2% ketoconazole · 1998
Hair density improved about as much as with 2% minoxidil.
A small study of men with pattern hair loss. Hair thickness and the share of growing hairs improved too.
Ketoconazole 2% Shampoo
Prescription-strength 2% antifungal shampoo that controls the scalp yeast behind dandruff, used alongside finasteride or minoxidil.
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$69.99
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Active Ingredients
Ketoconazole
Calms scalp inflammation
Research-backed
formulas
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Why 2%
Can't I just use Nizoral?
Same drug, twice the strength. The Nizoral on drugstore shelves is 1% ketoconazole. Anagen's ketoconazole shampoo is 2%, the prescription strength.
1%DrugstoreOver the counter
2%AnagenPrescription, online
Randomized · open-label
Tested side by side, 2% worked faster and held up longer
After 4 weeks of use, the end of treatment
After 4 weeks of use, the end of treatment: 91% on 2% were clearly better, against 63% on 1%; 73% on 2% had low scalp yeast, against 25% on 1%.
66 adults with severe dandruff or seborrheic dermatitis were randomly given 1% or 2% to use twice a week for 4 weeks, then checked again 4 weeks after stopping (2001). 2% did significantly better at every check (p ≤ 0.001).
How we got this
Piérard-Franchimont C, Piérard GE, Arrese JE, De Doncker P. Dermatology 2001;202:171-6 (PubMed (opens in a new tab)). “Clearly better” is the study's clinical rating of healed or markedly improved. “Low levels” means 100 or fewer yeast cells per square millimetre of scale, counted by a lab that didn't know which shampoo each person used. Percentages are of the people the paper counted at each check: 32, then 29, on 1%, and 33 on 2%. People knew which strength they were using. Relapses after stopping were 23% on 2% and 39% on 1%, a difference too small to be statistically significant. The shampoos came from Janssen, and one author worked at McNeil Consumer Healthcare, both Johnson & Johnson companies.
And in hair studies
Separate studies, not head to head1% ketoconazole · 2002
Shedding fell 17%. Hair density didn't change.
150 men with hair shedding and dandruff, split across three shampoos, over 6 months. On 1% ketoconazole, hair thickness and the share of growing hairs also rose about 5%.
Who it's for
Is this you?
My scalp itches or flakes
88%
had an excellent response after 2 to 4 weeks of 2% ketoconazole, twice a week.
Keeping it awayUsed once a week after that, 19% saw it come back over 6 months, against 47% on a placebo shampoo.
575 adults with dandruff or seborrheic dermatitis. The 312 who responded joined a 6-month double-blind, placebo-controlled phase. 1995.
I'm losing my hair
78%
of men with pattern hair loss at one clinic also had seborrheic dermatitis.
Where 2% ketoconazole fitsIn a small 1998 study of men with pattern hair loss, it improved hair density about as much as 2% minoxidil.
520 men at one Korean hair-loss clinic, 2008.
I'm on finasteride or minoxidil
77%
of men regrew hair on minoxidil when the scalp had no inflammation around the follicles. With inflammation, 55% did.
Where 2% ketoconazole fitsIt targets the scalp yeast thought to feed that inflammation. Whether that improves minoxidil results hasn't been tested.
44 men treated with minoxidil, scalp biopsies, 1993.
Dive deeper
Ketoconazole for hair loss: what the studies show
Learn more
Do shampoos help or hurt hair growth?
Learn moreHow long hair loss treatments take to work
Learn more
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Frequently asked questions from Anagen customers
- Yes. It is designed to be used alongside them, not instead of them. In a small one-year randomized study, finasteride combined with ketoconazole shampoo ranked ahead of finasteride alone for hair growth. Use it 2 to 4 times a week, and on those days apply any leave-on scalp treatment, such as topical minoxidil, once your scalp is dry.
- FDA Approval Status: Ketoconazole 2% shampoo is an FDA-approved prescription antifungal. Its US prescribing information covers tinea versicolor and includes double-blind trials in dandruff and seborrheic dermatitis. Its use for hair loss is off-label. Prescription required.
- Ketoconazole is an antifungal that controls Malassezia, the scalp yeast behind dandruff, seborrheic dermatitis and the inflammation around hair follicles. In a trial of 575 people with moderate to severe dandruff or seborrheic dermatitis, 2% ketoconazole shampoo used twice a week for 2 to 4 weeks gave an excellent response in 88%. In the double-blind, placebo-controlled phase that followed, using it once a week cut the six-month relapse rate to 19%, against 47% with placebo. In a separate 331-person trial it improved dandruff severity more than 1% zinc pyrithione shampoo (73% against 67% after 4 weeks), with fewer recurrences. For hair loss, it is used alongside other treatments. In a long-term study of men with androgenetic alopecia, 2% ketoconazole shampoo improved hair density, hair size and the share of follicles in the growing (anagen) phase by about as much as 2% topical minoxidil, while an unmedicated shampoo did not. In a one-year randomized study of 100 men, finasteride with ketoconazole shampoo ranked ahead of finasteride alone, though that group was small. A 2020 systematic review of seven studies called topical ketoconazole a promising adjunct for androgenetic alopecia while noting that larger randomized trials are still needed. In laboratory studies ketoconazole also binds the androgen receptor, though whether that matters on the scalp is not yet known.
- In 11 double-blind dandruff and seborrheic dermatitis trials of 264 patients, increased hair shedding and scalp irritation each occurred in fewer than 1% of people. Abnormal hair texture, scalp pustules, mild dryness and itching have also been reported, as have hair discoloration and contact dermatitis. Severe allergic reactions, including anaphylaxis, are rare; stop using it and get medical help if you develop swelling, hives or trouble breathing. Very little reaches the bloodstream: ketoconazole was not detected in the blood of people who used the shampoo 4 to 10 times a week for 6 months.
- This formulation is suitable for both men and women. Do not use it if you are allergic to ketoconazole or any of its ingredients. If you are pregnant, may become pregnant or are breastfeeding, talk to your provider first; it should be used in pregnancy only if the benefit justifies the risk. Tell your provider if you use a steroid on your scalp long term, as it may need to be reduced gradually when you start this shampoo. Its safety and effectiveness in children have not been established.
- Use 2 to 4 times a week, or as your provider directs. Wet your hair, then massage the shampoo into your scalp until it lathers. Leave it on for 5 minutes, then rinse thoroughly. Keep it out of your eyes, and rinse with water if it gets in them. Store at room temperature (68 to 77°F), protected from light.
- Yes. In a trial of 575 people with moderate to severe dandruff or seborrheic dermatitis, 2% ketoconazole shampoo used twice a week for 2 to 4 weeks gave an excellent response in 88%. In the placebo-controlled phase that followed, using it once a week kept it from coming back in most people: 19% relapsed over six months, against 47% on placebo.
- Over-the-counter shampoos such as Nizoral A-D contain 1% ketoconazole and are approved for dandruff. The 2% strength needs a prescription and has twice the concentration. The long-term hair-density study and the finasteride combination study both used 2%.
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