Antifungal Shampoo Dosing Recommendations
For antifungal shampoos, the recommended dosing varies by product and condition being treated, with ketoconazole 2% shampoo typically used twice weekly for 2-4 weeks for initial treatment of seborrheic dermatitis, followed by once weekly for maintenance. 1
Dosing by Condition
Seborrheic Dermatitis and Dandruff
- Ketoconazole 2% shampoo: Apply to wet scalp, massage for 2-3 minutes, rinse thoroughly, and repeat. Use twice weekly for 2-4 weeks for initial treatment 1
- Maintenance therapy: Once weekly application of ketoconazole 2% shampoo is effective for preventing relapse of seborrheic dermatitis 1
- Selenium sulfide: Apply to affected areas, lather with small amount of water, allow to remain on scalp for 2-3 minutes, rinse thoroughly, and repeat application. Use as directed by physician 2
Tinea Versicolor
- Ketoconazole 2% shampoo:
- Selenium sulfide: Apply to affected areas, lather with small amount of water, allow to remain on skin for 10 minutes, rinse thoroughly. Repeat once daily for 7 days 2
Tinea Capitis
- Ketoconazole 2% shampoo: When used as adjunctive therapy with oral antifungals, apply daily, massage into scalp, leave for 5 minutes, then rinse 4
- In cases where oral therapy cannot be used, daily application for 8 weeks has shown effectiveness in some studies, though this is not the standard of care 4
Application Technique
- General instructions:
- Shake bottle well before using 2
- Remove jewelry before application to prevent damage 2
- Apply to wet hair/scalp/skin 2, 1
- Massage thoroughly to create lather 2
- Allow product to remain on affected area for the recommended time (varies by product and condition) 2, 1, 3
- Rinse thoroughly 2
- Wash hands well after application 2
Prophylactic Use
- For prevention of recurrent seborrheic dermatitis:
- Ketoconazole 2% shampoo once weekly is significantly more effective than placebo in preventing relapse (19% vs 47% relapse rate) 1
- For fungal infections including candidiasis and dermatophyte infections, prophylactic antifungal wash for 5 weeks along with standard antifungal treatment reduces recurrence rates (4% vs 60% at 6 months) 5
Important Considerations
- Duration of treatment should be followed precisely to ensure complete eradication of the fungal infection 1, 5
- Premature discontinuation may lead to higher recurrence rates 1
- For severe or resistant cases, combination therapy with oral antifungals may be necessary 4
- Patients should be advised about the importance of completing the full course of treatment even if symptoms improve rapidly 5