, Xolegel, and Ketoderm. However, the most popular brand name is Nizoral, and it’s well known as an anti-fungal and anti-dandruff agent.

How It Works

The main mechanism by which ketoconazole operates is through its killing of fungi and yeasts. The drug stops the production of an organic molecule commonly found in fungus and yeast – ergosterol – and this interferes with the cell membrane of both organisms.

With the cell membranes compromised, the organisms are no longer able to reproduce.

Additionally – and of particular interest to those with Androgenetic Alopecia (AGA) – ketoconazole may also play a role in the inhibition of 5-alpha-reductase.

This is the enzyme responsible for the conversion of testosterone to DHT, and DHT is believed to be particularly harmful to individuals with AGA.

Is Ketoconazole Effective?

As with any hair loss treatment, effectiveness will depend on a number of factors. For ketoconazole, these factors include hair loss causes and severity, as well as application frequency.

Overall, ketoconazole-containing hair products (including Nizoral shampoo) are used with positive results.

This is especially true for those who suffer from dandruff and seborrheic dermatitis, and has recently proven to also be true for those with male-pattern hair loss.

What Does the Research Have to Say?

Fortunately for us, ketoconazole is a drug that has been studied for a number of years.

This means we have a decent idea of the effects that it can have.

Let’s take a look at a few of the drug’s most known abilities.

It Cleanses the Hair Follicles

When it comes to battling AGA, one of the best ways to do so is to target and remove DHT from the scalp.

This is because those with AGA are sensitive to DHT (even normal levels), and this can cause irritation and miniaturization of the hair follicle.

As the follicle miniaturizes, the hair growth cycle slows and, eventually, ceases completely.

Ketoconazole is believed to play a role in process of hair follicle cleansing, specifically through the inhibition of 5-alpha-reductase.

As seen in a study performed by Rafi & Katz, ketoconazole makes an excellent addition to a number of other hair loss treatment routines.

For example, in the mentioned study, researchers tested a novel hair loss treatment, NuH (a hypoallergenic combination of finasteride, dutasteride, and minoxidil) alongside a number of other popular treatments.

The various treatment groups included:


NuH + finasteride (oral)

NuH + ketoconazole

NuH + finasteride (oral) + ketoconazole 2% shampoo

NuH + finasteride (oral) + ketoconazole 2% shampoo + minoxidil (foam)

Here’s a look at the results of the individual who chose to use NuH Hair only:

And, here are the results of the individual who combined NuH Hair with ketoconazole 2% shampoo:

As can be quite clearly seen, the individual who used ketoconazole alongside NuH say a significant improvement in hair thickness and coverage.

Compared to the NuH-only treatment, it’s easy to see that ketoconazole played a role in hair growth.

Hair growth isn’t the only positive effect of cleansed hair follicles, however.

In addition, eight out of the ten patients who incorporated ketoconazole 2% shampoo into their care regimen presented with Seborrheic Dermatitis (SD) at the beginning of the study.

With use of the shampoo, however, all experienced resolution of their symptoms within one month.

It Promotes a Healthy Scalp

As a continuance of the above discovery – that ketoconazole shampoo is an effective treatment method for SD – it seems quite obvious that this drug’s use would also lend itself to a healthy and clean scalp.

It’s believed that ketoconazole works so well at treating SD and similar conditions (such as dandruff) due to their causes. SD and dandruff are both believed to be caused by an overgrowth of the yeast Malassezia.

With a powerful anti-fungal applied, however, the yeast is no longer able to reproduce or survive.

Actually the only way to treat dandruff long term is with improvements to your diet, as well as avoiding hot showers!

(Find out more about how you can naturally treat Seborrheic Dermatitis here.)

A review study, performed by Naldi & Diphoorn, compared the effects of ketoconazole scalp preparations on patients with different scalp conditions from a variety of previously performed studies.

As the review clearly shows, ketoconazole outperformed the placebo treatment in a few ways. Most notably, it improved scaling and reduced other bothersome symptoms, such as itching, redness, and dandruff.

It Stimulates the Growth of Healthy Hair

While the above two benefits are certainly noteworthy, the growth of healthy hair is of biggest concern to people with AGA. A few studies have been performed which indicate that ketoconazole is an effective promoter of hair growth.

A 2005 Japanese study was one of the first to directly study ketoconazole’s role in hair growth. This was performed on mice, and the results are quite promising.

A similar study was performed – again on mice – but this time it compared ketoconazole to minoxidil and minoxidil with tretinoin.

The mice were first split into four groups (each containing five), and their dorsal hairs were shaved. A stain was then applied so researchers could better track the growth of new, non-dyed hairs.

The groups were split as such:

Group I was the control, and it received 1 mL of 95% ethanol once daily for 6 days/week for 3 weeks.

Group II received Ketoconazole solution 2%, 0.1 mL once daily for 3 weeks.

