Ketoconazole as a topical agent in hair loss

Ketocaonzole is a an anti fungal agent that helps treat scalp flaking from dandruff and the closely related condition called seborrheic dermatitis. Numerous studies over the past many years have suggested that this drug also helps hair loss. I will often recommend ketoconazole shampoos to individuals with genetic hair loss.

What is the data to support use of ketoconazole for hair loss?

A fairly long (18 month) research study looked at the use of topical minoxidil and how it compared to ketoconazole 2 % shampoo. Study participants received the 2 % shampoo or an unmedicated shampoo with or without minoxidil 2 %. Much to the surprise of many, hair density and follicle size improvements were similar with both ketoconazole and minoxidil regimens. The exact way that topical ketoconazole increases hair density and hair growth is unclear, but may be due to is anti-inflammatory effects against certain cells of the immune system   (i.e. T lymphocytes) and a particular yeast in the scalp responsible for inflammation (known as Malassezia). Ketoconaozle also lowers DHT levels and inhibits steroid product in the scalp. All of these mechanisms are likely relevant to the effects of ketoconazole.

STUDIES:

Inui.  J dermatol Sci 2007; 45: 66-8.

Pierar Franchimont Dermatology 1998; 196: 474-7