Ketoconazole Shedding Explained (What You Need To Know)

Ketoconazole shedding

Ketoconazole & Shedding

Find out more about ketoconazole and hair shedding.

Why Use Ketoconazole For Male Pattern Baldness ?

Ketoconazole is an antifungal medication and weak anti-androgen that can be used topically to treat male pattern baldness. Several studies have demonstrated its effectiveness – ketoconazole is definitely a useful tool in the fight against hair loss.

There is a debate about whether using ketoconazole for hair loss can cause hair shedding. Some people on social media and web forums believe that ketoconazole increases hair shedding, while others think that it reduces hair loss.

But what does the science say?..

Does Ketoconazole Cause Hair Shedding?

The scientific consensus is that using ketoconazole cream or shampoo actually DECREASES hair shedding.

A study published in 2002 found that 1% ketoconazole shampoo was effective in reducing hair shedding by 17.3%. However, although the research may have included some participants with male pattern baldness, study selection was based on people with dandruff.(1)

Separate research from 1998 focused specifically on ketoconazole for male pattern baldness.(2) Scientists investigated the use of 2% topical ketoconazole for a period of 21 months. It was found that ketoconazole cream increased hair density and the amount of hairs in the anagen (growth) phase.  No mention was made of increased hair shedding.

Although these results are reassuring, it is important to note that the studies involved relatively few participants 

Those Studies Are Old. What About Recent Research?

In recent years, there has only been one main study investigating ketoconazole and hair loss. It was published in 2019 and compared minoxidil and ketoconazole for female pattern baldness.(3) Although the pattern of hair loss is different between males and females, the cause – androgenetic alopecia – is still the same.

Again, ketoconazole was found to be effective against androgenetic alopecia, with comparable results and less side effects than minoxidil.

50% of minoxidil users reported side effects compared to just 10% of people using ketoconazole liquid on their scalps.

But I’m Using Ketoconazole And Losing Hair!

While the available research on the subject indicates that ketoconazole decreases hair shedding, the study from 2019 may give some indication as to why some people say that they shed hair while using it.

Scientists found that the positive effects of minoxidil started working around month 4 of the treatment regime, while those using ketoconazole had to wait until month 6 to see regrowth.(3)

This lag in visible success could mean that hair loss continues for the first few months of using ketoconazole. Users may then blame ketoconazole for the hairs they are still shedding and quit before the good results actually start.

Nizoral shedding

Could Other Shampoo Ingredients Cause Hair Shedding?

The ingredients of ketoconazole shampoos and creams vary wildly. It’s probably best to avoid products with a long list of ingredients and additives. If you haven’t seen success with one ketoconazole shampoo, then give another a try before quitting.

A quick search online shows that hydrochloric acid(?!) is used in some ketoconazole shampoos, which is an extremely strong abrasive substance. Sodium lauryl sulfate is another ingredient that has its detractors and with overuse could be an irritant.

If you are finding that your scalp is red, inflamed, or just irritated when using a ketoconazole product, then it’s best to let your scalp recover and switch to another brand with different ingredients.

Is Ketoconazole Cream Or Shampoo Better?

Both ketoconazole shampoos and creams are effective and can breach the skin barrier to reach hair follicles. However, shampoos are specifically formulated to bypass hair and be absorbed into the scalp. So unless you have a shaved head or very close cropped hair, it’s likely cream will act more as a styling gel than an effective hair loss treatment. 

A shampoo containing 2% Ketoconazole (used twice weekly to daily) has repeatedly been demonstrated to be effective against hair loss. So it is best to stick to this regime if you want to experience the best results.

If you are concerned about hair shedding while using ketoconazole, consult your doctor who can thoroughly examine your scalp for any issues that may be present.