Group III received Minoxidil solution 5%, 0.1 mL once daily for 3 weeks.

Group IV received equal amounts of Minoxidil solution 5% + Tretinoin 0.1%, 0.1 mL once daily for 3 weeks.

As results were compared after three weeks, it was obvious that ketoconazole, minoxidil, and minoxidil with tretinoin were all superior to the placebo group.

This was shown when comparing both the number of hair follicles, as well as the mean diameter of hair follicles.

Of course, these results were also visually significant, as shown by the side-by-side comparison image below.

On the left is the control group, showing insignificant growth (as noted by the presence of dye). On the right is the ketoconazole treatment group, showing significant growth in just three weeks’ time.

As noted by the researchers, the positive effects of ketoconazole likely “stem from its antiandrogenic properties”.

One thing to note here is that hair growth in mice, although an indicator of hair growth performance in humans, just doesn’t translate directly over.


What’s the #1 scalp condition affecting millions of people worldwide each year?

You’ve guessed it – dandruff!

This condition – characterized by itching and large, white flakes – is more than just a case of dry scalp. Actually, a 2014 study found a major culprit of dandruff to be the Malassezzia species of yeast.

And, this is crazy:

There was a significant difference in Malassezzia presence in people with dandruff (84%) as opposed to healthy people (30%)!

But what does this have to do with ketoconazole?

As mentioned previously, ketoconazole has been shown to cleanse the hair follicles and promote a healthy scalp environment. This may help to remove the yeast buildup from the scalp which is responsible for this embarrassing condition.

Seborrheic Dermatitis

As mentioned in various places above, Seborrheic Dermatitis is a scalp condition characterized by inflammation, itching, scaling, redness, flaking (yellowish or white), and overproduction of grease. This is considered a more severe form of dandruff, but it’s also a condition all its own.

While it mainly presents on the scalp, it can spread to the surrounding areas, including the ears, eyelids, neck, upper back, chest, and armpits.

While there’s no exact cause pinpointed, it’s believed that SD is dependent on a number of factors. These include age, gender, and immune system health.

Unfortunately, this condition can impact the lives of sufferers significantly, both mentally and physically. Mentally, this condition can effect self esteem and self confidence.

Physically, sufferers can experience permanent scarring and consistent irritation during flare ups, and if left to progress long enough, can also experience hair thinning and permanent hair loss.

Fortunately, when the condition is treated early enough, some of the longer-term effects (such as scarring and hair loss) may be able to be avoided.

So, what’s the most common treatment?

As prescribed by doctors and endorsed by sufferers, SD is typically treated with ketoconazole-containing products, such as Nizoral shampoo.

How to Use Ketoconazole Most Effectively

If you decide to add ketoconazole to your hair loss treatment plan (again, I actually don’t recommend this!), there are a number of other methods which you can use alongside it.

These methods are natural, and they can further promote positive hair growth results.

Inhibit 5-Alpha-Reductase

As a precursor to DHT, the inhibition of 5-alpha-reductase can go a long way in preventing male-pattern hair loss.

This can be done in two ways: through topical application of proven 5-alpha-reductase inhibitors, or through oral ingestion of similarly-inhibiting substances.

For example, you can easily add reishi mushroom and green tea to your daily diet, or you can create a shampoo or hair growth serum that contains saw palmetto.

Costs and Availability

While tablets and creams are the typical prescription method, there are a few over-the-counter formulas available for purchase. These consist of shampoos (both 1% and 2%), as well as ointments.

As a popular over-the-counter fungal treatment, there are a number of brands to choose from. The most common brand is Nizoral, and an 8-oz bottle can typically be purchased for around $15.

While this may seem a bit pricey, the product is only used a few times per week in the beginning of treatment (afterwards, its use is intermittent).

This means that the product will last a reasonable length of time. Take a look at Revivogen shampoo as well

Ketoconazole Side Effects

As with any medication, ketoconazole has a few possible side effects that may interfere with its proper use, or make continuation of its use impossible.

According to the Mayo Clinic, some of the more bothersome side effects (such as itching, peeling, burning, or stinging) are not a common occurrence.

In the event they do occur, they may subside as your body becomes accustoms to the medication.

Of course, it’s recommend that you stop use if the effects begin to interfere with your daily life.

As with any supplementary product, it’s a good idea to consult with your physician prior to usage. This is especially true if you’re currently on any prescription medications, or if you have any chronic health conditions.

How to Add Ketoconazole to Your Hair Care Routine

As a readily-available shampoo, ketoconazole products can be easily added into your regular hair care routine.

As a medicated product, it’s recommend that you follow a consistent regimen for 6-8 weeks. This means using the shampoo every 2-4 days for the mentioned length of time, and then using periodically (1-2 times per month) for continued benefits.

How to Use Ketoconazole Shampoo

If you decide to use ketoconazole, you’ll want to ensure you’re using it most effectively.

