Ketoconazole Shampoo

Ketoconazole 2% shampoo (available in the UK as Nizoral and generic brands) is an antifungal medicated shampoo used to treat fungal infections of the scalp and skin, including seborrhoeic dermatitis, pityriasis capitis (dandruff), pityriasis versicolor, and tinea capitis (ringworm of the scalp). Prescription-strength ketoconazole 2% shampoo is more potent than the over-the-counter 1% formulation.

How It Works

Ketoconazole is an imidazole antifungal that works by inhibiting the synthesis of ergosterol, an essential component of the fungal cell membrane. Without ergosterol, the cell membrane becomes permeable and the fungal organism dies. Ketoconazole shampoo has both antifungal and anti-inflammatory properties, making it effective not only against the Malassezia yeast species that contribute to dandruff and seborrhoeic dermatitis but also in reducing the scalp inflammation associated with these conditions.

Indications

The prescription 2% formulation is indicated for seborrhoeic dermatitis and scalp psoriasis (as an adjunct), pityriasis versicolor on the body and scalp, and as prophylaxis for fungal scalp infections in immunocompromised patients.

How to Use Ketoconazole Shampoo

For treatment of dandruff or seborrhoeic dermatitis of the scalp: Apply to wet hair and scalp, lather thoroughly, leave on for three to five minutes, then rinse. Use twice weekly for two to four weeks. Most people see significant improvement within this period.

For ongoing prevention after treatment: Use once every one to two weeks to prevent recurrence. Many people need long-term intermittent use to keep seborrhoeic dermatitis under control.

For pityriasis versicolor on the body: Apply to the affected skin, leave for three to five minutes, then rinse. Use once daily for five days.

The shampoo contains ketoconazole 2%, an antifungal that targets the Malassezia yeast responsible for dandruff and seborrhoeic dermatitis. Allow it to contact the scalp skin during the waiting period, not just the hair.

Ketoconazole shampoo 2% is available in 60 mL and 100 mL bottles. Treatment regimens vary by indication: twice weekly for 2–4 weeks for seborrhoeic dermatitis, then once weekly for maintenance. For pityriasis versicolor: apply to skin daily for 5 days. Keep out of eyes and mucous membranes.

Common Side Effects

Ketoconazole shampoo is generally well tolerated with topical use. Possible local effects include:

• Scalp irritation or itching
• Dryness of the scalp
• Changes in hair texture or oiliness
• Temporary hair loss (uncommon)

Hypersensitivity

Hypersensitivity reactions including urticaria (hives) and contact dermatitis can occasionally occur. If you develop a rash, significant irritation, or swelling after using the shampoo, stop use and speak to your doctor. Avoid contact with the eyes — if this occurs, rinse thoroughly with water. Do not use ketoconazole shampoo on broken, inflamed, or infected scalp skin without medical guidance.

Avoid contact with eyes. Do not use on broken or abraded skin. Avoid chemical hair treatment (dyeing, perming) during the treatment period. If you are allergic to imidazole antifungals, do not use ketoconazole shampoo without medical advice. Caution in patients with sulphite sensitivity (some formulations contain sodium sulphite as an excipient). Not recommended in children under the age of 12 without medical advice.

Contraindicated in patients with known hypersensitivity to ketoconazole or to any excipient in the formulation. For topical use only; do not ingest.