From the Research
Ketoconazole shampoo is a highly effective treatment for seborrheic dermatitis and dandruff, with a recent study showing significant improvement in symptoms and low relapse rates 1.
Key Points to Consider
- The shampoo works by disrupting the fungal cell membrane, inhibiting ergosterol synthesis, and killing the fungus or preventing its growth.
- Most formulations (typically 1% or 2% strength) should be used twice weekly for 2-4 weeks, then reduced to once weekly or every other week for maintenance.
- Common side effects may include scalp irritation, dryness, or increased hair loss.
- If treating seborrheic dermatitis on the face, apply a lather to affected areas during your shower and rinse after a few minutes.
- For persistent or severe conditions, consult a healthcare provider as you may need a stronger prescription or different treatment approach.
Evidence-Based Recommendations
- A 2024 narrative review found ketoconazole shampoo to be a safe and effective treatment for seborrheic dermatitis of the scalp, with significant improvement in irritation and scaling and low relapse rates 1.
- A 2019 systematic review of topical ketoconazole found it to be clinically effective for the treatment of Malassezia-related conditions, including seborrheic dermatitis and pityriasis versicolor, with a reported efficacy of 63-90% and 71-89%, respectively 2.
- A 2002 multicenter randomized trial found ketoconazole 2% shampoo to be significantly superior to zinc pyrithione 1% shampoo in the treatment of severe dandruff and seborrheic dermatitis, with a 73% improvement in the total dandruff severity score compared to 67% for zinc pyrithione 1% 3.