But how?

Let’s take a closer look at the instructions:

  1. Wet the area of the scalp affected by hair loss.
  2. Apply the ketoconazole shampoo directly to the area affected by hair loss, and a large radius around it.
  3. Massage the shampoo into the affected area for one minute, allowing it to fully lather.
  4. Let sit for 5 minutes.
  5. Rinse with lukewarm/cool water.

While ketoconazole shampoo can be applied to the entire scalp, you do want to ensure you pay particular attention to the area of hair loss. This means focusing the majority of your massaging efforts there, and using a circular motion while doing so.

By allowing it to sit, you also ensure the ingredients penetrate the scalp and hair follicles.

But you may be wondering:

“Why must I rinse with lukewarm/cool water?”

The fact is, hot water causes damage to the scalp and hair follicles. It leads to dryness, inflammation, and irritation and it should be avoided whenever possible.

By rinsing your scalp with lukewarm/cool water, you prevent any irritation from occurring.

Cold water rinses have other benefits, too!

Namely, it increases circulation which is great for oxygen/nutrient delivery and waste removal.

Are There Natural Alternatives to Ketoconazole?

The use of store-bought products is not something which I promote at all.

This is because the majority are full of chemicals which will only lead to more scalp and hair follicle damage in the long run.

Further, the use of homemade products such as shampoos can be tailored to fit your exact needs.

So, what do I recommend instead?


  • Apple Cider Vinegar (1 cup)
  • Water (1 cup)
  • Rosemary (1 bunch)
  • Jojoba Oil (20 drops)
  • Peppermint Essential Oil (10 drops)


Bring water to a boil, then add the rosemary and remove from heat. Allow rosemary to steep until the tea has cooled.

While the tea cools, combine the apple cider vinegar, jojoba oil, and peppermint essential oil in the container of your choice. Drain the rosemary tea, adding the tea water to the combined ingredients and discarding of the rosemary.

To use, lather onto your hair and massage deep into your scalp. Allow to sit for 1-3 minutes, and then rinse thoroughly with cool water.

Hair Benefits:

When treating dandruff and similar scalp conditions that lead to inflammation, irritation, and scaling, you want to focus on hydration while also soothing the scalp and bringing it back to its natural pH balance.

This recipe does just that, combining the soothing effects of rosemary and peppermint oil and the hydrating effects of jojoba oil.

In addition, the apple cider vinegar gently cleanses the scalp and hair, and the peppermint oil also brings the scalp’s pH back to its natural balance.

An Easier Solution

The benefits of preservative-free shampoos cannot be overstated. But, not everyone has the time or willingness to make their own at home.

So, what now?

That’s where our line of Grogenix products comes in!

Using the Grogenix Caffeine Shampoo, you can cleanse and reinvigorate your scalp. There’s no harsh chemicals or preservatives – just all natural ingredients that stimulate the hair follicles and help fight hair loss.

And with Grogenix, you never have to mix your own products again! This is a time (and money) saver for many, and it’s something you should consider if you’re having trouble saying goodbye to off-the-shelf products.

Why You Should Stop Using Chemical Shampoos Altogether

I have found that to reverse hair loss, the health of your scalp is very, very important. In fact it’s hard to overstate just how important scalp health is for hair regrowth.

Just think of a plant growing in a garden, the top soil is probably the most important factor to whether the plant thrives or dies (given it has sunlight and air.)

Although ketoconazole shampoo may initially feel like it is helping, over time the scalp of your health will get worse because of the chemicals.

If you have scalp fungus, this really isn’t the way to get rid of it.

Let me show you what to do instead.

You must actually change your diet, and doing so will make it impossible for fungus to grow in the first place, it will also basically completely stop your dandruff.

Firstly, get rid of yeasty foods such as bread and beer. Cut down your intake of yeast promoting foods such as sugary drinks, refined grains, dairy products and refined oils.

Increase your intake of vegetable juices, herbs, spices, and fruits.

Dandruff can also be solved by diet changes. I recommend adding more healthy fats to your diet.

This includes:

  • Avocado
  • Coconut oil
  • Brazil nuts
  • Cashew nuts
  • Cold water fish
  • Bone broth

Try adding in these foods to your diet and removing the ones I mentioned earlier, and in a few weeks time you’ll have a much healthier scalp, and as a result, much healthier hair.


There’s no doubt that ketoconazole can help significantly (temporarily) in the treatment of SD and dandruff, and in the promotion of hair growth.

This doesn’t mean, however, that it’s the best option available to you.

Remember that SD and hair loss are conditions that best resolved internally. Such methods will lead to longer-term results, and will have a number of other positive health effects, too.

Such a task isn’t always easily undertaken, especially when you’ve been conditioned to survive on the typical Western diet of grains, processed sugar and lots of yeasty foods.